Case report: Splenic infarction secondary to asymptomatic atrial fibrillation, necessitating splenectomy

Splenic infarction caused by thrombi rarely causes abdominal pain in acute abdomen patients. This report describes a case of splenic infarction caused by thrombus detachment due to paroxysmal atrial fibrillation, which was successfully treated and discharged from the hospital.

A 52-year-old woman walked into the emergency room with left upper abdominal pain, nausea, and vomiting 12 h prior. Abdominal examination revealed tenderness in the left upper abdomen, with no palpable mass, rebound tenderness, or guard stiffness. Initial treatment included fasting and analgesia, as well as relevant auxiliary examinations. Intravenous contrast computed tomography (CT) revealed splenic branch artery obstruction with a large splenic infarction, and further examination with 24-h dynamic electrocardiogram monitoring revealed rapid atrial fibrillation. Five days after admission, because there was no significant improvement in her abdominal pain after fasting, fluid replacement, analgesia, etc., she was finally given a laparotomy with total splenectomy.

In general, most surgeons do not advocate surgical intervention for splenic infarction, as infarction can lead to autologous splenectomy, and the spleen gradually becomes fibrotic, atrophies, and eventually disappears. However, for patients whose atrial fibrillation episodes continue to increase and whose conservative treatment is still ineffective, surgery provides a more favorable treatment method.

This case report highlights that in patients with splenic infarction due to cardiac thrombosis and unrelieved abdominal pain, splenectomy can be considered if cardiac function is stable and tolerable and if the ASA anesthetic is below class V.