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.).