Problem of Imputability in Case of Post Splenctomy Stroke Following a Traffic Accident

The occurrence of perioperative stroke related to noncardiac, nonaortic surgery is frequently less expected than cardiovascular related one. Splenectomy could be one of these situations. The advent of post-splenectomy stroke following trauma involving third party, whether accidental or intentional, can arise several questions and be particulary challenging from legal point of view. Aims of this manuscript are to report a case of post splenectomy stroke following a traffic accident and to discuss both imputabilities of the stroke to the splenectomy and the stroke to the traffic accident. A 40-year-old male, without past medical history, was a victim of a traffic accident. Body-scan showed a Haemoperitoneum of medium abundance, a ruptured spleen and a fracture of the right humerus. An emergent splenectomy was performed. The postoperative examination revealed a Glasgow scale of 9 with anosocoria, hypotension and tachycardia. He was reanimated. A computed tomography (CT) scan, performed 6 hours after surgery,  showed brain ischemia in the territory of the left middle cerebral artery (MCA) suggestive of thrombembolism with deviation of the median line and  sub-falcoral engagement. Few hours later, he was declared deceased.