Splenic infarction

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Classification according to ICD-10
D73.5 Infarction of the spleen
ICD-10 online (WHO version 2019)

An ( anemic ) splenic infarction is the destruction of splenic tissue due to an occlusion of the splenic artery or its branches.

Clinical picture

The rare acute, complete occlusion of the splenic artery leads to the clinical picture of an acute abdomen with symptoms in the left upper abdomen. Color-coded duplex sonography can lead to a preoperative diagnosis (blood flow to the splenic artery is interrupted). In the case of a smaller infarct, there is an hypoechoic area below the spleen capsule. The splenic infarction is hypodense on computed tomography .

In the differential diagnosis , an acute abdomen with symptoms predominantly in the left upper abdomen should also be considered as a splenic abscess .

Intraoperatively, the spleen is discolored gray-black, flaccid and usually already necrotic . If a bacterial infection occurs at this stage, acute epigastric peritonitis with the corresponding septic complications can develop. The incomplete occlusion of the splenic artery often remains asymptomatic or leads to uncharacteristic upper abdominal complaints.

Pathogenesis

Acute embolic occlusion due to absolute arrhythmia or endocarditis is extremely rare. Occlusions of the vessels by tumor cells are more common, for example in myeloid leukemia . An occlusion of the splenic artery, and more often a splenic vein thrombosis, can occur in the course of acute, necrotizing pancreatitis and are often not noticed in this highly acute clinical picture. The thrombosis leads to a hemorrhagic splenic infarction.

therapy

The partial (partial) splenic infarction can heal without treatment, leaving a corresponding scar. For a complete infarction, splenectomy (removal of the spleen) is the only possible therapy.

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