Yu Peihe, Hu Junchao, Deng Lan, Luo Hua, Yang Pei, Zeng Xintao
Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Int J Surg Case Rep. 2025 Jan;126:110756. doi: 10.1016/j.ijscr.2024.110756. Epub 2024 Dec 17.
Splenic infarction caused by thrombi rarely causes abdominal pain in acute abdomen patients. This report describes a case of splenic infarction caused by thrombus detachment due to paroxysmal atrial fibrillation, which was successfully treated and discharged from the hospital.
A 52-year-old woman walked into the emergency room with left upper abdominal pain, nausea, and vomiting 12 h prior. Abdominal examination revealed tenderness in the left upper abdomen, with no palpable mass, rebound tenderness, or guard stiffness. Initial treatment included fasting and analgesia, as well as relevant auxiliary examinations. Intravenous contrast computed tomography (CT) revealed splenic branch artery obstruction with a large splenic infarction, and further examination with 24-h dynamic electrocardiogram monitoring revealed rapid atrial fibrillation. Five days after admission, because there was no significant improvement in her abdominal pain after fasting, fluid replacement, analgesia, etc., she was finally given a laparotomy with total splenectomy.
In general, most surgeons do not advocate surgical intervention for splenic infarction, as infarction can lead to autologous splenectomy, and the spleen gradually becomes fibrotic, atrophies, and eventually disappears. However, for patients whose atrial fibrillation episodes continue to increase and whose conservative treatment is still ineffective, surgery provides a more favorable treatment method.
This case report highlights that in patients with splenic infarction due to cardiac thrombosis and unrelieved abdominal pain, splenectomy can be considered if cardiac function is stable and tolerable and if the ASA anesthetic is below class V.
血栓引起的脾梗死在急腹症患者中很少引起腹痛。本报告描述了一例因阵发性心房颤动导致血栓脱落引起的脾梗死病例，该病例经成功治疗后出院。
一名52岁女性在12小时前因左上腹疼痛、恶心和呕吐走进急诊室。腹部检查发现左上腹压痛，未触及肿块、反跳痛或肌紧张。初始治疗包括禁食、镇痛以及相关辅助检查。静脉注射造影剂的计算机断层扫描（CT）显示脾分支动脉阻塞伴大面积脾梗死，24小时动态心电图监测进一步检查显示快速心房颤动。入院五天后，由于禁食、补液、镇痛等治疗后腹痛无明显改善，最终对其进行了剖腹全脾切除术。
一般来说，大多数外科医生不主张对脾梗死进行手术干预，因为梗死可导致自体脾切除，脾脏会逐渐纤维化、萎缩并最终消失。然而，对于心房颤动发作持续增加且保守治疗仍无效的患者，手术提供了一种更有利的治疗方法。
本病例报告强调，对于因心脏血栓导致脾梗死且腹痛未缓解的患者，如果心功能稳定且可耐受，且美国麻醉医师协会（ASA）麻醉分级低于V级，则可考虑行脾切除术。
