E206 UCTN – Unusual cases and technical notes following gastroscopy [3]. To our knowl- edge, only few cases have been reported Spleen rupture complicating upper endoscopy in the medical literature [3–5]. We think that the excessive stretching of spleno-diaphragmatic ligaments and of spleno-peritoneal lateral attachments Fig. 1 Computed during endoscopy and possibly the loca- tomography (CT) scan of abdomen in an 81- tion of most of the stomach in the thoracic year-old woman with cavity had contributed to the spleen rup- generalized weakness, ture [5,6]. Rapid diagnosis in the presence persistent nausea, and of suggestive symptoms of hemodynamic difficulty swallowing, instability and abdominal pain following showing hemoperito- upper endoscopy is life-saving. neum, subcapsular spleen hematoma, and blood around the liver. Endoscopy_UCTN_Code_CPL_1AH_2AJ Competing interests: None F. Jabr1, N. Skeik2 1 Hospital Medicine, Horizon Medical Center, Tennessee, USA 2 Vascular Medicine, Abott Northwestern An 81-year-old woman with history of peritoneum with subcapsular hematoma Hospital, Minneapolis, USA chronic lymphocytic leukemia and recent on the spleen (●" Fig. 1). The patient was diagnosis of Clostridium difficile colitis, diagnosed as having splenic rupture. Ex- and maintained on oral vancomycin, pre- ploratory laparotomy showed large he- References sented for generalized weakness, persis- moperitoneum (about 1500 mL blood), 1 Lopez-Tomassetti Fernandez EM, Delgado Plasencia L, Arteaga González IJ et al. Atrau- tent nausea, and a long history of difficulty subcapsular hematoma of the lateral in- matic rupture of the spleen: experience of swallowing (food hangs in her chest and ferior portion of the spleen, as well as a 10 cases. Gastoenterol Hepatol 2007; 30: does not move down to her stomach). large amount of coagulated blood in the 585–591 Workup revealed low potassium and splenic fossa and free blood in the perito- 2 Rhee SJ, Sheena Y, Imber C. spontaneous rup- white blood cell count of 41 000/mm with neal cavity. The spleen short gastric ves- ture of the spleen: a rare but important dif- ferential of an acute abdomen. Am J Emerg lymphocytes predominance. Renal func- sels attached to the stomach fundus were Med 2008; 26: 733, E5-E6 tion and liver enzyme levels were within intact, but partial disruption of the lateral 3 Hunter RC Jr. Gastroscopy and delayed rup- normal. The patient received intravenous peritoneal attachments of the spleen was ture of the spleen; a review and report of fluids and electrolytes replacement. A di- noted. Splenectomy was done and the possible case. Gastroenterology 1955; 29: – agnostic upper endoscopy was done to de- bleeding sites were sutured. The stomach 898 906 4 Lewis FM, Moloo N, Stiegmann GV et al. lineate the cause of the dysphagia, and the was found to be herniated through a large Splenic injury complicating therapeutic findings were tortuous esophagus, slight paraesophgeal hernia. The stomach was upper endoscopy and ERCP. Gastrointest En- narrowing of the esophageal sphincter, then fixed with double gastrostomy tube dosc 1991; 37: 632–633 and an enormous intrathoracic stomach. gastropexy. A pathological study of the 5 Estevez-Boullosa P, Alonso-Aguirre PA, Couto- Wörner I et al. Splenic rupture following a Most of the stomach except for the antrum spleen showed normal parenchyma. The diagnostic upper endoscopy. World J Gas- was above the diaphragm. The scope was patient recovered well and was dis- trointest Endosc 2010; 2: 235–236 passed through the hiatus entering the an- charged several days later. 6 Lemon M, Dorsch M, Street K et al. Splenic trum. Below the hiatus, there was acute Rupture of the spleen following trauma is rupture after vomiting. J R Soc Med 2001; – This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. angulation into the antrum and fair man- well known. Spontaneous rupture of the 94: 527 528 euverings were required to reach the py- spleen has also been described in various lorus and into the duodenum. Biopsies conditions such as certain hematological Bibliography were taken and esophageal sphincter bal- malignancies, infections (malaria, Ep- DOI http://dx.doi.org/ loon dilatation was done. Shortly after the stein–Barr virus infection, human immu- 10.1055/s-0032-1308924 procedure, the patient became diaphoret- nodeficiency virus infection), metabolic Endoscopy 2012; 44: E206 © Georg Thieme Verlag KG ic, hypotensive, and tachycardic, requiring disorders, tumors of the spleen, pregnan- Stuttgart · New York fluid resuscitation and vasopressors. She cy, and connective tissue diseases [1,2]. It ISSN 0013-726X also developed abdominal pain and is also described as a complication after marked tenderness, predominantly at the colonoscopy, left-sided thoracotomy, and right upper quadrant. shockwave lithotripsy [1,2]. Some serious Corresponding author F. Jabr A blood workup revealed slight drop in complications such as viscus perforation Horizon Medical Center – Hospital Medicine hemoglobin but increase in the white and gastrointestinal bleeding have been HWY 70 E, Dickson blood cell count up to 70000/mm. An im- rarely reported after upper endoscopy Tennessee 37055 mediate computed tomography (CT) scan [3]. However, spleen injury or rupture is USA without contrast showed massive hemo- an exceptional and very rare complication [email protected] Jabr F, Skeik N. Spleen rupture complicating upper endoscopy… Endoscopy 2012; 44: E206.