MORE CAUSE, MORE EFFECT: A CASE REPORT OF SIMULTANEOUS SPLENIC INFARCTION AND RENAL INFARCTION

Abstract

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.

Keywords

• Splenic infarction
• Renal infarction
• Abdominal pain

References

1. 1. Chapman J, Helm TA, Kahwaji CI. Splenic ınfarcts. In: Statpearls. Treasure ısland: statpearls publishing; 2024 jan. Pmıd: 28613652
2. 2. Wand O, Tayer-Shifman OE, Khoury S, Hershko AY. A practical approach to infarction of the spleen as a rare manifestation of multiple common diseases. Ann Med. 2018;50(6):494-500.
3. 3. Lin JW, Chen CT, Kuo Y, Jeng MJ, How CK, Huang HH. Risk factors for mortality among patients with splenic infarction in the emergency department. J Formos Med Assoc. 2024:S0929-6646(24)00246-8. doi: 10.1016/j.jfma.2024.05.010.
4. 4. Eren N, Gungor O, Kocyigit I, Guzel FB, Erken E, Altunoren O ve ark. Acute renal infarction in turkey: a review of 121 cases. Int Urol Nephrol. 2018;50(11):2067-2072.
5. 5. Mesiano P, Rollino C, Beltrame G, Ferro M, Quattrocchio G, Fenoglio R et al. Acute renal infarction: a single center experience. J Nephrol. 2017;30(1):103-107.
6. 6. Mizusugi M, Kenzaka T. Asymptomatic ıdiopathic renal ınfarction detected ıncidentally on contrast-enhanced computed tomography: a case report. Medicina (kaunas). 2023;59(6):1176.
7. 7. Popov SV, Orlov IN, Topuzov TM, Malevich SM, Chernysheva DY. Modern aspects of diagnostics and treatment of renal infarction. Urologiia. 2023;(1):101-105.
8. 8. Weber E, Grangeon F, Reynaud Q, Hot A, Sève P, Jardel S et al. Acute renal and splenic infarctions: a review, QJM: An International Journal of Medicine. 2020;3: 186-193.

9. 9. Nilajkar G, Aditya P, Cyrus P. A curious case of splenic infarction. Indian Journal of Case Reports. 2018;4(6):478-480.
10. 10. Yen CC, Wang CK, Chen SY, Gao SY, Lo HY, Ng CJ, et al. Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study. Sci Rep. 2021;11(1):21423.
11. 11. Frippiat F, Donckier J, Vandenbossche P, Stoffel M, Boland B, Lambert M. Splenic infarction: report of three cases of atherosclerotic embolization originating in the aorta and retrospective study of 64 cases. Acta Clin Belg. 1996;51(6):395-402
12. 12. Saju JM, Leslie SW. Renal infarction. In: StatPearls. StatPearls Publishing. 2024.