Successful transcatheter arterial embolization (TAE) for delayed splenic rupture in a patient on maintenance hemodialysis (HD)

A maintenance HD case with delayed splenic rupture is reported. A 67-year-old man with chronic glomerulonephritis had been started on chronic HD in April, 1981. He had a past histry of rupture of a left iliac artery aneurysm in 1987. On April 7th in 1994, he fell and was treated for left 7th and 8th rib fractures. He had experienced left chest pain since this episode. Approximately one month later, he was admitted because of acute onset of severe left back pain. Physical examination revealed a systolic blood pressure of 70mmHg and left abdominal tenderness. The hemoglobin level was 6.5g/dl. CT scan of the abdomen disclosed an intraparenchymal hematoma of the spleen with free fluid in the peritoneal cavity. Confirming the bleeding point by angiography of the splenic artery, TAE was performed. His postoperative course was uneventful. HD was safely continued using low molecular weight heparin for anticoagulation. About one year after the initial trauma, CT scanning revealed essentially normal findings. TAE appears to be an effective means of conserving the injured spleen. This is the first case of delayed splenic rupture in an HD patient successfully managed with TAE.