splenic infarct caused by emboli from la clot

1. “Abdomen:
still a Pandora’s box”
Dr ASHMAL KT
JR,EMERGENCY MEDICINE
GMC KANNUR , PARIYARAM

2. CASE REPORT
56 year old Male
Abdominal Pain – 1 day
Vomiting- 1 day
TRIAGE--RED
PRIMARY SURVEY
AIRWAY - PATENT.
BREATHING
RR-22 SPO2-96% IN RA
Air entry – BE, Trachea – Midline
CIRCULATION
PR- 48/min BP-140/90 CRT
<2 sec S1S2+
DISABILITY
GCS –E4V5M6 Pupil- b/l
reacting
No FND GRBS -186
EXPOSURE
Temp-98.6 F
PAIN SCORE - 8/10

3. SECONDARY SURVEY
•S- sudden onset of abd pain
since day morning
--Left sided abdominal pain-
severe, continuous
--multiple episodes of
vomiting
• A- No known allergies
• M-on inhaler
• P- k/c/o BA
• L- Last meal at 10 pm of
previous day
• E- nil
Cardiac examination
PR-38 /min
Heart sounds- S1S2 +
Diastolic murmur
Abdomen examination
Soft, not distended
Tenderness + left
hypochondrium
Bowel sounds +

4. ADJUNCTS
1.ECG
•AF WITH
VARIABLE
BLOCK
• SLOW
VENTRICULA
R RATE

5. 2.VBG
pH- 7.29
pCO2- 38.7
pO2- 48.1
HCO3- 18
Lact -2.6
Hb- 15.2
K+ - 4.4
Na- 128
Creat - 0.86
BE - -7.3
Metabolic acidosis with
partial compensation
3. ECHO
Severe MS
LA dilated
IVC collapsible
MS

6. DIFFERENTIAL DIAGNOSIS
Mesenteric ischemia
Acute pancreatitis
Acute pyelonephritis
Aortic dissection
Gastric perforation
Splenic infarct
Acute coronary syndrome
left lower lobe pneumonia

7. CHEST XRAY

8. CECT
ABDOMEN
A/C LEFT RENAL
INFARCT
A/C SPLENIC
INFARCT

9. ECHO
LA
CLOT
• RHD
• Severe MS
• Moderate-
Severe MR
• Moderate AR
• Mild PAH
• No RWMA
• Normal LV
systolic function
• 27x12 cm clot at
LA appendage

10. FINAL DIAGNOSIS
RHD - SEVERE MS /MR
AF WITH LAAPPENDAGE CLOT
ACUTE SPLENIC AND LEFT KIDNEY INFARCT
POSSIBLY EMBOLIC INFARCT
ED MANAGEMENT
Initial resuscitative measures including analgesics, IV
fluids.
Cardiology opinion obtained and started on IV
anticoagulants, DAPT
Discharged home on day 6 and advised oral
anticoagulants and to return for Valve Replacement
Surgery

11. LEARNING POINTS
Think beyond !!!
In case of acute
abdominal pain
always think of
extra abdominal
causes !!
Splenic infarction must be considered as a
potential cause of acute abdominal pain in a
patient presenting with left upper quadrant
abdominal pain !

12. THANK YOU