Abstract text (incl. references and figure legends)
Case history: A 45-year-old man was admitted to the Internal Medicine Department and diagnosed with Pneumonia and left pleural effusion.
Clinical findings: Despite early antibiotic treatment, the patient's status worsened clinically and analytically. Antibiotic treatment was escalated, from amoxiclav to piperacillin/tazobactam, and a thoracic CT showed a loculated pleural effusion with associated left lower lobe subsegmental atelectasis. A CT-guided percutaneous drainage of pleural fluid was performed and pigtail catheters were left in place.
Investigation: The patient developed acute abdominal pain with hemodynamic instability after this procedure. After initial resuscitation and obtained hemodynamic stability, a thoracoabdominal CT scan was performed that diagnosed a large splenic hematoma with active hemorrhage.
Diagnosis: The patient underwent emergent laparotomy and splenectomy for splenic laceration grade V (AAST).
Therapy and Progression: The patient had a good clinical outcome and was discharged from the Surgery ward on the fifth postoperative day and transferred to the Pneumology ward for complementary treatment of Pneumonia. No other complications were identified, and the patient was discharged from the hospital on the 18th day.
Comments: Nine to 40% of splenectomies are caused by iatrogenic injuries, most frequently occurring during abdominal surgery. Rarely, injuries to the spleen can occur during nonsurgical invasive procedures, and this injury may go undetected at an early stage until the patient develops symptoms. CT scan is the best diagnostic imaging test and should be performed only if the patient is hemodynamically stable. In case of HD instability, emergent splenectomy is mandatory.
References: Galperin-Aizenberg M, Blachar A, Gayer G. Iatrogenic injury to the spleen-CT appearance. Semin Ultrasound CT MR. 2007;28(1):52-56.
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