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Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection
Ioannis Dimitriou1, Nikolaos Christodoulou1, Kleanthis Chatzimargaritis1
11st Surgery Department, General Hospital of Rhodes, Rhodes, Dodecanese, Greece.
Insights
A rare splenic artery infarct occurred in a COVID-19 patient, causing severe abdominal pain. While anticoagulant therapy showed limited success, a splenectomy ultimately resolved the issue, highlighting potential surgical intervention for visceral artery thrombosis.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Coronavirus disease (COVID-19) is associated with a hypercoagulable state, increasing risks of arterial and venous thrombotic events.
- Visceral artery infarcts, including splenic artery occlusion, are rare but documented complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Acute abdominal pain in COVID-19 patients can stem from unusual thrombotic events affecting visceral arteries.
Observation:
- A 46-year-old unvaccinated male with COVID-19 presented with severe epigastric pain and fever.
- Abdominal imaging revealed complete splenic artery occlusion and a large splenic infarct.
- Initial treatment with low molecular weight heparin showed minimal improvement.
Findings:
- Surgical intervention, including splenectomy, was required due to refractory pain and extensive splenic infarction.
- The patient underwent two surgeries and a prolonged hospitalization but recovered well.
- No relapse of splenic infarction or related complications was observed post-discharge.
Implications:
- Visceral infarcts, though rare, are an emerging complication of COVID-19 that requires prompt recognition.
- Splenic artery infarction is an exceptional cause of acute abdominal pain in COVID-19 patients.
- While anticoagulant therapy is the first line of treatment, splenectomy may be essential for managing refractory cases and preventing further complications.
Abstract:
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.
