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Purpose: To better understand the occurrence of splenic disease as a potential manifestation of babesiosis by retrospectively estimating the frequency of acute splenic injury on abdominal and pelvic CT in a cohort of patients with active babesia infection. Materials and methods: In a search of our single institution, suburban teaching community hospital database, 57 patients were found to have positive babesia infection between the years 2021–2023. 29 of these patients underwent abdominal and pelvic CT (22 with and 7 without intravenous contrast), and 3 underwent abdominal ultrasound without any CT. The imaging was reviewed for the presence or absence of splenic abnormalities, and for follow-up imaging. Parasitemia levels at the time of imaging were also reviewed; parasitemia levels < 4% are associated with mild to moderate disease, whereas parasitemia levels > 4% are associated with severe disease. Results: 21/32 (66%) patients who underwent any type of abdominal imaging (ultrasound, MRI, and CT) had splenomegaly. Of the 22 patients who had IV contrast-enhanced CT scans, 6 were found to have splenic infarction (27%). One of these 22 patients had multiple rounded non-peripheral hypoenhancing foci on both CT and MRI which did not meet criteria for infarction, in association with splenomegaly, and which resolved after treatment. 0/6 patients in the splenic infarction group had parasitemia levels greater than 4%, while 4 of the 16 patients (4/16) without infarction had parasitemia levels of greater than 4%. Conclusion: Our study showed that splenic disease in patients with babesiosis mostly took the form of splenomegaly, and in a substantial minority of patients as splenic infarction. There were no cases of splenic rupture and perisplenic hematoma in our case series, likely reflecting a limitation of the relatively small study size. Concordant with prior studies, we found no identifiable association between parasitemia levels and the presence of splenic infarction. [ABSTRACT FROM AUTHOR]

Introduction and importance: Wandering spleen is a rare condition characterized by the extreme laxity or absence of ligaments that normally secure the organ in its anatomical position in the left upper quadrant. Torsion of a wandering spleen is an uncommon cause of acute abdominal pain and is rarely diagnosed preoperatively. Torsion involving the distal pancreas is even more unusual. Although patient presentations can be atypical, early diagnosis and prompt intervention can lead to successful outcomes. Case presentation: A 40-year-old Black female patient of Amhara ethnicity, from Ethiopia, presented with dull, aching abdominal pain and episodes of vomiting. After initial physiological stabilization and radiologic evaluation, laparotomy was performed, revealing torsion of a wandering spleen with involvement of the pancreatic tail, accompanied by adhesions of the small bowel and omentum. Following the release of adhesions, a splenectomy was performed. The patient was discharged in stable condition and continued to do well during follow-up visits. Conclusion: Despite its rarity and potential for atypical presentations, a high index of suspicion for torsion of a wandering spleen is essential, particularly in patients with risk factors. With prompt diagnosis and timely intervention, patients with this condition can achieve favorable outcomes. [ABSTRACT FROM AUTHOR]

A 41-year-old male with a history of tobacco and alcohol use presented to our clinic for a follow up of an incidentally diagnosed splenic mass. The patient was sent for further diagnostic evaluation, and computed tomography showed a large splenic mass with heterogenous enhancement raising concern for neoplasm. Due to the uncertain nature of the splenic lesion and high complication rate of percutaneous splenic biopsy, a splenectomy was performed. The specimen was sent to pathology, and the report favored neoplasm but was inconclusive. The samples were sent to another institution for a consult, where the patient's spleen was determined to be the result of a previously suffered hemorrhagic infarct. This case demonstrates the difficulty of diagnosing splenic lesions using diagnostic imaging and the discrepancy that may occur between radiology and pathology assessments. In the setting of uncertain pathology, the removal of what might be a functional spleen is often preferred over a percutaneous biopsy due to concerns of intraabdominal bleeding and tumor dissemination.

Abstract Clinical data Chlamydia psittaci pneumonia is a community-acquired pneumonia caused by Chlamydia psittaci. While severe cases may lead to critical conditions such as respiratory failure, splenic infarction is relatively uncommon. A severe patient with Chlamydia psittaci pneumonia admitted to our hospital experienced a splenic infarction during treatment. Fortunately, the patient’s situation was improved after careful treatment. Now, the patient has been discharged. Further exploration of the mechanism of concurrent splenic infarction is required. Backgroud Psittacosis pneumonia, a zoonotic infectious disease transmitted from birds to humans, is caused by Chlamydia psittaci and represents a type of chlamydial pneumonia [1]. Insome instances, the disease may progress to severe pneumonia and respiratory failure, necessitating intensive support measures, including mechanical ventilation. The advent of technologies such as Metagenomic Next-Generation Sequencing (mNGS) for the etiological diagnosis of infectious diseases [2] has improved the diagnostic and treatment success rates for Psittacosis. Instances of severe chlamydial pneumonia with complications such as splenic infarction are uncommon. A patient with severe Psittacosis pneumonia complicated by splenic infarction was admitted to the Emergency Intensive Care Unit (EICU) of Haining People’s Hospital and subsequently improved following effective anti-infective and anticoagulant therapy. This report is provided herein.

Invasive mucormycosis is an aggressive fungal infection characterized by rapid progression, primarily impacting immunocompromised individuals. Herein, we report a case of splenic infarction in association with gastrointestinal fistula and brain abscess as a rare presentation of mucormycosis biopsy, proven in a 56‐year‐old patient diagnosed with acute myeloid leukemia. The patient initially sought medical attention with a 3‐week history of fever, night sweats, and malaise. Considering the chest computed tomography findings compatible with fungal disease and neutropenia, he underwent broad‐spectrum antifungal therapy. Following the occurrence of splenic infarctions and a gastric fistula, the patient underwent a partial gastrectomy and splenectomy. Despite the interventions, the patient did not have a successful outcome and died on the second postoperative day. This case highlights the importance of timely suspicion, immediate antifungal therapy, and surgical intervention to improve the survival prospects of patients with multifaceted manifestations of mucormycosis. [ABSTRACT FROM AUTHOR]

Dieulafoy lesions are a rare cause of gastrointestinal bleeding, characterized by an enlarged submucosal blood vessel that bleeds without visible abnormalities. The diagnosis is typically made via endoscopy, and treatment usually involves endoscopic therapy. This case involves a 46-year-old female who presented with upper gastrointestinal bleeding due to a Dieulafoy's lesion, treated with band ligation and later embolization after the lesion was found to originate from the left phrenic artery. The patient developed rare complications, including splenic infarction and pleural effusion, which required additional management. Upon initial investigations, the patients had an accidental finding on computed tomography of asymptomatic celiac artery compression that was advised to take into consideration for the possibility of developing median arcuate ligament syndrome and was treated conservatively. The case highlights the diagnostic and therapeutic challenges of Dieulafoy's lesion and underscores the need for individualized treatment and further research. [ABSTRACT FROM AUTHOR]

Aim and background: Mucormycosis is a rare and often fatal opportunistic illness that is more common in immunocompromised patients. Involvement of the gastrointestinal tract is uncommon, accounting for only 7% of all reported cases. Here, we present an unusual manifestation with gastric perforation and splenic infarction due to a splenic artery mycotic thrombus, along with a literature review. Case description: A 40-year-old female with poorly controlled diabetes mellitus presented with acute decompensated heart failure and diabetic ketoacidosis. During her course, she had a significant hemoglobin drop and was diagnosed with multiple necrotic gastric ulcerations with subsequent gastric perforation and splenic infarction. We searched the PubMed and Embase databases with the terms: (splenic infarction) AND (gastric perforation) AND (mucormycosis) till May 2024. To date, six cases have been reported of combined gastric and splenic involvement by mucormycosis. Most of the patients had an underlying immunosuppressive state. Despite combined medical and surgical treatment modalities, only 17% survived the illness. The most common presentation was necrotic ulceration. Conclusion: Due to the disease's rarity, the precise diagnosis of gastric mucormycosis may be delayed. Diligent clinical insight is required for the early diagnosis and management of the disease, especially in immunocompromised patients. Radiological imaging modalities, such as computed tomography (CT) scans or magnetic resonance imaging of the abdomen, generally demonstrate non-specific findings. Additional testing involving endoscopic or surgical biopsies of the lesions is necessary for rapid diagnosis. Clinical significance: The early diagnosis and timely initiation of antifungal therapy can be beneficial in halting the fulminant course of gastrointestinal mucormycosis. [ABSTRACT FROM AUTHOR]

Clinical data: Chlamydia psittaci pneumonia is a community-acquired pneumonia caused by Chlamydia psittaci. While severe cases may lead to critical conditions such as respiratory failure, splenic infarction is relatively uncommon. A severe patient with Chlamydia psittaci pneumonia admitted to our hospital experienced a splenic infarction during treatment. Fortunately, the patient's situation was improved after careful treatment. Now, the patient has been discharged. Further exploration of the mechanism of concurrent splenic infarction is required. Backgroud: Psittacosis pneumonia, a zoonotic infectious disease transmitted from birds to humans, is caused by Chlamydia psittaci and represents a type of chlamydial pneumonia [1]. Insome instances, the disease may progress to severe pneumonia and respiratory failure, necessitating intensive support measures, including mechanical ventilation. The advent of technologies such as Metagenomic Next-Generation Sequencing (mNGS) for the etiological diagnosis of infectious diseases [2] has improved the diagnostic and treatment success rates for Psittacosis. Instances of severe chlamydial pneumonia with complications such as splenic infarction are uncommon. A patient with severe Psittacosis pneumonia complicated by splenic infarction was admitted to the Emergency Intensive Care Unit (EICU) of Haining People's Hospital and subsequently improved following effective anti-infective and anticoagulant therapy. This report is provided herein. [ABSTRACT FROM AUTHOR]

Splenic infarcts are uncommon and may not be readily considered in the emergency department, as the clinical presentation often mimics acute abdominal pain. While atherosclerotic damage commonly occurs at the abdominal aorta and its branching parts**, it can also affect the splenic artery, potentially leading to splenic infarction. Although it is widely acknowledged that the abdominal aorta and its branches are the most common sites for atherosclerotic damage, atherosclerosis of the splenic artery can also be an etiological factor for splenic infarction, leading to impaired blood flow in the spleen. Splenic infarction represents a clinical scenario that is not frequently encountered, and its presentation can resemble other causes of acute abdominal pain. This case report describes a patient who presented to the emergency department (ED) with abdominal pain and was subsequently diagnosed with splenic infarction secondary to atherosclerosis of the splenic artery.

Granulamatous polyangiitis (GPA) is a rare systemic vasculitis that makes up most of the antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The disease is more likely to affect the upper and lower respiratory tract, kidney and skin. The gastrointestinal tract involvement is more rare. In the general population, spleen infarction is a rare condition. Most spleen infarcts are asymptomatic, and most patients receive a diagnosis by chance during the evaluation. The most common causes of non-traumatic spleen infarction in the general population include cardiac causes such as atrial fibrillation, infections, thrombophilic conditions, and malignancies. In rheumatic diseases, various spleen involvement has been identified, such as splenomegaly, spleen rupture, spleen abscess, asplenia and spleen infarction. The development of spleen infarct in antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) is well known. It is not well known whether GPA is a risk factor for spleen infarction. However, publications including cases of developing spleen infarction due to GPA are increasing. This review highlights the occurrence of spleen infarction in patients with GPA, by presenting two GPA cases with splenic infarction. It also emphasizes that spleen infarction can occur in GPA and may frequently be without symptoms.

Abstract Background Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not. Case presentation We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful. Conclusion Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.

Abstract Background Plasmodium ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have previously been reported. Case presentation A case of severe P. ovale malaria in a healthy Caucasian man with a triangle splenic infarction and clinical progression towards Acute Respiratory Distress Syndrome was reported despite a rapid response to oral chloroquine treatment with 24-h parasitaemia clearance. Conclusion Plasmodium ovale malaria is generally considered as a benign disease, with low parasitaemia. However, severe disease and death have occasionally been reported. It is important to be aware that occasionally it can progress to serious illness and death even in immunocompetent individuals.

Background: Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not. Case presentation: We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful. Conclusion: Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications. [ABSTRACT FROM AUTHOR]

Background: Splenic infarction is a rare cause of acute abdomen. The two main causes are thromboembolic diseases and infiltrative hematological disorders. The splenic abscess is the result of a hematogenous seeding, whose causes are trauma, splenic artery embolization, endocarditis, and immunocompromised states. Clinical case: 48-year-old male patient with a history of chronic myelomonocytic leukemia on mercaptopurine-based treatment, who presented intermittent asthenia, adynamia, and abdominal distension for 2 months; a computed tomography of the abdomen with intravenous contrast was performed, reporting areas of infarction and an image suggestive of a splenic abscess in the upper pole, for which an open splenectomy was performed with adequate clinical evolution. A documentary review of the disease and of the therapeutic options was carried out, with an emphasis on surgical management. Conclusion: The main cause of morbidity and mortality in the case presented was splenic infarction, which is aggravated by the presence of hematological diseases; therefore, the identification of those patients at risk of complications will allow in a timely manner a diagnostic and therapeutic approach, and the detection of those who require urgent surgical management. [ABSTRACT FROM AUTHOR]

Background: Plasmodium ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have previously been reported. Case presentation: A case of severe P. ovale malaria in a healthy Caucasian man with a triangle splenic infarction and clinical progression towards Acute Respiratory Distress Syndrome was reported despite a rapid response to oral chloroquine treatment with 24-h parasitaemia clearance. Conclusion: Plasmodium ovale malaria is generally considered as a benign disease, with low parasitaemia. However, severe disease and death have occasionally been reported. It is important to be aware that occasionally it can progress to serious illness and death even in immunocompetent individuals. [ABSTRACT FROM AUTHOR]

Ectopic spleen or wandering spleen is an uncommon presentation in which the spleen’s anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen.

Abstract Background Owing to challenges associated with heart failure and cardiac embolism, infectious endocarditis emerges as a critical pathology characterized by elevated mortality and morbidity rates. Our case stands out as a rare instance of endocarditis involving multisystem embolization, with a successful outcome. Case presentation We present the case of an 81-year-old man whose admission was further complicated by various septic emboli affecting the brain (manifesting as a brain abscess and ischemic stroke), spleen (resulting in splenic infarction), and spinal cord. The patient received a diagnosis of infective endocarditis affecting the native mitral valve. Following prompt medical and surgical intervention, the overall progression was favorable despite encountering several challenges. Conclusions This case is notable for its detailed description and analysis of the multiple embolic events. More importantly, it underscores the significance of timely surgical intervention and the collaborative approach of a heart team in the face of complicated endocarditis marked by numerous septic emboli. Despite the typically grim prognosis associated with such cases, the outcomes emphasize the positive impact of timely surgery on prognosis.

Abstract Background Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. Herein, we present a case of a 70 year-old man, initially diagnosed with splenic infarction and was successfully treated laparoscopically. Case presentation A 70-year-old man with abdominal pain admitted to our hospital. Abdominal-enhanced computed tomography revealed a poorly contrasted area in the spleen and stenosis at the root of the celiac artery. Arterial dilatation was observed around the pancreaticoduodenal arcade, however, no obvious aneurysm formation or arterial dissection was observed. Abdominal-enhanced magnetic resonance imaging indicated the disappearance of the flow void at the root of the celiac artery. The patient had no history of atrial fibrillation and was diagnosed with splenic infarction due to median arcuate ligament compression syndrome. We performed a laparoscopic median arcuate ligament section with five ports. Intraoperative ultrasonography showed a retrograde blood flow in the common hepatic artery and the celiac artery. After releasing the compression, the antegrade blood flow from the celiac artery to the splenic artery, and the common hepatic artery were visualized using intraoperative ultrasonography. The postoperative course of the patient was uneventful, and he was discharged on postoperative day 9. Postoperative computed tomography a month after surgery revealed no residual stenosis of the celiac artery or dilation of the pancreaticoduodenal arcade. Furthermore, the poorly contrasted area of the spleen improved. Conclusions Reports indicate that hemodynamic changes in the abdominal visceral arteries due to median arcuate ligament compression are related to the formation of pancreaticoduodenal aneurysms. In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery.

Abstract In this review article, we focus on recent papers on organ‐preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new‐onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade‐off between increased short‐term morbidity and long‐term preservation of endocrine function. When the outcomes of two types of spleen‐preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post‐splenectomy infection is seen. The advantages of duodenum‐preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ‐preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long‐term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.

Many studies have shown that COVID-19 can progress with coagulopathy and multisystem thrombotic pathologies. This article presents the case of a patient who, 9 days after laboratory-confirmed coronavirus pneumonia against the background of anticoagulant therapy, was diagnosed with splenic infarction in combination with acute myocardial infarction during subsequent hospitalization. Prevention of thrombosis with prophylactic doses of low molecular weight heparin in hospitalized patients with COVID-19 may not be sufficient to prevent the development of coagulopathy. Abdominal visceral thromboembolism should be suspected in a COVID-19 positive patient with abdominal pain despite anticoagulant therapy and normal D-dimer levels.

Background: Wandering spleen (WS) is a rare condition characterized by hypermobility of the spleen due to maldevelopment or absence of the ligaments that hold it in its normal location. Splenic infarction following torsion of a wandering spleen is a rare cause of acute abdomen in children and can be difficult to diagnose, especially at secondary healthcare facilities. Case presentation: A 10-year-old girl presented to our clinic with a two-week history of abdominal pain, fever and vomiting. On physical examination she was pale, cachectic and dysmorphic. Painful splenomegaly was noted on palpation. Inflammatory markers were elevated (CRP: 26.7 mg/L; WBC: 20.4 x 109/L). A contrast-enhanced CT of the abdomen revealed splenomegaly with complete splenic infarction due to torsion of the splenic pedicle, consistent with a wandering spleen. The patient underwent an emergent laparotomy through a left subcostal incision. A markedly enlarged spleen was found, with its pedicle completely torsed. The spleen had no attachments to the abdominal wall or diaphragm and appeared non vital. We proceeded with a complete splenectomy. The patient recovered well and was discharged in stable condition on the fifth postoperative day. At 6 months of follow up, she has had no recurrent episodes of abdominal pain. Conclusion: While torsion of a WS is a rare condition, it must be included in the differential diagnosis of children with abdominal pain of unknown etiology.

Background: Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. Herein, we present a case of a 70 year-old man, initially diagnosed with splenic infarction and was successfully treated laparoscopically. Case presentation: A 70-year-old man with abdominal pain admitted to our hospital. Abdominal-enhanced computed tomography revealed a poorly contrasted area in the spleen and stenosis at the root of the celiac artery. Arterial dilatation was observed around the pancreaticoduodenal arcade, however, no obvious aneurysm formation or arterial dissection was observed. Abdominal-enhanced magnetic resonance imaging indicated the disappearance of the flow void at the root of the celiac artery. The patient had no history of atrial fibrillation and was diagnosed with splenic infarction due to median arcuate ligament compression syndrome. We performed a laparoscopic median arcuate ligament section with five ports. Intraoperative ultrasonography showed a retrograde blood flow in the common hepatic artery and the celiac artery. After releasing the compression, the antegrade blood flow from the celiac artery to the splenic artery, and the common hepatic artery were visualized using intraoperative ultrasonography. The postoperative course of the patient was uneventful, and he was discharged on postoperative day 9. Postoperative computed tomography a month after surgery revealed no residual stenosis of the celiac artery or dilation of the pancreaticoduodenal arcade. Furthermore, the poorly contrasted area of the spleen improved. Conclusions: Reports indicate that hemodynamic changes in the abdominal visceral arteries due to median arcuate ligament compression are related to the formation of pancreaticoduodenal aneurysms. In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. [ABSTRACT FROM AUTHOR]

Background: Owing to challenges associated with heart failure and cardiac embolism, infectious endocarditis emerges as a critical pathology characterized by elevated mortality and morbidity rates. Our case stands out as a rare instance of endocarditis involving multisystem embolization, with a successful outcome. Case presentation: We present the case of an 81-year-old man whose admission was further complicated by various septic emboli affecting the brain (manifesting as a brain abscess and ischemic stroke), spleen (resulting in splenic infarction), and spinal cord. The patient received a diagnosis of infective endocarditis affecting the native mitral valve. Following prompt medical and surgical intervention, the overall progression was favorable despite encountering several challenges. Conclusions: This case is notable for its detailed description and analysis of the multiple embolic events. More importantly, it underscores the significance of timely surgical intervention and the collaborative approach of a heart team in the face of complicated endocarditis marked by numerous septic emboli. Despite the typically grim prognosis associated with such cases, the outcomes emphasize the positive impact of timely surgery on prognosis. [ABSTRACT FROM AUTHOR]

A 48-year-old woman underwent transcatheter arterial embolization (TAE) for a splenic artery aneurysm, which resulted in a partial splenic infarction in the middle lobe. Five years after TAE, a 20-mm diameter mass in the noninfarcted area of the spleen was detected on imaging, which grew to 25 mm in diameter after 6 months. MRI after gadolinium administration showed a 35 × 34 mm mass within the superior pole and 15 × 12 mm mass within the inferior pole. The patient underwent laparoscopic splenectomy and had an uneventful postoperative recovery. No evidence of recurrence was observed during the 2-year follow-up period after surgery. The mass was pathologically confirmed to be sclerosing angiomatoid nodular transformation (SANT) of the spleen. While some studies hypothesize that SANT is a response to vascular injury or trauma, to the best of our knowledge, there have been no previous reports of SANT occurring after procedures directly affecting splenic blood flow. Additionally, multifocal SANTs are reported to be very rare, accounting for only 4.7% of all reported SANTs of the spleen. We highlight a rare course of SANT of the spleen and discuss the possible relationship between blood flow abnormalities and the appearance of SANT. [ABSTRACT FROM AUTHOR]

In this review article, we focus on recent papers on organ‐preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new‐onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade‐off between increased short‐term morbidity and long‐term preservation of endocrine function. When the outcomes of two types of spleen‐preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post‐splenectomy infection is seen. The advantages of duodenum‐preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ‐preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long‐term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected. [ABSTRACT FROM AUTHOR]

Brucella infection often involves multiple organ systems with non-specific clinical manifestations, and cutaneous involvement is uncommon. Splenic infarction and leukocytoclastic vasculitis also rarely occur together in the course of brucellosis infection. We report the case of a 47-year-old man with Brucella combined with splenic infarction. The patient presented with fever; large liver, spleen, and lymph nodes; muscle and joint pain; positive laboratory tests for blood cultures (Brucella abortus); and imaging suggestive of splenic infarction. After treatment with streptomycin, doxycycline, and rifampicin, the patient's clinical symptoms and splenic damage improved. Detailed history taking, correct interpretation of laboratory results, and knowledge of rare complications of human brucellosis facilitate early diagnosis and treatment of the disease. [ABSTRACT FROM AUTHOR]

Abstract Background Diagnosis of aortic graft infections (AGI) is challenging. Here, we report a case of AGI with splenomegaly and splenic infarction. Case presentation A 46-year-old man who underwent total arch replacement for Stanford type A acute aortic dissection one year prior presented to our department with fever, night sweat, and a 20-kg weight loss over several months. Contrast-enhanced computed tomography (CT) revealed splenic infarction with splenomegaly, fluid collection, and thrombus around the stent graft. Positron emission tomography-CT (PET-CT) revealed abnormal 18F-fluorodeoxyglucose uptake in the stent graft and spleen. Transesophageal echocardiography revealed no vegetations. The patient was diagnosed with an AGI and underwent graft replacement. Blood and tissue cultures in the stent graft yielded Enterococcus faecalis. After the surgery, the patient was successfully treated with antibiotics. Conclusions Splenic infarction and splenomegaly are the clinical findings of endocarditis but are rare in graft infection. These findings could be helpful to diagnose graft infections, which is often challenging.

Abstract Background Over the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections. Case presentation A 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcus cremoris, is a rare cause of human infections. The first case of Lactococcus lactis cremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases. Conclusions To our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.

This case report is intended to describe a rare case of splenic infarction (SI) associated with biliary atresia, which contributed to the worsening of the prognosis. In this case study, a boy diagnosed with biliary atresia underwent the Kasai procedure at the age of 3 months. The patient presented an intense abdominal pain, ascites and fever at the age of 6 years. A computed tomography (CT) scan showed enlargement of the spleen and an image suggestive of SI. The symptoms improved with the administration of antibiotics, analgesics, while ascites decreased with the use of diuretics. Liver transplantation was indicated. SI is an extremely rare event characterized by vessel occlusion, parenchymal ischemia and tissue necrosis. The symptoms are non-specific and may be confounding factors with other causes of acute abdominal pain. Splenomegaly-inducing diseases may be a risk factor. There are few case reports of SI and cirrhosis of different etiologies in childhood. Abdominal CT scan with intravenous contrast is the imaging modality of choice and the treatment ranges from supportive care to splenectomy. Despite being a rare condition, its knowledge is extremely important, as it allows early clinical suspicion, with immediate institution of treatment, which may interfere with the prognosis.

BACKGROUND: Superior mesenteric artery (SMA) syndrome, a rare condition in which the SMA and aorta occlude the third duodenal portion, can cause serious complications. We present the case of an 83-year-old Japanese man who presented with shock because of massive gastric dilatation due to SMA syndrome and developed multi-organ ischemia. CASE REPORT: The day before admission, the patient had visited the emergency department with abdominal pain and was sent home following spontaneous symptom resolution, but experienced abdominal pain flare-up. His history included diabetes mellitus, hypertension, gastric ulcer, prostatic hypertrophy, esophageal hiatal hernia, and esophageal cancer. Plain computed tomography showed gastric dilatation and obstruction of the duodenal third portion by the SMA, leading to SMA syndrome diagnosis. Since a nasogastric tube could not be manually inserted into the stomach and the gastric dilatation could not be decompressed, the tube was inserted endoscopically. Endoscopy revealed mechanical obstruction of the gastric cardia and gastric mucosal ischemia. He was admitted to intensive care, and blood pressure was maintained with vasopressors and blood transfusion. The next day, contrast-enhanced computed tomography performed for persistently elevated lactate levels revealed extensive ischemia affecting multiple gastrointestinal organs. Surgery and other treatments were considered too risky due to the patient’s advanced age and condition. Best supportive care was administered after discussion with the family, and he died on the second day of hospitalization. CONCLUSIONS: SMA syndrome with extensive ischemia and infarction is rare. Given this, clinicians should remain vigilant for its potential complications. [ABSTRACT FROM AUTHOR]

Splenic infarction is a rare complication of both malaria and COVID-19. We report a splenic infarction case due to COVID-19 and malaria co-infection. A 35-year-old male with no known chronical disease tested positive for both COVID-19 and malaria in Turkey in 2022. Oral artemether and lumefantrine treatment was started. On the third day of the treatment, he complained about a severe left upper quadrant pain. A repeated abdominal CT showed splenomegaly and 8 cm diameter hypodense areas throughout the spleen consistent with splenic infarction. The patient was discharged with low molecular weight heparin. A rare complication that can be seen in both diseases developed a more rigorous recommendation for anticoagulant therapy is needed for co-infections of COVID-19 with diseases that may present similar thrombotic complications. [ABSTRACT FROM AUTHOR]

We described a rare case of a splenic infarction associated with typhoid fever in a 26-year-old Bangladeshi man who returned from a vacation 10 days ago from his home country and presented to the emergency department with fever followed by left hypochondrial pain. Contrast-enhanced computed tomography of the abdomen showed multiple areas of splenic infarction. Salmonella typhi, which was sensitive to ceftriaxone, grew in the blood culture. The patient received intravenous ceftriaxone, analgesics, hydration, antiemetics, and other supportive care. He showed significant clinical improvement and was discharged. The patient was seen at the hospital two months after discharge, he was doing well and no splenic infarction could be detected by sonography.

Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.

Abdominal pain is one of the most common reasons for presentation to the emergency department. Splenic infarction and renal infarction in the differential diagnosis of abdominal pain are rare clinical conditions caused by organ hypoperfusion. The majority of predisposing factors for both splenic infarction and renal infarction include hypercoagulable states and thromboembolic events. Contrast-enhanced CT imaging is the gold standard for both diagnoses. Conservative treatment is mostly preferred for both infarction conditions; however, surgery is performed in some cases. A 65-year-old woman presented to the emergency department with a long-standing complaint of abdominal pain. She had a history of both hypercoagulability and thromboembolic diseases. INR was 4.08 in blood tests: 4.08. Contrast-enhanced abdominal CT scan showed multiple infarct areas in the spleen and a large infarct area in the posterior and superior aspect of the left kidney. The patient was transferred to the ward for follow-up. With conservative treatment, the patient had no problems related to both clinical events, but he died on the 8th day of follow-up due to pathologic conditions related to his sub-diseases. With this case report, we wanted to draw attention to the fact that splenic infarction and renal infarction may occur simultaneously in the presence of multiple predisposing factors in the differential diagnosis of abdominal pain. [ABSTRACT FROM AUTHOR]

Situs inversus totalis is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. Splenic infarctions are considered a rare cause of abdominal pain, although the exact prevalence is unclear. We present a rare case of a 62-year-old male who presented to the emergency department with abdominal pain and was found to have large splenic infarcts with situs inversus totalis on computed tomography. The patient was admitted and treated conservatively. In conclusion, diagnosing situs inversus in cases of emergency is important because patients will present with abnormally located symptoms, and splenic infarction should be kept in mind when considering the differential diagnosis of abdominal pain despite its rarity. [ABSTRACT FROM AUTHOR]

Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that is characterized by sudden onset abdominal pain, typically occurring in middle-aged men. Although its clinical course is mostly benign, it may progress to true lumen occlusion. No established therapeutic guidelines are available for SICAD associated with splenic infarction. This report describes two patients who presented with sudden onset abdominal pain and were diagnosed with SICAD with splenic infarction based on computed tomography (CT) findings. Patients were treated with bowel rest and anticoagulants. After a week of medical therapy, the abdominal pain resolved. Follow-up CT revealed no progression of the dissection flap. The patients received oral anticoagulants for 3 months and did not experience any symptom recurrence. Medical therapy with anticoagulants may be considered for patients with SICAD and splenic infarction. Associated splenic infarction itself is not an indication for endovascular or surgical intervention for SICAD.

Splenic infarction is a rare complication of both malaria and COVID-19. We report a splenic infarction case due to COVID-19 and malaria co-infection. A 35‑year‑old male with no known chronical disease tested positive for both COVID-19 and malaria in Turkey in 2022. Oral artemether and lumefantrine treatment was started. On the third day of the treatment, he complained about a severe left upper quadrant pain. A repeated abdominal CT showed splenomegaly and 8 cm diameter hypodense areas throughout the spleen consistent with splenic infarction. The patient was discharged with low molecular weight heparin. A rare complication that can be seen in both diseases developed a more rigorous recommendation for anticoagulant therapy is needed for co-infections of COVID-19 with diseases that may present similar thrombotic complications.

Background: Diagnosis of aortic graft infections (AGI) is challenging. Here, we report a case of AGI with splenomegaly and splenic infarction. Case presentation: A 46-year-old man who underwent total arch replacement for Stanford type A acute aortic dissection one year prior presented to our department with fever, night sweat, and a 20-kg weight loss over several months. Contrast-enhanced computed tomography (CT) revealed splenic infarction with splenomegaly, fluid collection, and thrombus around the stent graft. Positron emission tomography-CT (PET-CT) revealed abnormal 18F-fluorodeoxyglucose uptake in the stent graft and spleen. Transesophageal echocardiography revealed no vegetations. The patient was diagnosed with an AGI and underwent graft replacement. Blood and tissue cultures in the stent graft yielded Enterococcus faecalis. After the surgery, the patient was successfully treated with antibiotics. Conclusions: Splenic infarction and splenomegaly are the clinical findings of endocarditis but are rare in graft infection. These findings could be helpful to diagnose graft infections, which is often challenging. [ABSTRACT FROM AUTHOR]

Abstract Background Mucormycosis is a rare but serious opportunistic fungal infection that occurs in immunocompromised individuals, especially those with diabetic ketoacidosis. Presently, early diagnosis of the disease remains a challenge for clinicians. Case presentation The patient, a 68-year-old woman with type 2 diabetes mellitus, was admitted with paroxic sharp pain in the left upper abdomen. CT imaging revealed a patchy hypodense shadow of the spleen with wedge-shaped changes. The patient was not considered early for fungal infection. The diagnosis of spleen mucormycosis was not confirmed until pathological biopsy after splenectomy. After surgery, blood glucose level was controlled, acidosis was corrected, and antifungal therapy was effective. Conclusions We report here, for the first time ever, a case of isolated splenic mucormycosis secondary to diabetic ketoacidosis that was diagnosed and treated with antifungal drugs and splenectomy. Following splenectomy, the presence of splenic mucormycosis was confirmed when characteristic mycelia were observed in a tissue biopsy. As the location of any fungal infection is extremely relevant for treatment options and prognoses, early diagnosis and clinical intervention can greatly affect outcomes and prognoses for patients.

Splenic infarction in COVID-19 patients is a rare entity with few documented cases. We report a case of symptomatic complete splenic infarction and discuss COVID-19 related thrombosis, splenic infarction, diagnostic imaging for splenic infarction, and the management. Thrombotic events related to COVID-19 have been reported in unusual locations, and our case highlights an example of one such location, the splenic artery. Contrast enhanced Computed Tomography (CT) is the standard diagnostic modality and will typically reveal foci of hypo-enhancement, peripheral and wedge-shaped. CT angiography can be performed to evaluate the arteries and diagnose thrombosis. The primary treatment is aimed at addressing the underlying cause and includes supportive care. It is important that physicians consider splenic infarction as an explanation for abdominal pain in COVID-19 patients.

Abstract Background Hereditary spherocytosis (HS) complicated by splenic infarction is very rare, and it is even rarer to develop splenic infarction after infectious mononucleosis (IM) as a result of Epstein–Barr virus (EBV) infection. Therefore, misdiagnosis or missed diagnosis is prone to occur. Case presentation A 19-year-old Chinese female previously diagnosed with HS was admitted to our institution with persistent high fever and icterus. On admission, the physical examination showed anemia, jaundice, marked splenomegaly, obvious tenderness in the left upper abdomen (LUA). Peripheral blood film shows that spherical red blood cells accounted for about 6%, and Immunoglobulin M (IgM) antibodies specific to Epstein–Barr virus (EBV) viral capsid antigen were detected. An abdominal CT scan revealed a splenic infarction. The patient was diagnosed with HS with splenic infarction following EBV infection and underwent an emergency laparoscopic splenectomy (LS). Pathological analysis showed a splenic infarction with red pulp expansion, white pulp atrophy and a splenic sinus filled with red blood cells. After two months of follow-up visits, the patient showed no signs of relapse. Conclusions HS complicated by splenic infarction is very rare and mostly occurs in men under 20 years of age and is often accompanied by other diseases, such as sickle cell traits (SCT) or IM. Although symptomatic management may be sufficient, emergency laparoscopic splenectomy may be safe and effective when conservative treatment is ineffective.

Ultrasonography (US) is widely used for abdominal imaging. Its noninvasiveness, extensive range of application, and low cost make US a useful and valuable tool for the detection, diagnosis, and follow-up of splenic abnormalities. Concomitantly with the increasing frequency of imaging, more splenic lesions are being discovered and the requirements for the differential diagnosis are rising. In this pictorial essay, we introduce the representative US findings of many different splenic lesions, including normal sonographic findings, normal variants and congenital anomalies, infectious conditions, benign and malignant neoplasms, and non-neoplastic lesions. Knowledge of the US features of various splenic lesions will help narrow the differential diagnosis and guide clinical decision-making.

Background: Over the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections. Case presentation: A 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcuscremoris, is a rare cause of human infections. The first case of Lactococcus lactiscremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases. Conclusions: To our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus is a multisystem autoimmune disease associated with a variety of arterial and venous thrombotic manifestations when combined with antiphospholipid syndrome. We present a case report of a 23‐year‐old female patient with a recent diagnosis of systemic lupus erythematosus who was admitted for abdominal pain and later diagnosed with splenic infarction via abdominal computed tomography. This was the only hematologic manifestation, with no prior history of thrombotic events or antiphospholipid antibodies. [ABSTRACT FROM AUTHOR]

Splenic infarction is one of many possible complications arising from a Malarial infection and is commonly caused by Plasmodium falciparum. It is largely underdiagnosed due to the non-specificity of its signs and symptoms. Only few cases have been reported in the literature. A 42-year-old male presented with five-day history of a high-grade fever, headache, myalgia and generalized body weakness. Peripheral blood smear confirmed malarial infection as a result of Plasmodium falciparum. Few days later, the patient developed left upper quadrant abdominal pain and splenic infarction was diagnosed by ultrasound and computed tomography and the patient was treated successfully. [ABSTRACT FROM AUTHOR]