TRANSCATHETER ARTERIAL EMBOLIZATION OF THE SPLENIC ARTERY FOR REBLEEDING OF DELAYED SPLENIC RUPTURE-A CASE REPORT-

Abstract

Conservative treatment is rarely successful for patients with delayed rupture of the spleen. We report a case with successful transcatheter arterial embolization (TAE) of the splenic artery for rebleeding of delayed splenic rupture.
A 64-year-old man fell down the stairs. Three days later, he came to our hospital because of persistent severe pain in his left chest. CT and X-ray revealed a fracture of spinous process of the 7th cervical spine and fractures of the right 2nd and left lst, 2nd, 8th and 9th ribs. He was admitted to the hospital, but he fell into hemorrhagic shock suddenly on his 7th hospital day. An abdominal CT demonstrated an intraparenchymal hematoma of the spleen with fluid retention in the peritoneal cavity. We diagnosed a delayed rupture of the spleen and placed the patient under conservative management. Two days later, he fell into hemorrhagic shock again, and an abdominal CT disclosed rebleeding from the spleen. Though no bleeding point could be detected by emergentcy angiography of the splenic artery, hemostasis was completed by TAE. Thereafter, he was discharged uneventfully on the 65th day. Non-surgical management for delayed splenic rupture is acceptable, and TAE is the method of choice in high-risk cases, including patients with liver cirrhosis.