Splenic Rupture Following Extracorporeal Shockwave Lithotripsy: A Case Requiring Emergency Splenectomy.

Abstract

BACKGROUND Extracorporeal shockwave lithotripsy (ESWL) is a common procedure, and splenic rupture is a rare complication of ESWL. Depending on the stage of injury and patient's condition, treatment options include non-operative management (NOM) and emergency splenectomy. Diagnosis is not difficult with symptoms such as deteriorating hemodynamic and hematologic indices, localized physical signs of peritoneal irritation in the left hypochondriac region, and confirmation provided by signs of free fluid (hemoperitoneum) seen on ultrasound or computed tomography (CT). Prompt diagnosis and treatment are essential for patient survival. If NOM is not feasible, emergency laparotomy with splenectomy is standard procedure. CASE REPORT A 72-year-old man with a medical history of arterial hypertension and cardiac arrhythmia was emergently admitted 1 day after undergoing ESWL for bilateral nephrolithiasis. He presented with abdominal pain, nausea, vomiting, and anemia. Urgent CT confirmed a splenic rupture, with intraperitoneal fluid. He underwent emergency splenectomy 24 h after ESWL. Complete splenic rupture (grade IV) was identified, accompanied by significant blood loss of 2000 mL. The postoperative course was uneventful, and he was discharged on postoperative day 7, with primary wound healing. CONCLUSIONS Splenic injury following ESWL is a rare but serious complication. Our case underscores the importance of monitoring for splenic injury following ESWL. Management should be multidisciplinary, considering physiological, anatomical, and immunological aspects. While splenectomy is the standard treatment, NOM can be considered for hemodynamically stable patients to avoid complications following splenectomy. Recent treatment protocols have improved stone breakage and reduced tissue damage, suggesting long-term adverse effects can be minimized or eliminated.