title: Spontaneous rupture of the splenic capsule with massive bleeding subsequent to the pringle maneuver during laparoscopic liver resection.
abstract: BACKGROUND
  The Pringle maneuver has its applications to minimize blood loss during hepatic resection. Splenic rupture during the Pringle maneuver in open liver surgery was described only in few cases. This is the first report of such a complication during laparoscopic surgery.
  
  
  METHODS
  A 58-year-old woman sustained major splenic capsular rupture during laparoscopic right lateral hepatic sectionectomy (resection of segments VI to VII) for a colorectal metastasis. Surgery was carried out with the patient in the left lateral position. She became hypotensive during the second application of the Pringle maneuver secondary to spontaneous rupture of the splenic capsule. This was controlled with application of thrombogenic hemostatic agents. The patient received 12 units of blood transfusion. Her subsequent recovery was uneventful, and she was discharged on the sixth postoperative day.
  
  
  CONCLUSIONS
  Unexplained hypotension during laparoscopic liver resection and the application of the Pringle maneuver should raise suspicion of splenic hemorrhage and prompt a timely and adequate intervention.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, North Manchester General Hospital, University of Manchester, Manchester, UK.
authors.forename: Jee K
authors.initials: JK
authors.lastname: Low
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Ayiomamitis
authors.forename: Akram
authors.initials: A
authors.lastname: Hamoudi
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008099:Liver; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013161:Splenic Rupture / Q000209:etiology*; D013997:Time Factors