SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Splenic Rupture With Hemorrhagic Shock in a Patient With Hypertriglyceridemia-Induced Acute Pancreatitis and Splenic Vein Thrombosis

Spontaneous Splenic Rupture With Hemorrhagic Shock in a Patient With Hypertriglyceridemia-Induced Acute Pancreatitis and Splenic Vein Thrombosis

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A 44-year-old man with diabetes, hypertension, prior pancreatitis, and severe hypertriglyceridemia presented with acute abdominal pain and vomiting. Initial findings were consistent with hypertriglyceridemia-induced acute interstitial edematous pancreatitis, with marked hyperglycemia, elevated lipase, anion gap metabolic acidosis, acute kidney injury, leukocytosis, ketonuria, and triglycerides of 4,425 mg/dL. He was treated with fluids and a DKA protocol.<br /><br />On day 9, he developed sudden severe left shoulder pain, hypotension, and a rapid drop in hemoglobin, raising concern for intra-abdominal bleeding. Imaging showed splenic rupture with diffuse hemoperitoneum, a rare but serious complication of pancreatitis. The likely mechanism was splenic vein thrombosis and inflammatory injury from the close proximity of the pancreatic tail to the spleen, leading to increased intrasplenic pressure and hemorrhage.<br /><br />Despite no evidence of active rebleeding on CTA, his clinical instability required urgent reversal of coagulopathy with KCentra and emergent exploratory laparotomy with splenectomy. The surgery involved significant blood loss, and he received crystalloid, whole blood, and packed red blood cells. He was managed in the ICU and ultimately discharged on hospital day 22.<br /><br />This case highlights spontaneous splenic rupture as a rare complication of acute pancreatitis, especially when associated with splenic vein thrombosis and severe inflammation. Early recognition of left shoulder pain, hypotension, and falling hemoglobin is critical for prompt diagnosis and life-saving surgical intervention.

Asset Subtitle

Arun Chaudhury

Meta Tag

Author List Abhijit Sahu, Arun Chaudhury, Mehaghni Chaudhury, Pravash Ranjan Mishra, Qi Shi, Roop Parlapalli, Venu Gopal Kankani, Yichen Wang

Category Clinical Vignettes

Concept Spontaneous Splenic Rupture

Concept Acute Pancreatitis

Concept Hypertriglyceridemia-Induced Acute Pancreatitis

Concept Hemorrhagic Shock

Concept Splenectomy

Distinguished Non-Finalist

Presenter Organization Geisinger Wyoming Valley

Presenting Author Arun Chaudhury

Track Adult

Keywords

acute pancreatitis

splenic rupture

hemoperitoneum

hypertriglyceridemia

diabetic ketoacidosis

splenectomy

splenic vein thrombosis

left shoulder pain

hypotension

abdominal bleeding

Spontaneous Splenic Rupture

Acute Pancreatitis

Hypertriglyceridemia-Induced Acute Pancreatitis

Hemorrhagic Shock

Splenectomy