Splenic infarction without thrombosis secondary to severe acute pancreatitis

Abstract

Introduction: Acute pancreatitis is a common disease that is usually mild, although in some cases it may present complications, among which are vascular ones such as splenic infarction.

Clinical case: A 71 years old woman was admitted for acute pancreatitis, who presented a torpid evolution throughout the first admission with associated acute cholecystitis and an encapsulated necrotic collection that required endoscopic drainage using a luminal apposition prosthesis and endoscopic necrosectomy. A month and a half later, the patient was readmitted for abdominal pain, with abdominal CT scan showing a very thinned splenic vein and patent artery without identifying thrombosis (with 700,000 platelets/mm3), associated splenic infarction as well as worsening of the inflammation of pancreatitis. Given these findings, we were decided to start anticoagulation with enoxaparin at prophylactic doses for splenic vascular stenosis, achieving resolution of the thrombocytosis (410,000 platelets/mm3), disappearance of the splenic necrotic area and improvement of the pancreatic inflammatory component confirmed by CT scan.

Conclusion: When splenic infarction is associated with severe pancreatitis with splenic thrombosis, anticoagulation is indicated. However, when there is no splenic thrombosis and the splenic infarction occurs in the context of critical vascular stenosis with high thrombocytosis, the indication for anticoagulation is controversial, with no consensus in the literature. Furthermore, at present it is not establish the active ingredient to be used or its dose, and highlights the need to carry out clinical trials in order to establish clinical or consensus guidelines.

Keywords: splenic infarction, severe acute pancreatitis.