title: A case of splenic rupture: a rare event after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after "uncomplicated" LC.
  
  
  METHODS
  A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. The post-operative course was uneventful and the patient was discharged on 7th postoperative day.Splenic injury rarely complicates LC. We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture.
  
  
  CONCLUSIONS
  Splenic rupture is an unusual but life-threatening complication of LC. Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.
authors.affiliation: School of Medicine and Surgery, Section of General and Thoracic Surgery (Chief: Giuseppe Modica, MD), University Hospital of Palermo, Via Liborio Giuffrè, 5, 90127 Palermo, Sicily, Italy. girolamo.geraci@unipa.it.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Geraci
authors.forename: Antonino
authors.initials: A
authors.lastname: Picciurro
authors.forename: Andrea
authors.initials: A
authors.lastname: Attard
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modica
authors.forename: Massimo
authors.initials: M
authors.lastname: Cajozzo
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sciumè
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000150:complications / Q000209:etiology; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D012769:Shock / Q000209:etiology; D013158:Splenic Diseases / Q000150:complications / Q000209:etiology; D013161:Splenic Rupture / Q000209:etiology*