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

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

Disclosures

BMC Surg. 2014;14(106) 

In This Article

Discussion

In a recent review, it was reported that up to 40% of all splenectomies are related to a iatrogenic splenic injury. In other studies, unplanned splenectomies range from 9% to 44% and incidental splenectomies are reported with a rate of 0.9% to 3.4% in gastric surgery, 1.2% to 8% in operations involving the left colon, 1.4% to 24% in left nephrectomies, 0.1%to 4% in abdominal vascular surgery, with an increase to 21.3% when manoeuvres of visceral rotation are performed and 60% in case of emergency surgery on the abdominal aorta. Among all abdominal operations, those performed in the upper left quadrant yield a higher rate of iatrogenic lesions (0.9% to 49%), whereas appendicectomies and cholecystectomies are the procedures with the lowest incidence of splenic injuries.[1]

The splenic capsule is more frequently injured, whereas the rate of injury to the hylum and the short gastric branches of the splenic artery is lower.[2]

Splenic injury following LC is more rare complication: after an extensive PubMed literature research (Search criteria: splenic, rupture, laparoscopy, lesion), we only found two manuscripts in which the patients required a splenectomy, respectively 3 weeks and 36 hours after LC (Table 1). Moreover, we also found six cases of splenic rupture during laparoscopic gynaecologic procedure (Table 2).

It is reasonable that our patient had some adhesions between the splenic capsule and the parietal peritoneum. So, when the pneumoperitoneum was estabilished at the start of the LC, stretching of the splenic capsule resulted in a small sub-capsular hematoma. This also seems to be supported by our histological findings. In addiction, the temporal proximity between LC and splenectomy, the lacking of history of abdominal trauma and the histological absence of splenic intrinsic pathological abnormality, confirm that splenic rupture represents a primary complication of LC.[3]

In the present case, haemoperitoneum and bleeding shock appeared about 12 hours following LC, when the subcapsular haematoma ruptured into peritoneum.

About the use of drainage during an uncomplicated LC, we follow the recommendation of a recent Cochrane Review in which "the Authors could not find evidence to support the use of routinary drainage after LC".[10]

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