82-year-old woman with a history of arterial hypertension, atrial fibrillation on anticoagulant treatment, diabetes mellitus and chronic renal failure.
She was admitted for obstructive jaundice secondary to choledocholithiasis. Therapeutic ERCP was performed with conscious sedation (midazolam-propofol and remifentanil), technically laborious, lasting 150 minutes. Suddenly at the end of the intervention he presented haemodynamic and respiratory instability. An abdominal computerised axial tomography (CAT) scan with direct intravenous contrast was performed as an emergency, showing a hypervascular image in the anterior pole of the spleen compatible with an area of splenic contusion, with free intra-abdominal fluid, mainly in the perisplenic region, left paracolic gout, perihepatic and also in the pelvis with intermediate density compatible with blood. The patient was transferred to the operating theatre with deterioration of general condition. An urgent laparotomy was performed, evacuating 2000 ml of haemoperitoneum due to a tear in the anterior splenic border in the area visualised by CT scan. Splenectomy, cholecystectomy, duodenostomy and extraction of the biliary mould with subsequent placement of a Kher tube were performed. There was no evidence of duodenal perforation.

Postoperatively, she presented a picture of septic shock due to biliary peritonitis, treated empirically with piperacillin-tazobactam, and the need for re-laparotomy, finding a biliary fistula due to the exit of the Kher tube. She was discharged from the resuscitation unit 12 days after admission.
The pathological anatomy report of the splenectomy specimen showed the existence of a solution of continuity of the capsule on its inner side. The rest of the parenchyma was unaltered.