Experience of significant splenic infarction at university hospital; case series

Objective: The aim of this study is to identify the causes of significant splenic infarction at King Fahd university hospital, Saudi Arabia over a-13 year period. Methods: A retrospective chart review of patients who were diagnosed with significant splenic infarction during a 13-year period at king Fahd university hospital, Saudi Arabia was conducted. Only computerized tomography proven diagnoses of splenic infarction were included. The clinical presentation and initial investigations were recorded. Results: We found 14 cases of acute significant splenic infarction. Sickle cell disease was the most common cause (seven cases, 50%). Two cases secondary to atrial fibrillation (14%), one case secondary to Wagner granulomososis (7%), one case secondary to acute pancreatitis (7%), one case secondary to liver cirrhosis and hypesplenisim (7%), one case secondary to aortic dissection (7%) and one case secondary to thalassemia major (7%). All of the reported cases of significant splenic infarction presented with left abdominal pain. 43 % of the cases had leukocytosis and 71 % had elevated Lactate dehydrogenase (LDH).29% of cases were managed surgically and 71 % were managed medically. Conclusion: the percentage of significant splenic infarction in our institution is very low. This is could be attributed to low doctors awareness and high threshold of computerized tomography imaging of such serious medical problem. This might result in missing a lot of cases. Sickle cell disease remain the most common cause due to epidemiological reasons. We recommend maintaining high clinical suspicion of splenic infarction in high risk group who came with left upper quadrant pain.