RESUMO
Introducción. La rotura de los aneurismas de arteria esplénica produce una hemorragia masiva abdominal con una mortalidad de hasta el 75%. Con frecuencia, agrava la hemorragia una coagulopatía de etiología multifactorial. Caso clínico. Mujer de 40 años que acudió al hospital por dolor abdominal agudo e hipotensión. En la ecografía había un importante hemoperitoneo. En el quirófano, la arteria esplçenica presentaba un aneurisma roto de 3 cm de diámetro, que se excluyó mediante ligadura. A pesar del control de la hemorragia masiva y las múltiples transfusiones intraoperatorias, persistía un sangrado difuso que no tenía origen en un vaso principal. Se atribuyó a una coagulopatía secundaria y se trató mediante un packing abdominal, con compresas y repetida inyección intravenosa del factor VII recombinante activado. Al segundo día se reintervino para retirar el packing y no se detectó un sangrado activo. Se le dio el alta domiciliaria a los 43 días. Conclusión. La rotura de los aneurismas de arteria esplénica se asocia frequentemente con una coagulopatía multifactorial, cuyo tratamiento puede requerir medidas hemostáticas extraordinarias. En este caso, la realización de un packing abdominal y la administración de factores activadores de la cascada de coagulación permitieron controlas satisfactoriamente esta complicación
Introduction. The rupture of splenic artery aneurysms gives rise to a massive abdominal hamorrhage with a mortality rate of up to 75%. The haemorrhage is often exacerbated by a coagulopathy with a multifactorial aetiology. Case report. A 40-year-old woman who went to hospital with acute abdominal pain and hypotension. Ultrasound imaging showed an important hemoperitoneum. In the operating theatre, the splenic cartery presented a ruptured aneurysm with a diameter of 3 cm, which was excluded by means of ligation. Despite controlling the massive haemorrhage and the numerous transfusion that the patient was given during the operation, there was still some diffuse bleeding that did not have its origin in a major vessel. It was attributed to a secondary coagulopathy and was treated by abdominal packing, with absorbent pads and repeated intravenous injections of activated recombinant factor VII. On the second day, a new operation was performed to remove the packing and no active bleeding was detected. After 43 days in hospital the patient returned home. Conclusions. Rupture of splenic artery aneuryms is often associated with a multifactorial coagulopathy, which may require extraordinary haemostatic measures to treat it. In this case, carrying out abdominal packing and administering factors to activate the clotting cascade made it possible to control this complication satisfactorily
