splenic infarct

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 VENTRICULAR 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 la 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 LA APPENDAGE 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