Splenic rupture following a diagnostic upper endoscopy

Abstract

Complications following endoscopic procedures have been rarely reported and spontaneous rupture of a normal spleen is an exceptional complication following a gastroscopy. This paper reports a case of a spontaneous rupture of a normal spleen following a gastroscopy.

Key Words: Spleen; Rupture; Gastroscopy; Upper endoscopy

INTRODUCTION

Some infrequent complications such as perforation of a viscus or gastrointestinal hemorrhage have been related to endoscopic procedures. This is a report of a case of a spontaneous rupture of a normal spleen following a gastroscopy.

CASE REPORT

A 52-year old man with no past medical history was admitted on an outpatient basis for an upper endoscopy because of general syndrome. A tumoral lesion was observed at the esophagogastric junction and biopsies of the lesion were obtained. Two hours later the patient was admitted to the emergency department due to a generalized and sudden abdominal pain and hypotension. An abdominal CT scan revealed a splenic subcapsular hematoma with active peritoneal bleeding related to splenic rupture (Figure 1). Emergency splenectomy and cauterization of vessels were successfully carried out with no postoperative complications. The pathological study of the surgical specimen revealed a normal spleen parenchyma. Several weeks later, surgery of the cardiac neoplasm was performed which showed no sign of extrinsical invasion.

Figure 1 Abdominal CT scan showing a splenic subcapsular haematoma of 15 cm × 9 cm.

DISCUSSION

Splenic rupture has been described following trauma or related to different conditions involving the spleen consistent in hematological malignancies, infections (Epstein-Barr virus, HIV, malaria), metabolic disorders, splenic tumors, pregnancy, connective-tissue diseases and after some therapeutic and diagnostic procedures such as colonoscopy, extracorporeal shockwave lithotripsy and left-side thoracotomy[1,2]. Serious complications such as perforation of a viscus or gastrointestinal haemorrhage have been rarely reported following endoscopic procedures and spontaneous rupture of a normal spleen is an exceptional complication following a gastroscopy[3]. To the best of my knowledge, only a few cases have been reported to date[3,4]. In the case of this patient, after having ruled out trauma as a possible triggering etiology of the splenic rupture and taking into account the temporal relationship between the event and the performance of the gastroscopy, it is probable that the nausea experienced during the procedure or the excessive stretching of the spleno-gastric and spleno-diaphragmatic ligaments[5] due to the cardias neoplasm may explain the splenic rupture.