Lowry Lacy E, Goldner Jonathan A
The Commonwealth Medical College, 525 Pine Street, Scranton, Pennsylvania, 18509, USA.
The Commonwealth Medical College; Pocono Medical Center, 206 East Brown Street, East Stroudsburg, Pennsylvania, 18301, USA.
J Med Case Rep. 2016 Aug 9;10(1):217. doi: 10.1186/s13256-016-1012-6.
Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common and thus consideration of this disorder while evaluating a patient who presents with abdominal pain while using these agents is extremely important. This is the first reported case of spontaneous splenic rupture associated with apixaban.
We describe the clinical case of an 83-year-old white man who complained of sudden severe abdominal pain 5 days into a hospital stay for acute-on-chronic congestive heart failure and exacerbation of chronic obstructive pulmonary disease. Neither he nor his wife reported any significant trauma for the past 6 months prior to his admission. His medical history included chronic atrial fibrillation treated with medications including apixaban 2.5 mg twice daily. An urgent abdominal computed tomography scan demonstrated a large splenic hematoma and evidence of intraperitoneal bleeding from which he rapidly declined, developing hypovolemic shock. An emergency splenic arteriogram displayed a patent splenic artery and an embolization was successful in stabilizing him. Due to evidence of recurrent bleeding, an exploratory laparotomy and splenectomy was subsequently performed the following day.
The diagnosis of spontaneous splenic rupture is important to consider in a patient using apixaban who presents with abdominal pain and associated signs of hypotension and anemia. For hemodynamically unstable patients, prompt treatment to stop significant bleeding through splenic artery embolization or splenectomy is warranted and may be lifesaving.
与抗凝剂使用相关的自发性脾破裂是一种罕见但可能致命的疾病。缺乏及时识别可能与患者预后不良有关。新型口服抗凝剂的使用越来越普遍，因此在评估使用这些药物时出现腹痛的患者时考虑这种疾病极为重要。这是首例与阿哌沙班相关的自发性脾破裂报告病例。
我们描述了一名83岁白人男性的临床病例，他因慢性充血性心力衰竭急性发作和慢性阻塞性肺疾病加重住院5天后突然出现严重腹痛。他和他的妻子均未报告入院前6个月内有任何重大创伤史。他的病史包括用药物治疗的慢性心房颤动，其中包括每日两次服用2.5毫克阿哌沙班。紧急腹部计算机断层扫描显示巨大脾血肿和腹腔内出血迹象，他的病情迅速恶化，发展为低血容量性休克。急诊脾动脉造影显示脾动脉通畅，栓塞成功使他病情稳定。由于有再次出血的迹象，次日随后进行了剖腹探查和脾切除术。
对于使用阿哌沙班且出现腹痛以及低血压和贫血相关体征的患者，考虑自发性脾破裂的诊断很重要。对于血流动力学不稳定的患者，通过脾动脉栓塞或脾切除术迅速治疗以停止大量出血是必要的，可能会挽救生命。
