[Infarction and splenic abscess as the cause of acute abdomen in a patient with myelomonocytic leukemia].

Abstract

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.