A Case of Non-Surgical Treatment in Hemodialysis Patient with Spontaneous Splenic Rupture / 대한신장학회지

ABSTRACT

Spontaneous splenic rupture is a rare disease but can cause a life threatening situation. It can occur under a pathological spleen such as infection, neoplastic, infiltrative and inflammatory disease. Although splenectomy is the treatment of choice for splenic rupture, it is uncertain that the effectiveness of non- surgical treatment in the hemodynamically stable patient. We report a case of a 66-year-old male undergoing hemodialysis for 4 years who presented to the emergency department with abdominal pain and distention. Blood pressure was 130/80 mmHg, heart rate was 108 bpm. White blood cell count was 7,130/mm3, hemoglobin was 6.7 g/dL, platelet was 156,000/mm3. PT INR was elevated up to 2.01 because he had taken warfarin due to splenic infarction. Abdominal CT scan revealed hemoperitoneum due to splenic rupture. We performed angiography but there was no active bleeding. We decided conservative management without embolization because of stable condition and increased bleeding risk in operation. He received 6 pints of packed red blood cell transfusion during continuous renal replacement therapy for 24 hours on ICU. He was discharged with complete recovery on the 21st hospital day. We suggest that non-surgical treatment in splenic rupture also could be considered in hemodynamically stable patients with a high risk of postoperative complication.