[A rare cause of acute abdomen: splenic infarction. Case report and review of the literature].
BACKGROUND
Splenic infarction is a rare cause of acute abdomen. It must be suspected in patient with hematologic diseases or thromboembolic conditions. The most common onset symptom is left-upper quadrant abdominal pain. Additional symptoms include fever and anemia. Laboratory may show elevated white blood cell and platelet counts.


METHODS
A 97-year-old female with a past history of atrial fibrillation presented with left-upper quadrant abdominal pain and fever since 20 days. Laboratory showed elevated white blood cell and platelet counts, increased C-reactive protein and lactate dehydrogenase. Both ultrasonographic and tomographic scans showed a large hypodense area of the spleen. The patient received intravenous antibiotic therapy, which led to significant clinical improvement with discharge 16 days after admission.


CONCLUSIONS
The diagnosis of splenic infarction is based both on clinical presentation and imaging studies. Angio-computed tomography is the diagnostic procedure of choice. Ultrasonography and conventional radiology are useful in the differential diagnosis with other abdominal and thoracic diseases mimicking splenic infarction. In our case the management was conservative, because the patient was hemodynamically stable and antibiotic therapy could control the sepsis. Moreover, advanced age and poor cardiac and respiratory conditions contraindicated surgery.


CONCLUSIONS
In our case splenic infarction was probably due to a thromboembolic event secondary to atrial fibrillation. In accordance with the literature, we suggest initial conservative therapy. Surgery is indicated only in the presence of complications.
Spaziani
E
E
Sapienza Università di Roma.
Di Filippo
A
A
Picchio
M
M
Pietricola
G
G
Ceci
F
F
Ottaviani
M
M
Martellucci
A
A
Pattaro
G
G
De Angelis
Francesco
F
Parisella
F
F
Pecchia
M
M
Stagnitti
F
F
D000006:Abdomen, Acute / Q000209:etiology*; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006801:Humans; D013159:Splenic Infarction / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents