Spontaneous Massive Splenic Infarction in the Setting of Renal Transplant and Septic Shock: A Case Report and Review of the Literature

Abstract

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy. We report the case of a 50-year-old man with a history of renal transplant who presented with diffuse abdominal pain and rapidly developed septic shock. A computed tomographic study (CT scan) of the abdomen demonstrated MSI. The surgical team was consulted for splenectomy but conservative management was maintained and immune function preserved. The patient's clinical condition was resolved over a three-week period. This report demonstrates successful nonoperative management of a spontaneous MSI most likely secondary to hypoperfusion and a hypercoagulable state from both septic shock and renal transplant.

Massive splenic infarction in a patient with acute calculous cholecystitis: a case report and literature review

“…Generally, few case reports of MSI, which were due to either hematological or nonhematological causes, have been published in literature. [1][2][3][4][5][6][7][8] The case presented here is particularly significant because it the rare occurrence of a spontaneous MSI for which the definitive cause of infarction was unclear. Moreover, up to the best of our knowledge, this is the first case in literature of MSI occurring in a patient with acute cholecystitis.…”

“…The presentation of MSI is variable, but the majority of cases, such as in our case, present with sudden onset of severe left upper quadrant abdomen pain. 1 Associated nonspecific symptoms may be present, such as nausea, vomiting, fever and chills. 3 Rarely, diffuse abdominal pain may occur in some cases of MSI if infarction ruptured.…”

“…[12][13][14][15][16][17][18] The role of splenectomy in the setting of MSI remains unclear. 1 Due to the risk of fatal, post-splenectomy sepsis, splenic preservation is preferable. 16 The indications that warrant surgical intervention for any type of splenic infarction are reserved for patients with persistent symptoms, mainly abdominal pain, or the presence of complications, including: splenic hemorrhage, abscess, or persistent pseudocyst.…”

Massive Splenic Infarction with Specific Sonographic Feature: Two Case Reports with Rare Etiologies

“…Etiologies of MSI include Sickle cell disease and Sickle cell variants, coagulopathies, therapeutic embolization of the spleen, sarcoidosis, hematological malignancies and organ transplant. Infection has also been linked to MSI [1]. Other unique causes of splenic infarction include Gaucher disease, pancreatitis, splenic artery aneurysm, septic emboli in endocarditis and collagen vascular diseases [2].…”

Acute Splenic Sequestration Crisis

“…MSI is extremely rare in children with SCA. It can develop spontaneously or be precipitated by other factors, namely, high altitude, acute chest syndrome, and severe stress in the form of septicemia or severe vasoocclusive crisis [6,14].Epidemiology ASSC is a serious and the earliest life-threatening complication seen in patients with SCA [15]. It may occur during the first weeks of life, and it could be the first symptom of the disease.…”