Introduction
The human body has various organs and systems that play their specific roles, such as the breathing system, and digestive system. The spleen is one of the important organs in the human body, located near the stomach, on the left side. It filters the blood to remove harmful components and provide immunity to the body to fight against infections caused by bacteria, or viruses.
When the blood supply to the spleen becomes insufficient for any reason, then the spleen becomes infarcted. There could be many reasons for decreased blood supply, for example, injury, trauma, damage to the blood vessels that supply blood to the spleen, or any other serious disease or condition. Spleen infarction is caused by some underlying disease or condition that the patient may or may not be aware of. That is why patients with spleen infarction are sometimes symptomatic or asymptomatic.
What Is Splenic Infarct?
Splenic infarction is a condition caused by decreased blood flow in the spleen. This causes ischemia in the spleen tissues and necrosis. Splenic infarcts appear deep red in the initial stages and become pale in later stages because of necrosis. The shape becomes wedge-shaped and may appear as single or multiple.
The condition occurs due to arterial and/or venous occlusion - an obstruction in blood vessels and constriction of veins caused by abnormal cell activity. This occlusion may occur in a part of the spleen or the entire spleen. Splenic infarct usually takes seven to 15 days to heal and symptoms to subside.
What Causes Splenic Infarct?
There are a few most common causes of splenic infarct:
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Thromboembolic disease is a condition in which a blood clot or thrombus is formed in the blood vessel that obstructs the flow of blood. It most commonly occurs in the veins of the leg and pelvis, causing pain and swelling. The splenic artery supplies the blood to the spleen along with other branches and gastric arteries that are affected in this condition.
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Infiltrative hematologic diseases such as sarcoidosis and Langerhans cell histiocytosis. This causes swelling in the spleen. It most commonly occurs in patients of age less than 40 years.
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Blood-related malignancies such as leukemia and myelofibrosis.
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Sickle cell disease.
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Trauma in the abdomen.
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Pancreatic disorders such as pancreatitis.
What Are the Symptoms of Splenic Infarct?
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Abdominal pain in the left side is the most common symptom - gripping pain.
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Other symptoms include fever, chills, nausea, shoulder pain, etc.
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Tenderness in the abdomen.
How to Evaluate Splenic Infarct?
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Patient’s Medical History: The doctor may ask about the presence of other diseases that may cause the splenic infarction.
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Physical Examination: The doctor will examine the abdomen of the patient to assess the severity of the abdominal pain.
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Lab Test: In order to know the cause of abdominal pain, lab tests are recommended, such as liver function tests, bilirubin tests, or lipase tests. These tests will help the doctor to find the source of pain, and the presence of leukocytosis and lactate dehydrogenase may suggest the presence of splenic infarction.
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Imaging Test: Ultrasound and computed tomography (CT) are preferred in suspected cases of splenic infarction. The computed tomography may show a wedge-shaped, dark shaded defect extending to the splenic capsule - a classic appearance of the infarcted spleen. It also shows a depression and/or notched area in the spleen borders.
What Is the Treatment for Splenic Infarction?
The treatment of splenic infarction depends on the underlying disease in the patient that is causing splenic infarction. In the absence of any infection:
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Analgesics are given to reduce the pain in the abdomen.
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Antiemetics are given to treat nausea and vomiting.
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Hydration therapy is given to maintain the water balance in the body and to avoid dehydration.
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If the patient has sickle cell disease, then hypoxia and acidosis must be treated.
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Antibiotics are given through injections, and cardiac evaluation is required if the patient has septic emboli.
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In order to treat the hematologic condition or autoimmune disease, further consultation with an expert is recommended.
What Are the Complications of Splenic Infarction?
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Pseudocysts - It occurs when the cells of the spleen become inflamed or injured, due to which the enzymes leak, further harming the tissues.
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Abscess Formation - It is an accumulation of infected fluid called pus that develops due to bacterial infection.
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Hemorrhage - It is excessive internal bleeding that occurs due to damage to blood vessels.
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Rupture - It is the rupture of the spleen that may lead to internal bleeding. The rupture may occur because of any injury.
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Aneurysm - Abnormal bulge or swelling in the blood vessel.
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Hepatomegaly - Enlarged liver may occur rarely.
What Is the Differential Diagnosis of Splenic Infarction?
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Malaria is a disease spread by the bite of an infected mosquito, and is mainly caused by plasmodium parasite. The fever causes high fever and chills.
- Sickle cell disease is an inherited red blood disorder that mainly affects the hemoglobin.
- Pancreatic cancer.
- Splenic trauma.
What Happens if the Splenic Infarct Is Left Untreated?
Usually, within two days of infarction, the surrounding inflammatory tissues start moving towards the dead, infarcted tissue. The patient’s body will start the degradation process on its own, and macrophages and polymorphs will start removing the dead tissues from the infarcted area. The tissues of the infarcted area or organ become weak, and the patient may die. If the blood supply becomes restricted in the small blood vessels, then the affected may have a patchy red appearance. If there is no bleeding in the infarcted area, then it may look pale. After this repairing process, a scar formation occurs that looks grey and becomes contracted because of all collagenous fibrous tissues.
Who Is More Likely to Have Splenic Infarction?
Splenic infarction can occur at any age because patients above 40 years of age are more susceptible to developing the thromboembolic disease, and those younger than 40 years of age are more likely to have the hematologic disease.
Conclusion
Spleen infarction is a medical condition that occurs because of an underlying disease or condition that the patient may or may not be aware of. It is important to rule out the cause of this condition and treat it. Generally, antibiotics, analgesics, and antiemetics are prescribed to the patient to treat the symptoms of bacterial infection, fever, and nausea respectively. If the causative disease is a hematologic condition or autoimmune disease, then consulting an expert is advisable.
