From the Guidelines
Splenic infarcts should be managed conservatively with pain control and rest, unless complications like abscess formation, hemorrhage, or rupture occur, in which case surgical intervention, including splenectomy, may be necessary. The management of splenic infarcts depends on the underlying cause and severity of the condition. For most small, uncomplicated splenic infarcts, conservative treatment with pain control using NSAIDs like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) is recommended, as seen in cases of infective endocarditis 1. Patients should rest and avoid strenuous activities until symptoms resolve, typically within 1-2 weeks.
Some key points to consider in the management of splenic infarcts include:
- The risk of complications like abscess formation, which can occur in up to 5% of patients with splenic infarction, particularly in the context of infective endocarditis 1
- The importance of treating the primary cause of the infarct, such as endocarditis, atrial fibrillation, or hypercoagulable states
- The potential need for anticoagulation therapy in cases of embolic causes
- The role of imaging studies, such as abdominal CT and MRI, in diagnosing splenic abscess or infarction, with sensitivities and specificities ranging from 90% to 95% 1
In cases where complications do occur, splenectomy with appropriate antibiotics may be necessary, and should be performed immediately unless urgent valve surgery is also planned. Additionally, percutaneous drainage or aspiration of splenic abscess may be an alternative to splenectomy for patients who are poor surgical candidates, and laparoscopic splenectomy may be considered as an alternative to formal laparotomy approaches 1. Patients should seek immediate medical attention if they experience worsening abdominal pain, fever, or signs of internal bleeding. Following resolution, patients with significant splenic infarcts should have follow-up imaging to ensure proper healing.
From the Research
Definition and Causes of Splenic Infarcts
- Splenic infarcts are associated with a prothrombotic state and can lead to subsequent thromboembolic complications 2.
- The main underlying mechanisms of splenic infarction include cardioembolic, vascular, haematologic disorders, and multiple causes 3.
- Cardiovascular disease and atrial fibrillation are the main causes of splenic infarction in elderly subjects, while hematological, infectious, and other causes are more prevalent in younger ones 3.
Clinical Presentation and Diagnosis
- Symptoms of splenic infarction include abdominal pain, fever, and chills, and constitutional symptoms 4.
- Patients with nonmalignant hematologic conditions are often asymptomatic, while abdominal pain is common in all groups, and fever is especially common in patients with embolic conditions 4.
- CT scan is the most frequent radiologic study used to diagnose splenic infarction, and it is currently the preferred diagnostic test 4.
- Ultrasound can also be used to diagnose splenic infarction, and it can show wedge-shaped or round, irregularly delineated or smooth, hypoechoic or anechoic lesions 5.
Treatment and Outcomes
- Anticoagulant therapy is associated with improved survival in patients with splenic infarction, and it is not related to an increased bleeding risk 2.
- The use of anticoagulation after initial splenic infarction is associated with a nonsignificant increase in recurrent splenic infarction, and it is not associated with the development of venous thromboembolism after splenic infarction 6.
- Splenic infarction in cancer patients is typically an isolated event with low recurrence risk, and anticoagulation use should be guided by other thromboembolic risk factors 6.
- Complications of splenic infarction include abscess, rupture, expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood, and flow phenomena in the area of infarction 4, 5.