General anesthesia complicated by perioperative iatrogenic splenic rupture

Patients with splenomegaly often present with diverse coexisting medical disease and thus offer a variety of anesthetic considerations. The challenges that come with splenectomy have also become increasingly common to the anesthesiologist, given the growing number of indications for surgical intervention including both benign and malignant disease. Removal of the spleen is associated with numerous intraoperative and postoperative risks, including massive intraoperative hemorrhage, perioperative coagulation abnormalities, and post-splenectomy infection. When caring for the patient with an enlarged spleen scheduled for splenectomy, the anesthetic plan must address both patient and procedure specific concerns. We present a medically challenging case of a 28 year old man with splenomegaly secondary to lymphoma, who underwent elective splenectomy, which was complicated by perioperative splenic rupture and hemorrhage.