Abstract text (incl. references and figure legends)
Case history:A 77-year-old woman was admitted to the emergency department with left thoracic pain after fall followed by syncope, pallor, and sweating. Left thoracic pain worsened with deep inspiration. The patient was under dual anti-platelet therapy for NSTEMI (non-ST-elevation myocardial infarction) 4 months ago.
Clinical findings:On arrival the patient was conscious, oriented, eupneic and hemodynamically stable. At physical examination referred pain on left chest palpation with small left lower thoracic ecchymosis. Pulmonary auscultation showed no changes and it was symmetrical. Mild pain on palpation of the upper quadrants of the abdomen, more intense on the left upper quadrant.
Investigation and diagnosis:Blood work up showed hemoglobin 9,2 g/dl, WBC at 9700/mm³, platelets 19500 and thoraco-abdominal TC revealed hemoperitoneum in association with active bleeding from the spleen.
Therapy and progressions:An emergency laparotomy revealed massive bleeding from a ruptured spleen and a splenectomy was carried out. During the surgery the estimated blood loss was 2500mL, hemoglobin 5,2 g/dl and 2 red blood cell transfusion units, 2 platelets units and 2g acid tranexamic was done. The post-operative course was uneventful, the patient returned the anti-platelet therapy 4 days after the surgery and was discharged on the 8th post-operative day without any complication.
Comments:Abdominal or thoracic trauma can lead to life-threatening injuries,including splenic rupture. Careful physical examination and targeted exams should be a priority for obtaining a diagnosis. Extra care should be taken in patients on antiplatelet or anticoagulation therapy due to the increased risk of hemorrhage. In this case postoperative period was challenging due the need to restart antiaggregation for post-NSTEMI condition.
References:Adrian A Maung, MD, FACSLewis J Kaplan, MD, FACS, Management of splenic injury in the adult trauma patient,In: Post TW,UpToDate;2022;Acessed October22.
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