Abstract
The patient was a 59-year-old woman who underwent thoracoscopic left lower lobectomy for the treatment of a lung adenocarcinoma. Fall of blood pressure was noted 2 hours after the operation. As a contrast-enhanced CT of the abdomen showed extravasation of contrast material from the spleen, a diagnosis of hemorrhagic shock associated with splenic rupture was made, and emergency transcatheter arterial embolization was performed. After the embolization, angiography showed disappearance of the extravasation during the arterial phase, whereas some extravasation was still evident during the portal venous phase. Therefore, emergency splenectomy was carried out. Pathologic examination of the spleen revealed hemorrhage, but there were no aneurysms or tumor metastases. There have been two cases of splenic rupture occurring after thoracic surgery reported in the literature, and there were left-side thoracotomy in every case. The cause and underlying mechanisms still remain unclear. Thus, it is of importance to bear in mind the possibility of intra-abdominal bleeding even in thoracic surgery patients developing evidence of hemorrhagic shock.
