From the Research
For a splenic infarct diagnosed by Computed Tomography (CT) of the abdomen, conservative management is recommended if the patient is hemodynamically stable without signs of splenic rupture, as indicated by the most recent study 1. This approach includes pain control using NSAIDs or opioids as needed, hydration, and close monitoring. Patients should be admitted for observation for 24-48 hours to ensure no complications develop. Follow-up imaging with a repeat CT scan in 1-2 weeks is advised to assess healing. Anticoagulation may be necessary if the infarct is due to a thromboembolic event, typically with heparin initially followed by warfarin for 3-6 months, as suggested by a recent case report 2. Surgical intervention with splenectomy is reserved for cases with complications such as splenic rupture, abscess formation, or persistent symptoms. The underlying cause of the infarct (such as hematologic disorders, embolic events, or vasculitis) should be investigated and treated. It is essential to consider that splenic infarcts can occur due to various conditions, including thromboembolic events secondary to atrial fibrillation 2, and that accessory spleen infarction, although rare, can present with vague symptoms like abdominal pain, nausea, or vomiting 1. In all cases, management should prioritize preventing complications while addressing the root cause, with a focus on morbidity, mortality, and quality of life as the primary outcomes. Key considerations in management include:
- Clinical stability of the patient
- Presence of complications such as splenic rupture or abscess formation
- Underlying cause of the infarct
- Need for anticoagulation or surgical intervention
- Close monitoring and follow-up imaging to assess healing and prevent complications, as supported by the literature 3, 4.