Atraumatic splenic rupture in a patient after apixaban use and radiologically inserted gastrostomy – a case report

Andrius Račiūnas1 

1Royal London Hospital, Barts Health NHS Trust, Ear, Nose & Throat Department, London, United Kingdom


Introduction. Atraumatic splenic rupture (ASR), also known as spontaneous splenic rupture, is a rare, potentially life-threatening condition that can be a result of infection, malignancy, inflammation, and a complication of various surgical procedures. There are not enough studies about patient characteristics, incidence rates, aetiology, and guidelines for management associated with ASR.

Clinical case. A 53-year-old gentleman had a transoral robotic resection of the left tongue base/aryepiglottic fold carcinoma and level 2-4 neck dissection. Subsequently, he had a radiologically inserted gastrostomy (RIG) for his dysphagia and airway protection. Two days after RIG was inserted, the patient collapsed in the ward. Blood tests were done and showed a severe haemoglobin level drop from 123 g/L to 73 g/L. Computer Tomography (CT) of the abdomen showed splenic bleeding. He had emergency laparotomy with splenectomy which showed no signs of traumatic spleen rupture secondary to RIG insertion. A histopathology sample taken in theatre showed no pathological changes in the spleen. There were no other causes apart from apixaban which was stopped before the procedure and resumed 24 hours after RIG insertion.

Conclusion. ASR is a rare event in healthcare and the symptoms are not specific. Abdominal pain on the left side that can spread to the shoulder, a decrease in haemoglobin level, and signs of haemorrhagic shock are all possible signs of bleeding in the spleen. Anticoagulant therapies such as apixaban, rivaroxaban, direct-acting oral anticoagulants (DOAC), and dabigatran are linked to instances of ASR.

Keywords. Atraumatic splenic rupture, splenectomy, radiologically inserted gastrostomy, apixaban.