Lithotripsy-induced splenic injury requiring emergent splenectomy at a level 1 trauma center.

Background: An exceptional occurrence, clinically-significant splenic injury secondary to extracorporeal shock wave lithotripsy (ESWL) is limited to 13 published reports since 1980. Case Report: 62-year-old female underwent ESWL targeting 5 mm ureteral stone at proximal left ureter. Following same-day discharge, medication-refractory abdominal pain precipitated emergency room visit where hypotensive with concern for acute abdomen. Of note, patient denied recent trauma to abdominal region. Imaging revealed acute splenic subcapsular hematoma and hemoperitoneum. Transferred to our institution for higher level of care. Hemodynamic instability with ongoing transfusion requirements and diffuse peritonitis dictated emergent procession to operating room, foregoing consideration of splenic artery embolization. Conclusions: Splenic injury is an exceedingly rare, potentially life-threatening complication of ESWL. We feature the 4th report since 2020 and 14th overall since practice inception in 1980. Despite the resources of a large level 1 trauma center, our case highlights non-operative management may not be pragmatic in the emergent circumstance. Patient and provider education and early recognition remain key to optimize outcomes.