Intra-abdominal bleeding probably due to splenic injury after thoracoscopic lingulectomy: A case report

A 77-year-old female was referred to our department with abnormal medical examination and chest CT, showing a part-solid ground grass nodule measuring 20 × 15 mm in the left upper lobe, and the tumor was diagnosed as lung cancer (cT1miN0M0 stage1A1). We performed video-assisted lingulectomy with hilar lymph node dissection (ND1b). The operative time was 130 minutes and the bleeding amount was small. Bradycardia and low blood pressure were observed 1 hour after returning to the room, and they were considered to be associated with sinus node dysfunction syndrome. Vital signs were stable with vasopressor administration and fluid loading, but anemia progressed slowly over the next few days. Chest tube output indicated a small amount of intrathoracic bleeding. On the 7th postoperative day, a blood test showed a high inflammatory response and abdominal CT revealed a large amount of bloody ascites, probably due to splenic injury. Since no obvious active bleeding was observed, careful follow-up was performed, and after confirming that there was no progression of anemia, the patient was discharged on the 25th postoperative day. If vital sign changes or progressing anemia are observed after thoracic surgery, it is necessary to suspect intra-abdominal bleeding.