Spontane Milzruptur nach Milzinfarkt unter Langzeit- Antikoagulationstherapie

This case report describes a 60-year-old female patient on long-term anticoagulation therapy who was admitted with tachycardia, acute abdominal pain in the left hypochondriac region and meteoritic distension of the abdomen. The ultrasound examination revealed splenic infarction as well as right renal infarction. Both were most likely caused by embolization of atheromatous plaques from the thoracic aorta. The clinical course of this rare acute abdominal disease was monitored from the first symptoms of splenic infarction to the spontaneous rupture of the spleen by laboratory test, ultrasound and CT imaging. Here, we discuss the etiology of splenic embolization as well as the pathogenesis and diagnosis of spontaneous splenic rupture following infarction. The most important diagnostic factors are the patient's clinical status and hemodynamic stability together with the results of the ultrasound examination and CT scan. The indication for surgical intervention is based on the patient's clinical status and hemodynamic stability. Severe septic complications after splenectomy (overwhelming postsplenectomy infection, OPSI) carry a mortality rate of 7-50% and can occur within a few days or decades after the splenectomy. Therefore, prophylactic measures should be undertaken including spleen autotransplantation, Streptococcus pneumoniae vaccination, Haemophilus influenzae vaccination, antibiotic prophylaxis and sufficient patient information.