Splenic infarction can be the result of various underlying diseases, such as leukemia or heart disease such as atrial fibrillation. In these cases, blood vessels in the spleen become blocked, leading to impaired blood flow and eventual death of cells in the spleen due to lack of oxygen.
What is splenic infarction?
Splenic infarction is the death of tissue in the spleen due to lack of blood flow. A basic distinction is made between acute splenic infarction and chronic recurrent splenic infarction. Typically, splenic infarction results in occlusion or stenosis of the lienal artery or its branches, resulting in little or no blood reaching the spleen, leading to tissue death. The most characteristic symptom of a blockage of the blood vessels supplying the spleen is the so-called acute abdomen. This refers to severe abdominal pain, which can also radiate to other parts of the body, such as the shoulders. If left untreated, splenic infarction can lead to autosplenectomy, or loss of complete splenic function.
Causes
There are several causes that may underlie a splenic infarction. Splenic infarctions not infrequently occur in cancers, such as chronic myeloid leukemia. Splenic infarction can also be caused by inflammation of the inner lining of the heart, i.e., endocarditis. A thromboembolism can also result in a splenic infarction. In this case, an embolus is carried through the bloodstream until it eventually gets stuck and blocks a major vessel, such as the lienal artery, which is the main artery of the spleen. Other common causes of splenic infarction include blood poisoning, inflammation of the arteries, and various infectious diseases. As a result of sickle cell anemia, occlusion of blood vessels is more common due to the deformed red blood cells. These recurrent circulatory disturbances can also affect the spleen, where they then lead to splenic infarction.
Symptoms, complaints, and signs
A splenic infarction is initially manifested by severe pain in the left upper abdomen, which occurs suddenly and radiates to the surrounding regions. This is accompanied by nausea and vomiting. In addition, typical fever symptoms may occur, i.e., increased body temperature, chills, malaise and faintness. The pain, which is typically localized in the area of the spleen, increases in intensity as the disease progresses. Sufferers usually have severe pressure pain, associated with sudden sweating and a strong feeling of illness. Externally, a splenic infarction can occasionally be recognized by the conspicuous swelling, which may be reddened or painful to the touch. In addition, ulcers may become apparent if the organ perforates and the tissue fluid penetrates into the surrounding tissue layers. In individual cases, a splenic infarction goes unnoticed. Then the dead tissue becomes scarred, causing dysfunction of the organ. A damaged spleen manifests itself, among other things, through fatigue during light physical exertion, lack of appetite, wound healing disorders and excessive bleeding. It can also cause digestive problems, chronic stomach pain in the area of the organ, and hormonal complaints. Severe inflammation of the spleen may also occur as a result of a whole or partial splenic infarction and may be associated with further complications and discomfort.
Diagnosis and course
The first step in making a diagnosis is to palpate the abdomen. Characteristic of a splenic infarction is left upper abdominal pain that starts as if out of nowhere and may radiate to the left shoulder. Typically, a splenic infarction causes an acute abdomen with very severe upper abdominal pain and fever. The attending physician checks whether he can feel a defensive tension on the patient’s left upper abdomen. In this symptom, a splenic abscess must also be considered as a differential diagnosis. To confirm the suspected diagnosis of splenic infarction, a so-called duplex sonography is performed. The lienal artery of the spleen is examined with the aid of ultrasound waves. Splenic infarction is usually clearly visible on ultrasound. If an ultrasound examination does not reveal any clear findings, a computer tomography scan can also be performed.
Complications
Splenic infarction represents a very serious complaint that must be treated by a physician in any case. Without treatment, this can result in the death of the affected person. For this reason, a medical professional should always be consulted in the event of a splenic infarction in order to avoid possible complications. Self-healing is also unlikely. Patients sometimes suffer from pain in the abdomen. Furthermore, vomiting and nausea also occur. Fever may also occur and patients suffer from severe pain in the spleen. If the complaint is not treated, the spleen may be completely damaged, leaving it without function. In some cases, the spleen can regenerate itself after the splenic infarction. In severe cases, the spleen must be completely removed. In most cases, this does not result in any particular complications and the affected person can survive without a spleen. However, patients are more susceptible to various diseases and infections as a result and therefore need to protect themselves better. It is possible that splenic infarction will reduce the patient’s life expectancy.
When should you go to the doctor?
If there is sudden or severe pain in the upper body, there is a disorder in the organism that must be clarified immediately by a doctor. If chronic pain develops, a medical examination should be initiated. If there is discomfort in the area of the upper abdomen, this may indicate a disease of the spleen. In case of nausea, vomiting as well as sweating, a doctor is needed. Swelling, elevated body temperature as well as chills should be examined and treated by a doctor. A doctor should be consulted if disorders such as malaise, fatigue, a lack of appetite as well as irregularities of the digestive tract occur. A pain to touch as well as functional disorders should be examined and treated immediately. There is a threat of organ failure in severe cases, potentially increasing the risk of endangering life. A physician should be consulted in the event of disturbances in wound healing, a loss of the usual level of performance, and a reduction in internal strength. An unwanted decrease in body weight, emotional abnormalities and a rapid fatigability, a doctor is needed. If the daily obligations can no longer be fulfilled, as a loss of strength quickly sets in, a visit to the doctor is required. Problems of the hormonal balance are further signs of an irregularity of the spleen. If the regulation during the course of the female cycle is disturbed or changes in the appearance of the skin occur, a doctor should be consulted.
Treatment and therapy
If it is a partial splenic infarction, i.e. only parts of the splenic tissue are affected, the infarction may proceed without symptoms and is often not even noticed. In such cases, the spleen heals on its own without medical assistance, leaving only scar tissue. There may be partial functional impairment of the spleen due to the formation of this scar tissue. In recurrent splenic infarctions, after some time, the increasing scarring may cause the spleen to shrink. In acute cases, heparin, which inhibits blood clotting, is often given; this attempts to clear the blockage of blood vessels in the spleen. The use of anticoagulants is important because otherwise splenic rupture or complete loss of splenic function may occur. If there are recurrent complaints and problems with the spleen, it is often advisable to remove the spleen. A so-called splenectomy, i.e., removal of the spleen, is always necessary without exception if there has been a complete loss of spleen function due to the infarction.
Outlook and prognosis
Splenic infarction is associated with a poor prognosis. Initially, an infarction of the organ results in various physical symptoms such as severe pain and nausea. In addition, there is a risk of life-threatening complications such as acute upper abdominal peritonitis, which develops as a result of bacterial infection of the spleen. In most cases, there are serious underlying conditions such as myeloid leukemia or splenic vein thrombosis, which in turn cause severe complications and worsen the prognosis. Partial infarction can nevertheless heal without further consequences, provided it is recognized and treated at an early stage. In the best case, only a scar remains. In the case of a complete infarction, the spleen must be removed.If the organ is missing, there is an increased risk of infection and, in particular, blood poisoning, which is fatal in half of all cases. Again and again, limbs have to be amputated. While quality of life is not necessarily impaired by a splenic infarction, life expectancy is usually reduced. In old age, patients increasingly have to take medication to compensate for the lack of protection provided by the spleen. In addition, medical monitoring is required in every case, which can be a considerable burden for those affected. Thus, the prognosis for splenic infarction depends on whether it is a partial or complete splenic infarction.
Prevention
To prevent splenic infarction, conditions such as thrombosis, or an increased risk of thrombosis in general, should be taken seriously. High blood pressure is also one of the risk factors, because clots formed as a result are more easily flushed through the bloodstream and then get stuck in the lienal artery, for example, leading to splenic infarction.
Follow-up
Because splenic infarction is a serious emergency condition, extensive ongoing symptoms are to be expected, making permanent consultation with the physician essential. Depending on whether there is a serious underlying disease as a trigger, it is important to keep this under control in order to exclude a further infarction. Affected persons should pay attention to a healthy lifestyle and a balanced diet. Excessive physical exertion should be avoided. The weakened immune system requires special monitoring, so patients should consult their physician at the slightest sign of discomfort to avert the risk of deterioration of the condition in time.
What you can do yourself
A mild splenic infarction does not always require medical treatment. However, the affected person should pay attention to unusual symptoms and pain in the area of the spleen in the period after the infarction. It is possible that scarring of the spleen tissue will occur, which in some cases will lead to functional limitations of the spleen. The most important self-measure is to avoid further infarctions. In addition to a change in lifestyle, a comprehensive medical examination must be performed in any case. Depending on the cause, which the physician determines, further measures can then be taken. If a thromboembolism is the cause, sports and physiotherapy are recommended. A healthy body weight and avoidance of stimulants are successful preventive measures. If blood poisoning has been identified as the cause, injuries and illnesses should be better treated in the future. The same applies if the doctor identifies an infectious disease as the cause. In principle, a severe splenic infarction cannot be treated by oneself. The most important measure is compliance with the prescribed therapy. In addition, good attention should be paid to the body’s signals, since secondary symptoms often occur as a result of a severe splenic infarction that require immediate clarification and treatment.
