Spleen Infarction: Symptoms, Causes, Treatment, What It Is, Signs

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Spleen infarction - what is it?

The content of the article:

Spleen infarction reasons
Classification
Spleen infarction symptoms
Complications
Diagnostics
Treatment
Forecast
Prevention
Video

A spleen infarction is a necrosis (necrosis) of an area of the spleen tissue, which develops as a result of an acute disturbance of the blood supply to this organ, caused by a prolonged spasm of a blood vessel, its thrombosis or embolism.

In many cases, the infarction of the spleen tissue is hidden.

The disease predominantly affects elderly people (over 60 years old), equally women and men. According to statistics, the incidence rate is 30 cases for every thousand of the adult population. However, in most cases, foci of necrosis are small, and the disease proceeds without pronounced clinical symptoms, remaining undiagnosed.

Spleen infarction reasons

The main cause of a focus of necrosis in the spleen is partial or complete occlusion (blockage) of the splenic artery or its branches. One of the following conditions can lead to the formation of this lesion:

malignant blood diseases (lymphogranulomatosis, leukemia, lymphoma);
changes in the physicochemical properties of blood caused by various factors (acquired and congenital pathologies of the coagulation system, hemolytic and sickle cell anemia, erythropoietin therapy, long-term use of oral contraceptives, impaired protein metabolism);
heart disease (arrhythmias, myocardial infarction, congenital and acquired valvular defects, septic endocarditis);
inflammatory and systemic vascular diseases (endoarteritis, atherosclerosis, vasculitis);
traumatic injuries to the ribs or abdominal organs, which can cause air or fat embolism of the lienal vessels;
parasitic and infectious diseases (malaria, typhoid, sepsis);
spleen pathology (cyst, increased organ mobility).

Classification

So what is spleen infarction? This is a site of necrosis formed in the organ, the development of which is caused by impaired blood flow in the system of lienal (splenic) vessels. Depending on the type of these disorders, two types of heart attacks are distinguished:

Ischemic. It occurs as a result of blockage of the splenic artery or one of its branches (thrombus, embolus) or disturbance of blood flow caused by severe vasospasm. As a result, blood ceases to flow to the tissues of the spleen, which is accompanied by their hypoxia and ischemia, and in the future, the formation of a necrosis focus. With this form of the disease, the spleen or its parts (macro-preparation) acquire a pale yellow color. If you conduct a study of the tissue of an organ under a microscope (microscope), you can identify foci of inflammatory infiltration.
Hemorrhagic. When a branch of the lienal artery is blocked, blood is discharged into the collateral vessels, which leads to an increase in pressure in them. As a result, the vessel ruptures, and blood flows into the parenchyma of the organ. In the histological description, it is indicated that the organ has a bright red color due to the poured out blood, clearly defined foci of necrosis and infiltrates are revealed in it.

Depending on the extent of the spread of the pathological process, the presence or absence of complications, the heart attack takes the following forms:

extensive;
small focal;
multiple;
unit;
uncomplicated;
septic.

Spleen infarction symptoms

The severity of the clinical picture is determined by the volume of the area of necrosis. If it is small, the patient usually does not present any complaints, or notes a slight weakness and malaise.

With significant damage to the spleen parenchyma, patients experience a feeling of heaviness and dull pain in the left upper quadrant of the abdomen. The first signs of a splenic infarction are usually nausea and vomiting, bloating, and diarrhea. In the absence of treatment, the patient's condition worsens - the body temperature rises, tachycardia and shortness of breath develop.

Symptoms of massive spleen necrosis:

severe pain in the region of the left hypochondrium of a cutting or stabbing nature, radiating to the epigastric region, chest, lower back, left scapula;
decreased diaphragm mobility;
rapidly growing symptoms of intoxication (fever, headache, weakness, lack of appetite);
delay in passing gas and stool.

Complications

Necrotized areas of the spleen parenchyma, when a secondary infection is attached, can undergo purulent fusion with the formation of single or multiple abscesses. When they break through into the abdominal cavity, the patient develops peritonitis and sepsis. Also, at the site of foci of necrosis, rather large pseudocysts can subsequently form.

Diagnostics

In view of the nonspecific clinical picture, the diagnosis of spleen necrosis often presents significant difficulties.

The diagnosis begins with an examination by the surgeon. The doctor examines the history of life and illness, conducts a physical examination and directs the patient for further laboratory and instrumental studies:

Ultrasound of the spleen is an affordable and very valuable diagnostic method, which makes it possible for a specialist to assess the structure and size of an organ, the state of its capsule, and features of the parenchyma. When conducting duplex scanning, the peculiarities of blood flow in the lienal artery basin are studied;
MRI of the spleen - allows you to accurately identify foci of necrosis, assess their size and exact localization;
CT - the method is auxiliary and is mainly used to clarify the nature of lienal formations (hematoma, cyst, abscess);
puncture biopsy with subsequent histological examination of the resulting tissue - rarely used in clinical practice due to high trauma;
laboratory diagnostics - in the early stages of the disease it is not very informative, but in the later stages it reveals signs of an inflammatory process.

The main method for diagnosing a heart attack is spleen ultrasound

Treatment

Patients with a heart attack are subject to urgent hospitalization in the surgical department. The tactics of their treatment depends on the size of the necrosis focus.

With a small lesion area, the patient is provided with strict bed rest. Cold is applied to the area of the left hypochondrium. If necessary, prescribe pain relievers, anticoagulants. In order to prevent purulent inflammation, broad-spectrum antibiotics are used.

Massive necrosis of the spleen is an indication for surgical (endoscopic or conventional) intervention. During the operation, the doctor assesses the condition of the organ and either removes the entire spleen (splenectomy), or its affected area.

Currently, preference is given to laparoscopic operations, since they are less traumatic, less often accompanied by the development of complications and can significantly reduce the duration of the rehabilitation period.

In the postoperative period, detoxification, anti-inflammatory, antibacterial and analgesic therapy is performed.

Forecast

The prognosis depends on the prevalence of pathological changes, the timeliness and usefulness of the treatment. With small foci of necrosis, the prognosis is generally favorable. It worsens significantly with multiple or massive foci, especially complicated by the formation of pseudocysts or abscesses. Death occurs in about 2% of cases.

Prevention

The specific prevention of the disease has not been developed. To reduce the risk of splenic infarction, it is necessary to timely identify and actively treat diseases that can lead to impaired blood flow in the lienal vessels.