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J Surg Case Rep. 2015 Oct 6;2015(10). pii: rjv121. doi: 10.1093/jscr/rjv121.

Atraumatic splenic rupture cases presenting with hemorrhagic shock and coagulopathy treated by splenic artery occlusion using a microballoon catheter before splenectomy.

Author information

1
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan yousuke.jpn4035@gmail.com.
2
Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
3
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
4
Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
5
R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.

Abstract

Atraumatic splenic rupture (ASR) is an uncommon pathologic condition in which bleeding from the spleen occurs for a variety of nontraumatic reasons. While the current trend in traumatic splenic rupture is nonoperative management including transcatheter arterial embolization, the current recommendation for the treatment of most patients with ASR is splenectomy. In this report, we describe two cases of ASR presenting with hemorrhagic shock and complicated by anticoagulation therapy. In patients with severe hemorrhagic shock and coagulopathy, a damage control strategy is recommended. Our successful treatment of these patients included a three-step strategy as a damage control: (i) rapid transient hemostasis by splenic artery occlusion using a microballoon catheter, (ii) damage control resuscitation and (iii) splenectomy as a definitive hemostatic treatment.

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