[Secondary splenic rupture after thrombolysis for acute myocardial infarction]

Area of Science:

• Cardiology
• Gastroenterology
• Trauma Surgery

Background:

• Acute myocardial infarction (AMI) treatment often involves thrombolysis.
• Thrombolytic therapy, while effective, carries potential risks, including bleeding complications.
• Secondary splenic rupture is a rare but serious complication that can occur after medical interventions.

Purpose of the Study:

• To report a rare case of secondary splenic rupture following thrombolysis for AMI.
• To highlight the importance of thorough patient history, including recent trauma, in managing AMI patients.
• To discuss the clinical presentation, diagnosis, and management of this rare complication.

Main Methods:

• Case report of a 67-year-old male with AMI.
• Systemic thrombolysis with rt-PA administered after excluding contraindications.
• Diagnostic imaging (ultrasound and CT) to identify intra-abdominal bleeding.
• Emergency laparotomy for splenic rupture.

Main Results:

• The patient experienced complete resolution of AMI symptoms post-thrombolysis.
• Two hours later, he developed acute abdomen and circulatory shock.
• Emergency surgery revealed a splenic rupture, likely related to a prior unreported fall.
• The patient later suffered a re-infarction and underwent successful angioplasty.

Conclusions:

• Thrombolysis is the primary treatment for AMI, but careful patient selection is vital.
• Thorough medical history, including potential trauma, is essential to avoid complications like secondary splenic rupture.
• Early recognition and surgical intervention are critical for managing intra-abdominal bleeding after thrombolysis.