Incidental and Asymptomatic Splenic Infraction and Infrarenal Thormbus in a Patient With Covid-19

Do, Cassandra; Gudipati, Mythili Kanthi; Ganti, Subramanya Shyam; Depa, Jayaramakrishna

doi:10.1016/j.chest.2021.07.318

Cited by 1 publication

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“…A combination of more than two agents is sometimes necessary, and prolonged treatment, even after improvement, is, at times, inevitable [ 45 ]. Routine use of LMWH should be followed in patients with SARS-CoV-2 infection, although some authors consider this controversial [ 11 , 27 , 31 , 38 , 39 ]. There is no consensus regarding the best therapy for arterial occlusion, and different authors have used a variety of medications for treating arterial infarcts after coronavirus infection [ 21 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, from a brief review of the literature, we observed that antithrombotic treatment with LMWH, ASA, and other anticoagulants results in improvement in splenic artery infarcts, causes recanalization of the splenic artery, and that splenectomy is required only in the case of clinical deterioration of the patient [ 20 , 30 , 31 , 33 , 41 , 47 ]. While we await further data from clinical trials regarding treatment guidelines, a reasonable approach would be to continue with regular-dose thromboprophylaxis in all COVID-19 patients and to provide therapeutic anticoagulation in patients with confirmed thrombotic events [ 2 , 14 , 21 , 24 , 35 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

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Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

Dimitriou

Christodoulou

Chatzimargaritis

et al. 2022

Case Reports in Surgery

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Introduction. Coronavirus disease (COVID-19) from SARS-CoV-2 infection is linked to a hypercoagulable state, leading to arterial and venous thrombotic events, of which pulmonary embolism is the most frequent. However, arterial thromboembolisms may also occur as visceral infracts in unusual sites, such as the renal, splenic, and intestinal arteries. Case Report. A 46-year-old unvaccinated male with a COVID-19 infection was admitted to the COVID-19 isolation ward with symptoms of respiratory infection. He complained of epigastric pain and fever for several days; radiological imaging of the abdomen revealed complete splenic arterial occlusion due to a large infarct. He was treated with low molecular weight heparin (enoxaparin) in therapeutic doses, resulting in minimal improvement. However, the pain worsened, and eventually, a laparotomy and splenectomy were performed. He was hospitalized for another 36 days before he was discharged in good condition. A second surgery was performed to remove a noninfected encapsulated hematoma from the subdiaphragmatic space. The patient remained healthy afterward, with no relapses. Discussion. Although rare, the number of cases of visceral infarcts in COVID-19 patients has increased. Splenic artery infarct is an exceptional case of acute abdominal pain that can be treated successfully with anticoagulant medication. Splenectomy may be required to manage refractory pain after failure of conservative management.

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