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[Spontaneous splenic rupture after mitral valve replacement for infective endocarditis]
T Sugimoto1, T Minowa, H Uchino
1Department of Surgery, Yamagata Prefectural Nihonkai Hospital, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|July 9, 1998
Summary
This case study details the successful management of spontaneous splenic rupture and massive bleeding following mitral valve replacement surgery. The patient recovered after splenic arterial embolization and splenectomy, highlighting a rare complication of infective endocarditis.
Area of Science:
- Cardiology
- Gastroenterology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves, often caused by bacteria like Staphylococcus epidermidis.
- Mitral valve replacement (MVR) is a surgical procedure to repair or replace a damaged mitral valve.
- Spontaneous splenic rupture is a rare but life-threatening condition characterized by sudden tearing of the spleen without apparent external trauma.
Observation:
- A 61-year-old male patient presented with fever and was diagnosed with IE and moderate mitral regurgitation.
- The patient underwent MVR but later developed hemorrhagic shock due to spontaneous splenic rupture on postoperative day 11.
- Computed tomography revealed splenic rupture and a large retroperitoneal hematoma.
Findings:
- The patient underwent successful splenic arterial embolization followed by splenectomy to control massive bleeding.
- The spleen was enlarged and partially necrotic, with a torn capsule but no mycotic aneurysms or abscesses.
- Postoperative recovery was uneventful, with discharge on day 43.
Implications:
- This case highlights a rare complication of IE, where splenic rupture can occur post-cardiac surgery.
- Anticoagulation therapy following MVR may have contributed to the severity of bleeding in this patient.
- Prompt diagnosis and intervention, including splenic artery embolization and splenectomy, are crucial for managing such critical events.