Splenic rupture after video-assisted thoracoscopic lobectomy: a case report

TL;DR

A rare case of splenic rupture after a minimally invasive lung surgery highlights the need for vigilance in detecting remote organ injuries.

Contribution

This case report presents a unique instance of traction-mediated splenic injury despite an intact diaphragm.

Findings

Splenic rupture occurred 90 minutes post-surgery with signs of hemorrhagic shock.

E-FAST confirmed hemoperitoneum, leading to emergency splenectomy.

Traction injury and delayed diagnosis were key features of this case.

Abstract

This report details a rare splenic rupture following left video-assisted thoracoscopic lobectomy in a 50-year-old male. Intraoperative tachycardia (78 → 110 bpm) and postoperative refractory hypotension (56/33 mmHg) progressed to hemorrhagic shock (Hb 57 g/L) at 90 min post-op. E-FAST confirmed splenic rupture with hemoperitoneum, leading to emergent splenectomy for a 3-cm diaphragmatic surface laceration (3000 mL blood loss). Unique features include: (i) Traction-mediated injury despite intact diaphragm; (ii) Diagnostic delay from nonspecific early signs. This case underscores the need for vigilance regarding remote organ injury in minimally invasive thoracic surgery, advocating systematic protocols to manage this lethal complication.

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