What are the most serious complications of splenic infarct?

Updated: Jul 27, 2020
  • Author: Manish Parikh, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Because of the intimate association of the pancreatic tail and the splenic hilum, pancreatic injury can occur, especially in the setting of intense inflammation and/or abscess. The majority of these injuries resolve with nonoperative management, which includes wide drainage, the use of a somatostatin analogue to decrease exocrine pancreatic function, and either total parenteral nutrition (TPN) or enteral alimentation distal to the ligament of Treitz.

As a consequence of the intense inflammatory reaction that can accompany splenic abscess, dissection of the spleen from the greater curvature of the stomach can be difficult, and inadvertent, unrecognized injuries to the greater curve of the stomach do occur. With adequate external drainage and with no obstruction to normal gastric emptying, these can be treated expectantly with TPN or distal luminal alimentation and nasogastric tube decompression.

OPSS is the most serious postsplenectomy complication; it occurs rarely (0.5%) in adult patients but carries a prohibitive mortality in unvaccinated patients. For this reason, a trend away from splenectomy and toward splenic conservation has emerged.


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