CASE REPORT   

Chirurgia 2020 February;33(1):58-61

DOI: 10.23736/S0394-9508.18.04948-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

A rare case of splenic injury due to a chest drain

Alessandro FEOLA ¹ ✉, Francesco LA SALA ², Noè DE STEFANO ³, Francesco DIURNO ⁴, Bruno DELLA PIETRA ²

¹ Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; ² Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy; ³ Unit of Histology and Anatomical Pathology, San Giuseppe Moscati Hospital, Avellino, Italy; ⁴ Unit of Anesthesiology, Resuscitation and Intensive Care Medicine, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy

Iatrogenic splenic injury is a recognized complication in diagnostic and therapeutic procedures performed on the gut (e.g., colonoscopy, colon surgery). However, iatrogenic splenic injury following other types of medical and surgical interventions have also been described in the literature. Spleen injury after chest tube insertion is a very rare event that must be investigated to assess medical error and liability. We present the case of a 68-year-old woman who underwent to thoracentesis for a pleural effusion. About 20 hours after, blood tests showed a marked decrease in the hemoglobin concentration (7.0 g/dL) and hematocrit (21%). Repeat abdominal ultrasonography showed a perisplenic hematoma and hemoperitoneum, and an emergency splenectomy was performed. The patient was admitted to the intensive care unit. Her clinical condition subsequently worsened, particularly her renal and cardiac function, and she died 6 days after surgery. As in this case iatrogenic lesions represent a field of interest for the forensic pathologist. The medicolegal investigation in such situations aims to assess the presence of elements compatible with profiles of professional responsibility of personnel involved in diagnostic and therapeutic procedures. In our case, the autopsy provided useful data to evaluate the pathophysiological processes underlying the splenic lesion.

KEY WORDS: Spleen; Chest tubes; Legal liability