Splenic Artery Embolization in Subcapsular Splenic Hematoma Secondary to Dengue Hemorrhagic Fever

Abstract

Dengue hemorrhagic fever (DHF) is a common syndrome of dengue viral infection but complications such as sub-capsular splenic hematoma leading to capsular rupture in dengue are rare. We report a case of a young male who presented with fever, breathlessness, and acute abdomen. His CT of the abdomen revealed subcapsular splenic hematoma measuring 16.7 cm × 13.0 cm × 11 cm. His laboratory parameters were suggestive of anemia, thrombocytopenia, acute kidney injury, coagulopathy, and hepatopathy because of which instead of splenectomy, splenic artery embolization with ultrasound-guided splenic hemorrhage drainage was performed for his management as his clinical condition deteriorated. This case report sensitizes newer modalities of treatment of subcapsular splenic hematoma with splenic arterial embolization.

Spontaneous splenic hematoma secondary to dengue infection: a rare case report

“…Spontaneous splenic rupture is rare and might be fatal. Subcapsular hemorrhage aggravated by vascular abnormalities and thrombocytopenia is thought to lead to splenic rupture 5 , 7 , 10 , 11 .…”

“…Nontraumatic causes include coagulopathies, infectious mononucleosis and rarely, pancreatitis, and cocaine use. About 1.5% of cases with DHF may have such a complication 5 , 12 . Most splenic complications reported in the literature are manifested in the acute phases of the illness and those occurring in the recovery phase have been sparsely reported 13 .…”

“…The exact mechanism of splenic hematoma is unknown, but is not limited to thrombocytopenia. Coagulation factor deficiency from dengue infection, invasion of splenic endothelium from the virus, and liver damage are postulated to play a role 5 , 14 . Though our patient was in the recovery phase during the presentation, the hematoma likely occurred during the acute phase of illness, given the history of onset of left-sided abdominal pain from the fourth day of fever.…”

“…Dronamraju, et al . 5 reported ultrasonography-guided percutaneous drainage of subcapsular splenic hematoma and splenic artery embolization as a safe and effective option to prevent splenic rupture in a patient with DHF 17 .…”

“…Dengue infection may have surgical manifestations, mainly acute cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture, bowel perforation, gastrointestinal bleeding, and hematomas 4 . Splenic hematoma in dengue hemorrhagic fever (DHF) is rare and present in 1.5% of cases 5 . Nepal being one of the endemic countries for dengue and in the current setting of a nationwide epidemic as of October 2022, we encountered this rare complication of dengue as splenic hematoma in a patient with dengue fever as discussed below.…”