Spontaneous non-traumatic massive intraabdominal spleen bleeding in young females: Importance of ATLS principles and trauma alarm

PATIENT Female, 28 FINAL DIAGNOSIS: Rupture of the splenic artery aneurysm Symptoms: Hypovolemic shock Medication: - Clinical Procedure: - Specialty: Surgery. OBJECTIVE Rare disease. BACKGROUND ATLS principles have become a standard of care for trauma patients. However, there is poor documentation in regard to spontaneous non-traumatic life-threatening bleedings. CASE REPORT Two women, a 21-year-old and a 28-year-old, presented to the admissions department in hemorrhagic shock. The latter woman was in her 26(th) week of pregnancy. The trauma alarm was raised and the patients received prompt, complex diagnostics including ultrasonography verifying massive intraabdominal fluid. Massive infusion therapy was initiated. The first patient was intubated in the emergency room and required cardiopulmonary rescue due to cardiopulmonary arrest. The patients were moved to the surgical theatre for life-saving operations at 30 and 60 minutes, respectively, after arrival in the emergency department. RESULTS In the first case, we found 4 L of intraabdominal blood and a rupture in the lower pole of the splenic capsule. Splenectomy was performed. The patient developed disseminated intravascular coagulation syndrome and was transferred to a first-level trauma centre for further treatment. She survived with slight sequelae in the form of psychosocial maladjustment, and low-grade spasms and myoclonic twitches due to prolonged brain ischemia. She was steadily improving at 17 months of follow-up. Viral mononucleosis was established as the cause of the spontaneous rupture of the spleen. In the second case, we found 2.5 L of intraabdominal blood and persistent bleeding from an aneurism of the splenic artery. A splenectomy was performed. She was transferred to a first-level trauma centre for further treatment. She lost the fetus and underwent autotransplantation of the right kidney after 3 months, due to the finding of an aneurism of the right renal artery on the abdominal CT. We also found an ectasia in the ascending aorta, which will require follow-up. The patient does not have any other sequelae and has made a complete recovery at 12 months of follow-up. CONCLUSIONS ATLS principles and trauma alarm readiness play a major role in lifesaving surgery in patients with non-traumatic hemorrhagic shock.