Iatrogenic Splenic Laceration from Cardiopulmonary Resuscitation - A Rare Complication

Sim KS, Lee SY, Tay HT and Chan CY

Department of General Surgery, Singapore General Hospital, Singapore
Department of Hepatopancreatobiliary & Transplant Surgery and General Surgery, Singapore General Hospital, Singapore

^*Correspondance to: Ser Yee Lee 

 PDF  Full Text DOI: 10.25107/2474-1647.1113

Abstract

Background: Chest compressions during cardiopulmonary resuscitation have been shown to cause unintended injury to its receiver. Intra-abdominal complications remain a rare but dangerous occurrence. We present a rare case of an iatrogenic splenic laceration and its management in a patient who had received cardiopulmonary resuscitation prior, along with a brief review of the literature.Case
Presentation: A 69-year-old gentleman with ischaemic heart disease underwent an elective cardiac catheterization and coronary angioplasty. The procedure was complicated by a rupture of the left circumflex artery, pericardial tamponade and cardiogenic collapse. He received cardiopulmonary resuscitation and required extracorporeal membrane oxygenation, intra-arterial balloon pump insertion and a sternotomy for haemostasis. On post-operative day one, he presented with a tense abdomen with haemodynamic instability. Computed tomography of his abdomen revealed a significant amount of haemoperitoneum with no definite source identified. Emergency exploratory laparotomy was performed with intra-abdominal four quadrant packing. The bleeding source was identified to be a splenic laceration. Haemostasis was secured with capsular stitching and the use of topical haemostatic agents without requiring a splenectomy. There was no occurrence of re-bleed post operatively. A brief review of the literature revealed 12 documented cases of splenic injuries post cardiopulmonary resuscitation. Of these, 7 patients were successfully managed with a splenectomy and 1 with splenic artery embolization.Conclusion: The importance of early detection of rare but life-threatening extra-thoracic complications of cardiopulmonary resuscitation is thus highlighted, and should be routinely considered in patients who have received chest compressions so as to allow for early intervention.

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Cite the article

Sim KS, Lee SY, Tay HT, Chan CY. Iatrogenic Splenic Laceration from Cardiopulmonary Resuscitation � A Rare Complication. Clin Surg. 2016; 1: 1113.