A Case of Splenic Rupture: A Rare Event After Laparoscopic Cholecystectomy

Girolamo Geraci; Antonino Picciurro; Andrea Attard; Giuseppe Modica; Massimo Cajozzo; Carmelo Sciumè

BMC Surg. 2014;14(106)

Background

Laparoscopic cholecystectomy (LC) is today the well defined "gold standard" treatment for gallstone disease, as it is well-tolerated and associated with lesser postoperative pain and discomfort, improved cosmesis, reduction of recovery and subsequent chance for early return to social activities.

However, in a small percentage of patients, LC can be complicated by bleeding, infection, bile duct injuries, retained gallstones, persistent pain, and more rarely damage to the bowel and other viscera.^[1]

We report an unusual case of urgent splenectomy for a ruptured subcapsular hematoma twelve hours after elective LC for cholelithiasis.

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Table 1. Splenic rupture after LC in literature
Author	Diagnosis	CT/US	Surgery	Outcome
Leff D, JSLS 2007 [3]	Splenic rupture 3 weeks following uncomplicated LC	CT: Heterogeneous poorly enhancing soft tissue mass in the left upper quadrant inseparable from the spleen, measuring 11 x 13 cm, associated with a large volume of free intraperitoneal fluid highly suggestive of splenic rupture	Midline laparotomy with splenectomy	Discharged home one week following splenectomy
Bracale U, Ann It Chir 2013 [1]	Splenic rupture 36 hours following uncomplicated LC	US: important heamoperitoneum with two major blood collections localized respectively in the right and in the left sub-phrenic space	laparoscopic exploration + Midline laparotomy with splenectomy	Discharged home one week following splenectomy
Geraci G, 2013	Splenic rupture 12 hours following uncomplicated LC	CT: Severe heamoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (16 x 5 cm) and in the left sub-phrenic space (active spreading of contrast medium)	Midline laparotomy with splenectomy	Discharged home one week following splenectomy

Table 2. Splenic rupture after laparoscopy
Author	Surgery (patient)	Intraoperative	Treatment	Hypothesis
Prian DV, Am J Obstet Gynaecol, 1974 [4]	Splenic rupture after pelvic laparoscopy	Posterior subcapsularhaematoma	Midline laparotomy with splenectomy	Pneumoperitoneum stretched some adhesions between spleen, omentum and abdominal wall
Makanji HH, Br J Obstet Gynaecol, 1980 [5]	Splenic rupture after pelvic laparoscopy	Small posteriorspleniclesion	Midline laparotomy with splenectomy	Pneumoperitoneum stretched some adhesions between spleen, omentum and abdominal wall
Mahlke R, Z Gastroent 1992 [6]	Splenic rupture 5 hours following uneventful diagnostic laparoscopy (female, 48 yrs)	Small posteriorspleniclesion	Midline laparotomy with fibrin glue reparation	This complication must have occurred while establishing the pneumoperitoneum: stretching of small adhesions of the spleen with the abdominal wall may have played a role
Takeuchi K, J Reprod Med 2001 [7]	Combination of laparoscopy and preoperative trauma to the left upper quadrant of the abdomen	Sub-capsular hematoma	Midline laparotomy with splenectomy	Tearing away of delicate peritoneal reflections or small adhesions on the splenic capsule due to induction of pneumoperitoneum can result in sudden rupture and hemorrhage
Habib E, HPB (Oxford) 2004 [8]	Splenic rupture 5 days after laparoscopy for duodenal perforation closed with two sutures reinforced with fibrin glue (male, 45 yrs)	Posterior sub-capsular haematoma of the spleen at the site of the adhesion to the posterior peritoneum	Midline laparotomy with splenectomy	A posterior subcapsularhaematoma located at the site of the adhesion of the spleen to the posterior peritoneum had dissected the capsule over the dome of the spleen, and had ruptured into the peritoneum (sub capsular haematoma of the spleen that remained asymptomatic until its rupture)
Huchon C, J Min Inv Gyn 2008 [9]	Splenic rupture 5 days after diagnostic laparoscopy (female, 52 yrs with history of abdominal surgery and with acute pelvic infection)	Sub-capsular hematoma, resulting in a splenic rupture	Midline laparotomy with splenectomy	Probably caused by an overlooked puncture by the Veress needle or by tension on splenic adhesions during the adesiolysis

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A Case of Splenic Rupture: A Rare Event After Laparoscopic Cholecystectomy

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