A stitch in time – dengue with spontaneous splenic rupture

Hemoperitoneum secondary to splenic rupture is a rare complication which is associated with dengue fever. A high degree of suspicion and an early diagnosis can save lives. A 28-year old male patient was admitted with warning signs on day 5 of dengue fever to our intensive care unit (ICU). His condition deteriorated rapidly with worsening abdominal distension and pain. In view of a previously noted episode of hypotension, he underwent further fluid resuscitation and Rapid Ultrasound for Shock and Hypotension (RUSH) protocol on admission to ICU which noted free fluid in abdomen prompting diagnostic aspiration. Aspirate confirmed hemoperitoneum leading to contrast enhanced computed tomography (CECT) of the abdomen revealed splenic hematoma with venous extravasation. He underwent splenic artery embolization within the next few hours in view of continued bleeding despite correction of the thrombocytopenia and coagulation parameters. His period in ICU was complicated by recurrent bleeding after 48 h which warranted abdominal CT followed by embolization of the splenic artery. There is a low threshold to undertake imaging for disproportionate ascites in severe dengue. This case shows the successful management of a rare complication of dengue with timely endovascular intervention.