Tratamiento de coagulopatía secundaria a la cirugía de un aneurisma esplénico roto

Introduction. The rupture of splenic artery aneurysms gives rise to a massive abdominal haemorrhage with a mortality rate of up to 75%. The haemorrhage is often exacerbated by a coagulopathy with a multifactorial aetiology. Case report. A 40-year-old woman who went to hospital with acute abdominal pain and hypotension. Ultrasound imaging showed an important hemoperitoneum. In the operating theatre, the splenic artery presented a ruptured aneurysm with a diameter of 3 cm, which was excluded by means of ligation. Despite controlling the massive haemorrhage and the numerous transfusions that the patient was given during the operation, there was still some diffuse bleeding that did not have its origin in a major vessel. It was attributed to a secondary coagulopathy and was treated by abdominal packing, with absorbent pads and repeated intravenous injections of activated recombinant factor VII. On the second day, a new operation was performed to remove the packing and no active bleeding was detected. After 43 days in hospital the patient returned home. Conclusions. Rupture of splenic artery aneurysms is often associated with a multifactorial coagulopathy, which may require extraordinary haemostatic measures to treat it. In this case, carrying out abdominal packing and administering factors to activate the clotting cascade made it possible to control this complication satisfactorily. [ANGIOLOGÍA 2008; 60: 145-8]