Table 1: shows normal blood tests
Abbreviations: A.P.T.T. : activated partial thromboplastin
time; P.T.T.: Partial thromboplastin time ; I.N.R.: international
normalized ratio; CRP: C-reactive protein; HS Troponin: high-sensitivity
troponin
Because of his recent flutter removal, a transthoracic cardiac
ultrasound is performed by the cardiologist on call and showed: a normal
cardiac function, no valvular disease, no ventricular overload and no
pericardial effusion.
He received as a treatment a painkiller and a filling of one litter of
crystalloid. After that, his blood pressure goes up slightly, but the
patient still has orthostatic discomfort. The cardiologist admitted him
in his cardiac service under telemetry for orthostatism on medications
and vagal illness on abdominal pain due to his chronic constipation.
During the night, the patient presented agitation, dyspnea and cutaneous
pallor. His blood pressure was low at 75/55 mmHg with a cardiac rate at
80 beats/minute. His pulsated blood oxygen saturation was unmeasurable.
Clinical examination showed signs of low capillary perfusion.
Considering the rivaroxaban intake and the recent atrial flutter
ablation, an intravenous contrast computed tomography scan of the
abdomen was performed and showed a splenic rupture with a subcapsular
hematoma (10 cm x 15 cm x 13 cm) and diffuse hemoperitoneum (Figure 1.).