Successful management of postpartum venous thrombosis following splenectomy for traumatic splenic rupture: a case report

Abstract

Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean section and splenectomy for splenic rupture has not been previously reported. This case report describes a case of multiple venous thromboses after caesarean section and splenectomy for traumatic splenic rupture in late pregnancy. A 34-year-old G3P1 female presented with abdominal trauma at 33⁺¹ weeks of gestation. After diagnosis of splenic rupture, she underwent an emergency caesarean section and splenectomy. Multiple venous thromboses developed during the recovery period. The patient eventually recovered after anticoagulation therapy with low-molecular-weight heparin and warfarin. These findings suggest that in patients that have had a caesarean section and a splenectomy, which together might further increase the risk of venous thrombosis, any abdominal pain should be thoroughly investigated and thrombosis should be ruled out, including the possibility of multiple venous thromboses. Anticoagulant therapy could be extended after the surgery.

Keywords: Traumatic splenic rupture; anticoagulation; caesarean section; multiple venous thrombosis; splenectomy.

Figure 1.

Computed tomography images of a 34-year-old G3P1 pregnant female who initially presented with ‘abdominal pain for 5 h after a fall’ at 33⁺¹ weeks of pregnancy and subsequently underwent a splenectomy. Images taken on postoperative day 19 showed multiple venous thromboses (arrows): (a) right branch of the portal vein; (b) splenic vein thrombosis; (c) superior mesenteric vein thrombosis; (d) inferior vena cava thrombosis; (e) right ovarian vein thrombosis and (f) left ovarian vein thrombosis.