Labaki Marie-Laure, De Kock Marc
Department of Intensive Care Centre Hospitalier de Wallonie Picarde (CHwapi) Tournai Belgium.
Clin Case Rep. 2022 Nov 3;10(11):e6462. doi: 10.1002/ccr3.6462. eCollection 2022 Nov.
Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64-year-old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast-enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.
非创伤性脾破裂（ASR）是一种罕见病症，主要与肿瘤、感染和炎症性疾病相关。与药物治疗相关的ASR更为罕见。在本病例报告中，我们重点介绍了直接口服抗凝剂利伐沙班的一种不寻常并发症。一名64岁男性患者因头晕和弥漫性腹部绞痛主诉入住急诊科。患者近期无外伤史。临床检查发现血流动力学不稳定，补液后有中度反应，触诊时有轻度腹部不适。他的病史包括慢性高血压、便秘和近期的心房扑动消融术。患者正在服用胺碘酮、比索洛尔、阿托伐他汀和利伐沙班。数小时后，腹部增强计算机断层扫描诊断为脾破裂。进行了大量输血和急诊剖腹脾切除术。解剖病理学分析未发现任何肿瘤、炎症或感染原因。患者3天后成功从重症监护病房出院。临床医生必须考虑ASR作为利伐沙班并发症在有腹部压痛和血流动力学不稳定患者中的可能性。不幸的是，临床表现并不总是典型的脾破裂表现。延迟诊断可能危及生命或致命。对于使用直接口服抗凝剂的不稳定患者发生脾破裂的情况，剖腹脾切除术仍然是最佳治疗选择。
