Splenic Infarcts and Splenectomy: 5 Years of Surgical Experience

Abstract

Splenic infarction is encountered rarely in clinical practice. The wide spectrum of clinical presentation makes its diagnosis elusive. It usually responds to conservative management but rarely surgical intervention is needed if it is refractory symptoms or secondary complication. We present our experience of splenectomy performed for splenic infarct which failed to respond to medical management over the last 5 years from 2015 to 2019. We performed 9 splenectomies (7 laparoscopic and 2 open). Most of these patients were young females (66.7%, 6/9). Mean age of patients in our series was 31.1 years (± 15.8 years). Fever (77.8%) and abdominal pain (66.7%) were the most common presenting symptoms. Diagnosis was made on the basis of contrast-enhanced CT scan of abdomen. Infective endocarditis (33.3%, 3/9) was the most common underlying aetiology. All of these patients initially received a trial of conservative management for a median duration of 19 days. Post-operative course was uneventful for most of these patients with a resolution of symptoms in post-operative period. There were two patients who developed surgical site infection and one who developed subdiaphragmatic collection which was drained percutaneously via a pigtail insertion. Patients were discharged after a median duration of 4 days after surgery and referred for post-splenectomy vaccination in haematology clinic. There is scarcity of literature on role of surgical intervention in symptomatic splenic infarct refractory to conservative management. How long should these patients be managed before considering them for splenectomy is a question worth exploring.