Splenic infarction natural history, complications and prognosis

• Hemorrhage: Hemorrhage can follow splenectomy due to the intense perisplenic inflammation.

• Splenic bed and/or subphrenic abscess: Abscess is not an uncommon complication. The first line of treatment is radiologic-guided percutaneous drainage.

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

• Gastric fistula: Due to the intense inflammatory reaction that can accompany splenic abscess, the dissection of the spleen from the greater curve 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.

• Overwhelming postsplenectomy sepsis: As discussed above, the incidence is unknown. The overall postoperative sepsis rate is high because splenectomy often is undertaken for treatment of splenic abscess. The rate of sepsis is due to the cause for the abscess rather than the splenectomy.

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