A362 Late post operative splenic Bleeding after laparoscopic sleeve gastrectomy: Case report

Abstract

The risk of postoperative bleeding after laparoscopic sleeve gastrectomy (LSG) has been reported to be between 1% and 6%. Most of them occur in the early post operative period. The bleeding may be intra or extraluminal. Late post operative splenic bleeding is rare and not described in the literature. Here we present a case report with massive late post operative splenic bleeding 10 days post routine LSG. We present a 45 years old morbidly obese female patient with BMI 42 without comormobidities underwent LSG. The operative and post operative course were uneventful with a stable hemodynamic state and CBC. The patient was discharged at POD2 feeling well with a prophylactic anticoagulation. In POD 10 she was admitted emergently to the emergency room (ER) with a clinical presentation of severe abdominal pain with a stable hymodynamic state. The patient underwent CT which revealed a massive active bleeding from the spleen. But after a short time she developed signs of hypovolemic shock and was taken emergently to the operation room. In the operation there was a huge ruptured sub capsular splenic hematoma, a splenectomy was performed. In POD 4 the patient developed pulmonary embolism and was discharged in POD 7. Our review of literature examines this diagnosis is extremely rare.