From the Research
Management of perisplenic inflammatory fat stranding typically requires a conservative approach with close monitoring unless complications develop. Initial management includes pain control with analgesics such as acetaminophen or NSAIDs, bed rest, and intravenous hydration if the patient is unable to maintain oral intake. The most recent and highest quality study 1 suggests that a conservative approach is often effective, and surgical intervention should be reserved for cases with complications. Key aspects of management include:
- Pain control with analgesics such as acetaminophen or NSAIDs (ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily)
- Bed rest
- Intravenous hydration if the patient is unable to maintain oral intake
- Vital signs should be monitored regularly to detect early signs of deterioration
- If infection is suspected, empiric antibiotics may be initiated, typically a broad-spectrum regimen such as piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours
- Serial imaging (ultrasound or CT scan) is recommended to monitor progression or resolution of the inflammatory changes
- Surgical intervention is generally reserved for cases with complications such as abscess formation, splenic rupture, or hemodynamic instability, as seen in cases described in 2 and 3. This conservative approach is preferred because perisplenic inflammatory fat stranding often represents a self-limiting inflammatory process that resolves with supportive care, and the spleen's important immunological functions make preservation desirable whenever possible, as highlighted in 1.