DOUBLE TROUBLE: LATE HEMORRHAGIC SHOCK FOLLOWING SPLENECTOMY carlotaduartemiranda@gmail.com

PE116

DOUBLE TROUBLE: LATE HEMORRHAGIC SHOCK FOLLOWING SPLENECTOMY

8

Portugal

Oral or Poster

Accessory spleens are congenital splenic remnants that may persist post-splenectomy. Although often asymptomatic, they can cause late hemorrhagic complications. We present a rare case of hemorrhagic shock secondary to rupture of accessory spleens 15 years after traumatic splenectomy.

A 61-year-old female with a history of traumatic splenectomy 15 years prior presented with fever, myalgia, and vomiting without recent trauma. Four days later, she developed diffuse abdominal pain and hemodynamic instability (BP 70/50 mmHg). Laboratory tests showed a decline in hemoglobin. Contrast-enhanced abdominal tomography demonstrated a voluminous retroperitoneal hematoma (10.3 x 9.9 x 14.3 cm) in the splenorenal recess, suggesting bleeding from accessory splenic tissue.

The patient was promptly resuscitated with a massive transfusion protocol and taken for emergent exploratory laparotomy. Intraoperatively, multiple accessory spleens were identified as the bleeding source. Surgical intervention included accessory splenectomy and evacuation of a 2L retroperitoneal hematoma. The patient required postoperative intensive care and subsequently stabilized and was successfully weaned from supportive measures.

Accessory spleen rupture is a rare but life-threatening late complication after splenectomy. Surgeons should maintain a high index of suspicion in post-splenectomy patients presenting with acute abdomen and hemorrhagic shock. Early diagnosis and prompt surgical intervention are needed for favorable outcomes.