Splenic Infarction.ppt

7/21/2019 Splenic Infarction.ppt

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Splenic InfarctionSplenic Infarction

Splenic infarction is a rather rareSplenic infarction is a rather rare

pathology most commonlypathology most commonly

associated with hematologicassociated with hematologicdisorders.disorders.


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Splenic infarction typically presents onSplenic infarction typically presents on

CT as a wedge-shaped region of lowCT as a wedge-shaped region of low

attenuation with the apex directedattenuation with the apex directedtoward the splenic hilumtoward the splenic hilum

The infarct may be segmental or involveThe infarct may be segmental or involve

the entire organthe entire organ


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Hematologic Disorders eu!emiaHematologic Disorders eu!emia

ymphomaymphoma

"yelofibrosis Hypercoagulable states"yelofibrosis Hypercoagulable states

#rythropoietin therapy#rythropoietin therapy$olycythmia %era$olycythmia %era

Sic!le hemoglobinopathiesSic!le hemoglobinopathies

#mbolic Disorders & #ndocarditis' (trial#mbolic Disorders & #ndocarditis' (trial)ibrillation' $rosthetic mitral valve' eft)ibrillation' $rosthetic mitral valve' eft

%entricular mural thrombus following%entricular mural thrombus following

myocardial infarctmyocardial infarct

%ascular Disorders & *egener+s%ascular Disorders & *egener+sgranulomatosis' polyarteritis nodosagranulomatosis' polyarteritis nodosa

(utoimmune,heumatoid &awasa!i(utoimmune,heumatoid &awasa!i

Disease' Systemic upus #rythematosusDisease' Systemic upus #rythematosus


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Clinical featuresClinical features

(symptomatic' with incidental discovery(symptomatic' with incidental discovery

from radiologic or postmortem studiesfrom radiologic or postmortem studies

hemorrhagic shoc! as a result ofhemorrhagic shoc! as a result of

subcapsular hematoma with rupture intosubcapsular hematoma with rupture into

the peritoneal cavity.the peritoneal cavity.

left upper /uadrant pain' fever' and chills.left upper /uadrant pain' fever' and chills.

(dditional symptoms include nausea'(dditional symptoms include nausea'vomiting' pleuritic chest pain' and leftvomiting' pleuritic chest pain' and left

shoulder painshoulder pain


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TreatmentTreatment

The mainstay of treatment for splenicThe mainstay of treatment for splenicinfarction' in the absence of complications'infarction' in the absence of complications'

is analgesia and observation. The arterialis analgesia and observation. The arterial

supply to the spleen via the splenic arterysupply to the spleen via the splenic artery

and the short gastric arteries 0from the leftand the short gastric arteries 0from the leftgastroepiploic1 allow sufficient collateralgastroepiploic1 allow sufficient collateral

flow to preserve much of the spleenflow to preserve much of the spleen

parenchyma with minimal intervention' evenparenchyma with minimal intervention' evenin the event of splenic artery occlusion.in the event of splenic artery occlusion.


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complications such as spleniccomplications such as splenicabscess from septic emboli orabscess from septic emboli or

infection of prior infarct re/uireinfection of prior infarct re/uireimmediate surgical attentionimmediate surgical attention


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Splenic abscessSplenic abscess

Splenic abscesses occur most commonly inSplenic abscesses occur most commonly inpatients with underlying disorders such aspatients with underlying disorders such as

infection' embolic disease' traumatic in2ury'infection' embolic disease' traumatic in2ury'

malignant hematologic conditions' ormalignant hematologic conditions' orimmunosuppression. Solitary abscessesimmunosuppression. Solitary abscesses

usually represent locali3ed disease. 4verall'usually represent locali3ed disease. 4verall'

the clinician will most often 05671the clinician will most often 05671

encounter patients with solitary abscessesencounter patients with solitary abscesses


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(n abscess in the right upper pole(n abscess in the right upper pole

of the spleen may rupture and formof the spleen may rupture and form

a left subdiaphragmatic abscess . Ifa left subdiaphragmatic abscess . Ifthe abscess is in the lower pole 'the abscess is in the lower pole '

rupture result in diffuse peritonitisrupture result in diffuse peritonitis.


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TreatmentTreatment

(s a rule ' owing to dense adhesions '(s a rule ' owing to dense adhesions '

drainage of the abscess is the onlydrainage of the abscess is the only

course . %ery rarely ' splenectomy maycourse . %ery rarely ' splenectomy maybe possible with the abscess in situ .Thebe possible with the abscess in situ .The

drainage may be performeddrainage may be performed

percutaneously ' under u,s or CTpercutaneously ' under u,s or CTguidance ' so avoiding the need forguidance ' so avoiding the need for

operative intervention .operative intervention .


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SplenectomySplenectomy

8- trauma & either following an accident or8- trauma & either following an accident orduring a surgical operation ' for example whenduring a surgical operation ' for example when

mobilising the splenic flexure of the colon .mobilising the splenic flexure of the colon .

9- removal en bloc with the stomach as part9- removal en bloc with the stomach as part

of a radical gastrectomy.of a radical gastrectomy.

:- removal as part of a staging laparotomy:- removal as part of a staging laparotomy

underta!en before treatment of a Hodg!in+sunderta!en before treatment of a Hodg!in+s

lymphoma' a very rare indication with thelymphoma' a very rare indication with theadvent of improved staging by imaging;advent of improved staging by imaging;


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ComplicationsComplications

- Hemorrhage' if a ligature slips off the- Hemorrhage' if a ligature slips off thesplenic artery.splenic artery.

- >astric dilatation following partial- >astric dilatation following partialmobilisation of the stomach whenmobilisation of the stomach whenligating the short gastric vessels.ligating the short gastric vessels.

- Hematemesis may rarely occur -- Hematemesis may rarely occur -

possibly due to mucosal damage to thepossibly due to mucosal damage to thestomach when ligating the short gastricstomach when ligating the short gastricvessels.vessels.


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- Splenectomy is fre/uently followed by- Splenectomy is fre/uently followed by

a rise in the white cell and platelet counta rise in the white cell and platelet count

a few days after operation. There may bea few days after operation. There may be

a ris! of thrombosis if the platelet counta ris! of thrombosis if the platelet count

rises above 8666666 perlitre and it isrises above 8666666 perlitre and it is

essential to anticoagulateessential to anticoagulate

prophylactically the patient should thisprophylactically the patient should this

level be attained.level be attained.


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- >astric fistula due to damage of- >astric fistula due to damage of

the greater curvature of the stomachthe greater curvature of the stomach

when ligating the short gastricwhen ligating the short gastricvesselsvessels.


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postsplenectomy septicemia. The spleenpostsplenectomy septicemia. The spleen

phagocytoses bacteria' particularlyphagocytoses bacteria' particularlyencapsulated bacteria.encapsulated bacteria.

Splenectomised patients are atSplenectomised patients are at

increased ris! of septicemia due toincreased ris! of septicemia due toStreptococcus pneumoniae' ?eisseriaStreptococcus pneumoniae' ?eisseria

meningitides' Haemophylous influen3aemeningitides' Haemophylous influen3ae

and @abesia rnicroti.and @abesia rnicroti.


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4pportunistic postsplenectomy infection4pportunistic postsplenectomy infection

04$SI104$SI1is now of ma2or concern.is now of ma2or concern.

$neumococcal vaccine 0$neumovax1$neumococcal vaccine 0$neumovax1

should be given 9 wee!s preoperatively.should be given 9 wee!s preoperatively.

It is important to advise the patient ofIt is important to advise the patient of

the dangers of 4$SI and to prescribethe dangers of 4$SI and to prescribe

antibiotics with all infections.antibiotics with all infections.

Splenectomised patients living inSplenectomised patients living inmalaria endemic areas should receivemalaria endemic areas should receive

antimalaria prophylaxis.antimalaria prophylaxis.


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)or children &long-term treatment)or children &long-term treatment

with antibiotic drugs to prevent post-with antibiotic drugs to prevent post-

splenectomy sepsis .splenectomy sepsis . ( benzathen( benzathenpenicillin 1.2 mega units per month )penicillin 1.2 mega units per month )

ong-term antibiotic use is usuallyong-term antibiotic use is usually

not necessary in adults.not necessary in adults.

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Splenic Infarction.ppt