P1112 - Left Sided Abdominal Pain: You May Have a Broken Spleen!

Mehak Bassi, MD, Akshay Chaudhary, MBBS, Shweta Chaudhary, MBBS, Anil Anandam, MBBS, MD, Kim Dixon, MD, Sugirdhana Velpari, MD, FACG, Andrew Korman, MD, FACG, Arkady Broder, MD, FACG
Saint Peter's University Hospital, New Brunswick, NJ

Introduction: Splenic infarction is one of the rare complications of acute pancreatitis. Acute pancreatitis accounts for only 5% of the spleen infarction. Clinicians should be aware of the rare yet life-threatening complication of splenic infarction in acute pancreatitis patients.

Case Description/Methods: Our patient is a healthy 53-year-old male who presented with a complaint of abdominal pain for 1 week prior to arrival at the hospital. Of note, the patient was diagnosed with acute pancreatitis a month ago which was managed conservatively. During this visit, his vitals were stable and the examination was remarkable for left upper quadrant tenderness. Laboratory investigations were significant for leukocytosis. Computed tomography of the abdomen and pelvis(CT) showed a 6.9 x 5.7 x 6.7 cm hypodensity within the spleen representing splenic infarct (Figure 1). Echocardiography with bubble study to find any obvious intracardiac source of emboli was performed. No arrhythmias identified on the telemonitor. Hypercoagulability workup was nonsignificant. After consultation with surgery and hematology specialists, the patient was discharged home on Apixaban which was based on mixed data, supporting the use of anticoagulation on patients with splenic infarct, case by case basis.

Discussion: The spleen receives 5% of the cardiac output making it susceptible to emboli (cardiogenic, paradoxical). Acute pancreatitis is identified only in 6% of the patients with splenic infarction. During acute pancreatic inflammation, the splenic artery is most susceptible to develop thrombosis given its proximity to the pancreas which puts it at risk of direct invasion. Abdominal pain in uncomplicated cases resolves in two weeks. Lethal complications include abscess, pseudocyst formation, hemorrhage, splenic rupture, and aneurysm. In some dangerous situations, the infarcted tissue undergoes a hemorrhagic transformation. Cardiogenic emboli, infection, autoimmune diseases, and lymphoproliferative disorders should be identified as other etiology. As most pancreatitis-related splenic complications regress spontaneously, primary conservative management may be approached. Treatment is focused on underlying etiology. These circumstances warrant emergent surgical consultation. Despite its rare occurrence, clinicians should pay attention to splenic infarction in a clinical setting.



Disclosures:


Mehak Bassi, MD, Akshay Chaudhary, MBBS, Shweta Chaudhary, MBBS, Anil Anandam, MBBS, MD, Kim Dixon, MD, Sugirdhana Velpari, MD, FACG, Andrew Korman, MD, FACG, Arkady Broder, MD, FACG. P1112 - Left Sided Abdominal Pain: You May Have a Broken Spleen!, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.