title: Spontaneous splenic rupture due to subcutaneous heparin therapy.
abstract: We report a case of spontaneous splenic rupture in a 59-year-old woman who was receiving 15,000 units of heparin subcutaneously (s.c. ) twice a day for deep venous thrombosis (DVT) prophylaxis. Her past medical history included multiple DVT, pulmonary emboli, and ovarian cancer stage III-C with known ascites. The diagnosis of splenic rupture was initially missed because of the ascites. This case illustrates both a previously undescribed complication of s.c. heparin therapy and a failure of ultrasound diagnosis. We emphasize the unique presentation, difficulty in diagnosis, and need for early surgical involvement to ensure the most favorable outcome.
authors.affiliation: Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, California 95817, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Weiss
authors.forename: T
authors.initials: T
authors.lastname: Smith
authors.forename: E
authors.initials: E
authors.lastname: Laurin
authors.forename: D H
authors.initials: DH
authors.lastname: Wisner
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001201:Ascites / Q000150:complications; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications; D010538:Peritonitis / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000150:complications; D012422:Rupture, Spontaneous; D013161:Splenic Rupture / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006493:Heparin