Delayed Splenic Rupture After a Percutaneous Transsplenic Approach to Treat Portal Vein Occlusion

To report a case of delayed splenic rupture after percutaneous transsplenic portal vein stent deployment.

A 72-year-old male patient presented at a medical center with abdominal pain and reduced liver function according to laboratory tests. Due to a history of right hemihepatectomy and left portal vein occlusion, the percutaneous transhepatic approach was considered inappropriate. Instead, percutaneous transsplenic access was selected as a suitable procedure for portal vein catheterization. Eight days following the procedure, the patient developed abdominal pain, and a computed tomography scan showed a small splenic pseudoaneurysm that was underappreciated at the time. Patient suffered acute splenic rupture 32 days post-procedure. Subsequent embolization was performed, achieving complete hemostasis.

The transsplenic approach should be considered when the transhepatic or transjugular approach is unfeasible or difficult to implement. A careful plugging of the puncture tract is necessary to prevent or minimize hemorrhage from the splenic access tract. In addition, careful serial follow-up computed tomography should be used to evaluate the splenic puncture tract.