Spleen rupture: an unusual postoperative complication after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the gold standard in the surgical treatment of symptomatic cholelithiasis and other benign gallbladder diseases. Laparoscopic cholecystectomy isn't devoid by some complications such as intra and post-operative bleeding, biliary injury, bile leakage, surgical site infection, port-site hernia and visceral injury. After an extensive literature research, we find only one case study in which the patients required a splenectomy after laparoscopic cholecystectomy. We present a case of uneventful laparoscopic cholecystectomy requiring an open splenectomy during the postoperative course.

The Authors report a case of ruptured spleen during the second post-operative day after an uncomplicated laparoscopic cholecystectomy. At 36 hours after the operation, the patient referred a sudden upper abdominal pain. We performed a splenectomy, intra-abdominal lavage and two drainages have been placed. The patient was discarged in the 7th post-operative day in good clinical condition.

As best of our Knowledge we report the second case of spleen rupture after a cholecystectomy, which is reported in the literature. We think that the splenic injury should not be due to direct trauma after or at the time of cholecystectomy, but it should be due to some adherences stretched by the pneumoperitoneum induction.