Splenic Syndrome: A Rare Indication for Splenectomy

Abstract

Splenic infarction due to sickle cell trait and high-altitude stress has been reported in the literature. Contributing factors leading to infarction are degree of altitude stress and status of physical condition. Medical therapy, which consists of evacuation from high altitude, intravenous fluids, supplemental oxygen, and pain control, has been the mainstay of treatment. However, some patients require surgical intervention. We describe six patients with sickle cell trait who sustained splenic infarctions due to high-altitude stress; two of these patients required splenectomy for near-total splenic necrosis and intractable pain. A review of the literature demonstrates that the common indications for splenectomy are splenic rupture, extensive splenic necrosis, or persistent abdominal pain.

Splenic infarction in sickle cell trait: A comprehensive systematic review of case studies

“…Altitude levels were reported for 59 individuals [ 9 , 11 , 13 , 17 ‐ 23 , 26 ‐ 28 , 30 , 34 , 37 , 39 , 41 , 43 , 44 , 46 ‐ 48 , 50 ‐ 52 , 55 , 57 , 59 ‐ 61 ]. Of the 59 cases reporting altitude, 2 (3%) cases occurred under 1000 m, 4 (7%) cases occurred between 1001 and 2000 m, 17 (29%) cases occurred between 2001 and 3000 m, 27 (46%) cases occurred between 3001 and 4000 m, 2 (3%) cases occurred above 4000 m, and 7 (12%) cases contained a range or ambiguous altitude levels.…”

“…In our study, 49% of cases reporting altitudes occurred at greater than 3000 m, and a number of these cases demonstrated resolution of symptoms upon descent to a lower altitude. However, 39% of cases reporting altitudes occurred below 3000 m, suggesting that altitude is not the sole environmental risk factor for this complication [ 9 , 11 , 13 , 14 , 22 , 26 , 30 , 41 , 44 , 50 , 51 , 60 , 61 ]. It is therefore difficult to deduce an approximate altitude at which splenic infarction is likely to occur and is important to acknowledge the possibility of infarction in the absence of a high altitude or hypoxic environment.…”

Isolated Splenic Infarction: An Initial Manifestation of Postoperative Atrial Fibrillation

“…14 , 15 Surgery, which may include splenectomy, is considered as a last resort in management of SI, limited to cases with splenic abscess, splenic rupture, or hemodynamic instability. 14 , 16 Ultrasound can be utilized to assess the resolution of SI, as well as to monitor complications secondary to SI. 17 …”

Splenic Infarct Secondary to High Altitude Exposure in Sickle Cell Trait Patients: A Case Series

“…Splenic infarction can lead to complications such as abscesses or pseudo-cyst formation, spleen rupture, and hemorrhage [16,18,19]. Generally it is benign, and conservative management is enough for relief of the symptoms.…”