TWO CASE REPORTS OF SPONTANEOUS SPLENIC RUPTURE PROBABLY RELATING TO ANTICOAGULANT THERAPY AFTER VALVE REPLACEMENT

Abstract

We report two cases of spontaneous splenic rupture in patients receiving anticoagulant therapy after valve replacement. Case I: A 65-year-old man, who had been receiving anticoagulant therapy after aortic valve replacement, was admitted to the hospital because of abrupt onset of left upper abdominal pain and a fever. Four days after admission he developed severe abdominal pain, and went into shock. Case 2: A 50-year-old man, who had been receiving anticoagulant therapy after a mitral valve replacement, was admitted to the hospital because of abrupt onset of left upper abdominal pain. In both cases, an emergency body CT revealed a hematoma in the spleen. Emergency exploratory laparotomies were undertaken soon after splenic rupture was indicated, and splenectomies were performed. The postoperative courses were uneventful and the patients recovered their social activities. On pathological examination, only the hematoma of the spleen was present and there were no findings of infection, inflammation, hematologic abnormalities, vascular disease, nor any causative underlying diseases such as neoplasm. These cases were diagnosed as spontaneous splenic rupture. Spontaneous splenic rupture should be considered in the differential diagnosis of acute abdominal pain in patients receiving anticoagulant therapy after valve replacement.