Splenic Infarction as a Rare Cause of Abdominal Pain: A Retrospective Analysis

Splenic Infarction as a Rare Cause of Abdominal Pain: A Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Splenic Infarction as a Rare Cause of Abdominal Pain: A Retrospective Analysis Umit Karabulut, Berat Ebik, Ramazan Yolacan, Yusuf Ugur, Fatma Yilmaz Oncul, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9146172/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Splenic infarction is a rare clinical condition that usually develops secondary to underlying systemic diseases. This study aimed to evaluate the demographic characteristics, clinical findings, etiological factors, diagnostic methods, and treatment approaches in patients diagnosed with non-traumatic splenic infarction. Method: A retrospective analysis was conducted on 67 patients diagnosed with splenic infarction by dynamic abdominal computed tomography at Dicle University Medical Faculty Hospital between January 2014 and December 2023. Demographic characteristics, presenting symptoms, laboratory and radiological findings, comorbid conditions, etiological factors, treatment strategies, and length of hospital stay were evaluated. Findings: The mean age of the patients was 50.9 ± 16.3 years, and 64.2% were male. Abdominal pain was the most common presenting symptom (100%). Etiological evaluation revealed hematologic diseases as the most frequent cause (31.3%), followed by cardiovascular diseases (11.9%), while no identifiable etiology was detected in 23.9% of the patients. Diagnosis was confirmed in all cases using contrast-enhanced abdominal computed tomography. Conservative management was sufficient in 89.6% of patients, whereas 10.4% required surgical intervention. Conclusions: Splenic infarction is often a manifestation of an underlying systemic condition and requires careful clinical assessment. Contrast-enhanced CT remains the gold standard for diagnosis, and conservative management is effective in the majority of cases. Early recognition and appropriate etiological investigation are essential to guide treatment strategies and prevent potential complications associated with delayed diagnosis. Splenic infarction thrombosis embolism computed tomography Figures Figure 1 Introduction Splenic infarction is a rare clinical condition resulting from ischemia due to embolic or thrombotic occlusion of the splenic vessels. Its primary causes include hematologic disorders, cardioembolic events, hypercoagulable states, and malignancies, while trauma, vasculitis, and splenic artery torsion are less common contributors [ 1 – 4 ].. The clinical presentation may vary widely, ranging from left upper quadrant pain to signs of acute abdomen; some patients may even remain asymptomatic. Dynamic abdominal computed tomography (CT) is typically used for diagnosis, revealing characteristic hypodense, wedge-shaped lesions. Treatment options vary based on the extent of infarction and the underlying cause, ranging from conservative approaches to surgical interventions [ 5 – 8 ]. This study aimed to retrospectively evaluate the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed with non-traumatic splenic infarction. Methods This retrospective study included patients who were admitted to the Department of Internal Medicine at Dicle University Medical Faculty Hospital between January 1, 2014, and December 31, 2023, and were diagnosed with splenic infarction based on digital archive records. Inclusion criteria required radiologically confirmed splenic infarction on dynamic abdominal CT. Patients with a history of trauma, those under the age of 18, and cases with incomplete medical records were excluded. A total of 67 patients who met the study criteria were included. Demographic data (age, gender), presenting complaints, associated systemic or hematological conditions, laboratory parameters (e.g., leukocyte count, hemoglobin, platelet count, LDH), radiological findings, treatment approaches, and duration of hospital stay were all reviewed and recorded in detail. Statistical Analysis All data were analyzed using SPSS for Windows, version 22.0. Categorical variables were expressed as frequency and percentage (%), while continuous variables were presented as mean ± standard deviation or median (minimum–maximum), depending on data distribution. Results The mean age of the 67 patients included in the study was 50.9 ± 16.3 years (range: 19–86), with 43 male (64.2%) and 24 female (35.8%) patients. The median age was 53 years. Abdominal pain was the most common presenting symptom (100%), followed by fever (40.3%) and nausea/vomiting (31.3%). All patients exhibited significant tenderness in the left upper quadrant during physical examination. Laboratory findings revealed leukocytosis in 42 patients (62.7%), anemia in 43 (64.2%), and thrombocytopenia in 36 (53.7%). Elevated LDH levels were observed in 49 patients (73.1%). Among those who underwent molecular genetic analysis, 4 patients (6%) tested positive for the JAK2 gene mutation, while all patients had negative thrombophilia panels (including Factor V Leiden, prothrombin mutation, MTHFR, etc.). Radiologically, splenic infarction was confirmed in 100% of patients via dynamic abdominal CT (Fig. 1 ). However, ultrasonography (USG) identified infarct lesions in only 20 cases (29.9%). Splenomegaly was observed in 54 patients (80.6%), with spleen lengths ranging from 110 mm to 340 mm. In terms of treatment, the majority of patients (89.6%) were managed conservatively, while 7 patients (10.4%) underwent surgical intervention (splenectomy). The average length of hospital stay was 6.1 days, ranging from 1 to 24 days. Mortality occurred in 4 patients (6%), all of whom had serious underlying systemic conditions such as malignancy or sepsis (Table 1 ). Comorbid conditions and predisposing factors included hematologic diseases in 21 patients (31.3%) such as acute leukemia and myeloproliferative disorders, cardiovascular diseases in 8 patients (11.9%) such as atrial fibrillation and heart failure and other systemic conditions such as diabetes, cirrhosis, pancreatic cancer, or infections in 22 patients (32.8%). No identifiable etiology was found in 16 patients (23.9%) (Table 2 ). Table 1 Demographic, Clinical, Laboratory, and Radiological Findings and Treatment Outcomes of the Patients Variable n ( %) Demographic Characteristics Mean Age (median, range) 50,9 (53, 19–86) Male/Female 43 / 24 (%64,2 / %35,8) Presenting Symptoms Abdominal pain 67 (%100) Fever (> 38°C) 27 (%40,3) Nausea or vomiting 21 (%31,3) Physical Examination Left upper quadrant tenderness 67 (%100) Splenomegaly 54 (%80,6) Laboratory Tests Leukocytosis 42 (%62,7) Anemia 43 (%64,2) Thrombocytopenia 36 (%53,7) Elevated LDH 49 (%73,1) Thrombophilia panel 0 JAK2 gene mutation 4(%6) Imaging Ultrasonography (USG) 20(%29,9) Dynamic CT 67 (%100) Outcome Supportive treatment 60 (%89,6) Splenectomy 7 (%10,4) Mean hospital stay (days) 6,1 (1–24) Mortality 4 (%6) Table 2 Medical History and Risk Factors Risk Factors n (%) Hematologic diseases 21( %31,3) - Acute myeloid leukemia 6 -Polycythemia vera 2 -Chronic myelomonocytic leukemia 2 -Myelodysplastic syndrome 2 -Chronic myeloid leukemia 3 -Myelofibrosis 3 -Paroxysmal nocturnal hemoglobinuria 1 -Sickle cell anemia 2 Cardiovascular diseases 8 (%11,9) - Atrial fibrillation 4 - Heart failure 2 - Aortic coarctation 2 Other systemic diseases 22 (%32,8) - Diabetes mellitus 6 - Liver cirrhosis 5 - Alcoholic hepatitis 2 - Pancreatic cancer 3 - Acute pancreatitis 2 - Sepsis 4 Unknown etiology 16 (%23,9) Discussion The findings of this study revealed that splenic infarction is most frequently observed in middle-aged and older individuals, with a slight male predominance. Similar patterns have been reported in the literature, where splenic infarction is more commonly diagnosed in older male patients [ 1 , 2 ]. It is noteworthy that all patients presented with left upper quadrant abdominal pain as their initial complaint. This symptom represents the most characteristic clinical manifestation of splenic infarction, often accompanied by splenomegaly, fever, and gastrointestinal symptoms. These findings underscore the importance of considering splenic infarction in the differential diagnosis of abdominal pain. However, the low specificity of these symptoms may lead to diagnostic delays. Particularly in patients presenting with acute abdomen, the clinical picture may mimic more common conditions such as appendicitis, pancreatitis, or renal colic. Indeed, previous studies have reported that splenic infarction can be diagnostically challenging and, in some cases, may even remain asymptomatic [ 3 , 5 ]. In our study, etiologic analysis showed that approximately one-third of the cases were associated with hematologic diseases, while a smaller proportion had underlying cardiovascular conditions. Notably, no identifiable etiology was found in about one-fourth of the patients. This suggests that splenic infarction does not always conform to a typical etiologic framework, and in some cases, the underlying mechanism may remain unclear. It is possible that unrecognized or clinically elusive predisposing factors may contribute to these unexplained cases [ 9 – 12 ]. Previous studies on the etiology of splenic infarction indicate that the condition is linked to a broad and heterogeneous range of causes. Hematologic disorders, thromboembolic events, and cardiac-origin emboli are among the most frequently reported factors in various patient series. These findings highlight the need for a comprehensive clinical assessment that extends beyond the hematologic or cardiovascular systems to include potential systemic diseases. Moreover, some studies have identified autoimmune diseases and infections as significant contributors to splenic infarction. This etiologic diversity suggests that splenic infarction is not confined to a specific patient profile and can present across a wide clinical spectrum [ 10 , 13 – 16 ] (Table 3 ). Table 3 Comparison of Etiological Factors in Different Patient Series Study Number of Patients (n) En Sık Saptanan Etiyolojiler Nores et al. (1998) n = 59 Hematologic disorders (n = 35), thromboembolic disorders (n = 17), other causes (n = 7) Antopolsky et al. (2009) n = 48 hypercoagulability (n = 22), cardiac causes (n = 22) Lawrence et al. (2010) n = 26 Hematologic malignancies (n = 6), cardiac thrombus and endocarditis (n = 8) Schattner et al. (2015) n = 32 Cardioembolic events (n = 20), autoimmune (n = 4), infectious causes (n = 4) Chieh Ching Yen et al. (2021) n = 130 Hypertension (n = 60), atrial fibrillation (n = 32), diabetes mellitus (n = 30) Cox et al. (2016) n = 123 Malignancy (n = 40) Bewersdorf et al. (2021) n = 206 Thromboembolic events (n = 42) Present study n = 67 Other systemic diseases (n = 22; e.g., DM, cirrhosis, sepsis, malignancy), hematologic diseases (n = 21), unknown etiology (n = 16) The association between malignancy and splenic infarction is one of the most frequently emphasized aspects in the literature. Several studies have reported that malignant diseases can affect splenic circulation both directly and indirectly, primarily through hypercoagulability. Clinical observations support this as well—splenic infarctions accompanying malignancies often present with minimal or no symptoms and have a low risk of recurrence. These findings suggest that malignancies may increase the risk of complications not only as primary diseases but also through their systemic effects, thus requiring careful evaluation [ 17 , 18 ] (Table 3 ). The biochemical findings observed in our study indicate that splenic infarction is not merely a vascular event, but also may be closely related to inflammatory processes. Elevated leukocyte counts may reflect not only infection but also tissue necrosis or inflammation. Furthermore, the presence of JAK2 mutations in certain cases stands out as a diagnostically valuable marker, particularly in the context of myeloproliferative diseases. This mutation has been associated with increased thrombotic risk in the literature, emphasizing the potential role of genetic predisposition in the etiology of splenic infarction [ 19 , 20 ]. The diagnostic value of contrast-enhanced abdominal CT was evident in all cases in our study. Especially the detection of wedge-shaped hypodense areas has made CT an indispensable imaging modality in the diagnosis of splenic infarction [ 9 ]. Although ultrasonography is often the initial imaging method in clinical practice, its limited sensitivity frequently results in early lesions being overlooked. In terms of treatment approaches, conservative management was sufficient in the vast majority of cases. These patients, whose clinical conditions stabilized with supportive care, demonstrate that splenic infarction is often a self-limiting condition that does not require invasive intervention. However, in cases involving splenic rupture, infected infarcts, abscess formation, or persistent symptoms, surgical treatment may become necessary. This approach is also supported by existing literature, and each case should be evaluated individually with careful assessment of the risk for complications [ 7 , 9 ]. In our study, four patients developed mortality during clinical follow-up, and all had significant underlying systemic illnesses such as malignancy or sepsis. This clearly highlights the impact of comorbidities on patient prognosis. One of the strengths of this study is the inclusion of a diverse patient population over an extended period in a regional referral center. This enabled the evaluation of a wide range of clinical presentations. Additionally, the use of dynamic abdominal CT to confirm the diagnosis in all cases enhanced the reliability of the findings and strengthened the methodological foundation of the study. Nonetheless, several limitations should be acknowledged. The retrospective design limited access to certain patient data, and some clinical details were incomplete. Furthermore, the absence of long-term follow-up data made it difficult to assess prognosis. The relatively small sample size may also limit the generalizability of the findings. Therefore, multicenter, preferably prospective studies are needed to support these findings and enable stronger conclusions. Conclusions Although splenic infarction is a rare condition, it is an important clinical entity that can occur particularly in association with systemic diseases and requires careful diagnostic evaluation. The findings of our study emphasize the pivotal role of contrast-enhanced CT in diagnosis and identify hematologic and systemic diseases associated with thrombotic predisposition as the most frequent etiological factors. As observed in clinical practice, splenic infarction is often overlooked; thus, early clinical suspicion and the effective use of diagnostic tools are essential. This approach is not only crucial for accurate diagnosis but also for the prevention of complications and avoidance of unnecessary interventions. Declarations Ethics approval and consent to participate The study was approved by the Clinical Research Ethics Committee of Dicle University Medical Faculty (Approval No: 157; May 17, 2023). Due to the retrospective design of the study and the use of anonymized medical records, the requirement for informed consent was waived by the Ethics Committee of Dicle University Faculty of Medicine. All procedures were conducted in accordance with the ethical standards of institutional and national research committees and the Declaration of Helsinki (1964). Clinical trial number: Not applicable Consent for publications Not applicable Availability of data and materials The data analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Author contributions Conceptualization, U.K. and B.E. ; methodology, R.Y. and Y.U.; formal analysis, F.Y.O.; investigation, B.E.. and M.K. ; resources, U.K. and B.E. and R.Y. ; data curation, R.Y. and Y.U. ; writing-original draft preparation, U.K.; writing review and editing, U.K. and B.E. and F.Y.O. and R.Y.. and Y.U. and M.K.; visualization, U.K.; supervision, B.E.; project administration R.Y. All authors read and approved the final manuscript. References Wang Q, Zhuo N, Li J. Splenic infarction secondary to multi-site thrombosis in lung adenocarcinoma with EGFR-L858R mutation: A case report. Oncol Lett. 2025 Jul 1;30(3):417. doi: 10.3892/ol.2025.15163 Tarrazo C, Barragán Mateos A. Splenic infarctions in acute Epstein‑Barr virus infection: a rare but possibly underdiagnosed complication in adults. Eur J Case Rep Intern Med.2025 Sep 1;12(9):005497. Brett A.S. , Azizzadeh N, Miller E.M., Collins R.J., Seegars M.B., Marcus M.A. Assessment of clinical conditions associated with splenic infarction in adult patients JAMA Intern Med, 180 (2020), pp. 1125-1128 Hakoshima M, Kitakaze K, Adachi H, Katsuyama H, Yanai H, Clinical. Hematological, biochemical and radiological characteristics for patients with Splenic infarction: case series with literature review. J Clin Med Res. 2023;15(1):38–50. Annan GK, Rauf M, Obeng-Kyei S, et al. Splenic Infarction at the Crossroads of Hematologic and Cardioembolic Risk. Cureus. 2025;17(1):e41253. doi:10.7759/cureus.41253 Wyttynck A, Bismut M, Belhomme N, Perlat A, Ballerie A, Lescoat A. Les causes des infarctus spléniques : une revue quasi systématique de la littératureThe causes of splenic infarction: An almost systematic review of the literature. La Revue de Médecine Interne Volume 45, Issue 5, May 2024, Pages 264-270 Kocher KE, Meurer WJ, Fazel R, et al. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58:452–462. 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. 2025;124(4):375–80. Arant K, Agaisse T, Vassilopoulos A, Ghanem S, Santos M. Splenic Infarction in Babesiosis: A Case Series. J Brown Hosp Med.2025 Oct 1;4(4):142207. doi: 10.56305/001c.142207 Nores M, Phillips EH, Morgenstern L, Hiatt JR. The clinical spectrum of splenic infarction. Am Surg 1998; 64 (2): 182-8 Ahmed M, Nasir M, Negash A, Haile K. Wandering spleen with splenic torsion: unusual cause of acute abdomen. Int Med Case Rep J. (2022) 15:625–30. 10.2147/imcrj.S388271 Perez-Rosillo MA, Gomez-Huertas M, Salmeron-Ruiz A, Lainez-Ramos-Bossini AJ. Acute abdomen secondary to torsion and infarction of a wandering spleen. Gastroenterol Hepatol. (2021) 44(8):585–6. 10.1016/j.gastrohep.2020.05.013 Antopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27 (3) :262-5 Lawrence, Y. R. et al. Splenic infarction: An update on William Osler’s observations. Isr. Med. Assoc. J. 12, 362–365 (2010) Schattner Ami, Adi Meital et al, Acute Splenic Infarction at an Academic General Hospital Over 10 Years, Medicine 94(36):e1363, DOI:10.1097/MD.0000000000001363 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. doi: 10.1038/s41598-021-00897-0. Cox M, Li Z, Desai V, et al. Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients. Emerg Radiol 2016;23(2):155‐160 Bewersdorf JP, Parmar N, et al. Clinical characteristics and outcomes of splenic infarction in cancer patients: a retrospective single-center report of 206 cases. J Thromb Thrombolysis. 2021;52:854-862. Moreira GS, Feijóo NdAP, Tinoco‑da‑Silva IB, et al. Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses. Trop. Med. Infect. Dis. 2024, 9 (4), 83; https://doi.org/10.3390/tropicalmed9040083 Ueda J, Mamada Y, Taniai N, Yoshioka M, Matsushita A, Mizutani S, et al. Evaluation of Splenic infarction ratio and platelet increase ratio after partial Splenic artery embolization. J Int Med Res. 2023;51(8):3000605231190967 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 May, 2026 Reviewers agreed at journal 12 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers invited by journal 05 May, 2026 Editor invited by journal 10 Apr, 2026 Editor assigned by journal 19 Mar, 2026 Submission checks completed at journal 19 Mar, 2026 First submitted to journal 17 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9146172","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639212620,"identity":"cec10d5d-d0ff-4665-b325-42240666c451","order_by":0,"name":"Umit Karabulut","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYDCCA0CcAIQMDDwMDA8YGOTAgg8IakmAaklgMDAGCyYQ0sKApCWxASyARwff7TOmGx7+SJM3bz97TCKx7U/6/LDDD4G22MnpNmDXInkux+xGQkKO4ZwzeWlALQa5G2+nGQC1JBubHcCuxeAMD0hLBeMMhhwziJbZCSAtBxK3EdBiP4P/DVhLuuHs9A/EaMlJnCEBsSVBXjoHvy2SZ9jKbiSkpSXPkHiXbJFwzthwg3ROwYEEA9x+4TvDvO3mD5tk2xn8uQdvfCiTk5efnb75w4cKOzlcWrA4FazSgFjlICDfQIrqUTAKRsEoGAkAAKoIZZrREKGGAAAAAElFTkSuQmCC","orcid":"","institution":"University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital - Diyarbakir","correspondingAuthor":true,"prefix":"","firstName":"Umit","middleName":"","lastName":"Karabulut","suffix":""},{"id":639212621,"identity":"4b4f2e7e-a3c7-4bf4-8735-fdc4fc93846d","order_by":1,"name":"Berat Ebik","email":"","orcid":"","institution":"University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital - Diyarbakir","correspondingAuthor":false,"prefix":"","firstName":"Berat","middleName":"","lastName":"Ebik","suffix":""},{"id":639212622,"identity":"7040f547-edee-4212-a09d-2342c455353c","order_by":2,"name":"Ramazan Yolacan","email":"","orcid":"","institution":"Gaziantep City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ramazan","middleName":"","lastName":"Yolacan","suffix":""},{"id":639212623,"identity":"918b26f6-228c-478e-a50c-2c512507207b","order_by":3,"name":"Yusuf Ugur","email":"","orcid":"","institution":"Dicle University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yusuf","middleName":"","lastName":"Ugur","suffix":""},{"id":639212624,"identity":"e98f041f-04fe-47e4-8e88-e81189e97f7b","order_by":4,"name":"Fatma Yilmaz Oncul","email":"","orcid":"","institution":"Dicle University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"Yilmaz","lastName":"Oncul","suffix":""},{"id":639212627,"identity":"d4a46744-fe91-422c-9f73-4b2acaeb459a","order_by":5,"name":"Muhsin Kaya","email":"","orcid":"","institution":"Dicle University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Muhsin","middleName":"","lastName":"Kaya","suffix":""}],"badges":[],"createdAt":"2026-03-17 08:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9146172/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9146172/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109215048,"identity":"5a9f6923-38d6-4c7b-a46c-f42f381a9590","added_by":"auto","created_at":"2026-05-13 17:51:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":342317,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A, B, C, D) Contrast-enhanced abdominal CT images show hypodense areas in the spleen (indicated by arrows), consistent with splenic infarction.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9146172/v1/8dda236f56bf41a34c85b3d9.png"},{"id":109252179,"identity":"0104fbc3-7e5c-4381-b128-bb1524ae4b68","added_by":"auto","created_at":"2026-05-14 09:21:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":545610,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9146172/v1/17035bd2-be51-4002-93ba-d573f40ba733.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Splenic Infarction as a Rare Cause of Abdominal Pain: A Retrospective Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSplenic infarction is a rare clinical condition resulting from ischemia due to embolic or thrombotic occlusion of the splenic vessels. Its primary causes include hematologic disorders, cardioembolic events, hypercoagulable states, and malignancies, while trauma, vasculitis, and splenic artery torsion are less common contributors [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]..\u003c/p\u003e \u003cp\u003eThe clinical presentation may vary widely, ranging from left upper quadrant pain to signs of acute abdomen; some patients may even remain asymptomatic. Dynamic abdominal computed tomography (CT) is typically used for diagnosis, revealing characteristic hypodense, wedge-shaped lesions. Treatment options vary based on the extent of infarction and the underlying cause, ranging from conservative approaches to surgical interventions [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to retrospectively evaluate the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed with non-traumatic splenic infarction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective study included patients who were admitted to the Department of Internal Medicine at Dicle University Medical Faculty Hospital between January 1, 2014, and December 31, 2023, and were diagnosed with splenic infarction based on digital archive records. Inclusion criteria required radiologically confirmed splenic infarction on dynamic abdominal CT. Patients with a history of trauma, those under the age of 18, and cases with incomplete medical records were excluded.\u003c/p\u003e \u003cp\u003eA total of 67 patients who met the study criteria were included. Demographic data (age, gender), presenting complaints, associated systemic or hematological conditions, laboratory parameters (e.g., leukocyte count, hemoglobin, platelet count, LDH), radiological findings, treatment approaches, and duration of hospital stay were all reviewed and recorded in detail.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll data were analyzed using SPSS for Windows, version 22.0. Categorical variables were expressed as frequency and percentage (%), while continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (minimum\u0026ndash;maximum), depending on data distribution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the 67 patients included in the study was 50.9\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3 years (range: 19\u0026ndash;86), with 43 male (64.2%) and 24 female (35.8%) patients. The median age was 53 years.\u003c/p\u003e \u003cp\u003eAbdominal pain was the most common presenting symptom (100%), followed by fever (40.3%) and nausea/vomiting (31.3%). All patients exhibited significant tenderness in the left upper quadrant during physical examination.\u003c/p\u003e \u003cp\u003eLaboratory findings revealed leukocytosis in 42 patients (62.7%), anemia in 43 (64.2%), and thrombocytopenia in 36 (53.7%). Elevated LDH levels were observed in 49 patients (73.1%). Among those who underwent molecular genetic analysis, 4 patients (6%) tested positive for the JAK2 gene mutation, while all patients had negative thrombophilia panels (including Factor V Leiden, prothrombin mutation, MTHFR, etc.).\u003c/p\u003e \u003cp\u003eRadiologically, splenic infarction was confirmed in 100% of patients via dynamic abdominal CT (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, ultrasonography (USG) identified infarct lesions in only 20 cases (29.9%). Splenomegaly was observed in 54 patients (80.6%), with spleen lengths ranging from 110 mm to 340 mm.\u003c/p\u003e \u003cp\u003eIn terms of treatment, the majority of patients (89.6%) were managed conservatively, while 7 patients (10.4%) underwent surgical intervention (splenectomy). The average length of hospital stay was 6.1 days, ranging from 1 to 24 days. Mortality occurred in 4 patients (6%), all of whom had serious underlying systemic conditions such as malignancy or sepsis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComorbid conditions and predisposing factors included hematologic diseases in 21 patients (31.3%) such as acute leukemia and myeloproliferative disorders, cardiovascular diseases in 8 patients (11.9%) such as atrial fibrillation and heart failure and other systemic conditions such as diabetes, cirrhosis, pancreatic cancer, or infections in 22 patients (32.8%). No identifiable etiology was found in 16 patients (23.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic, Clinical, Laboratory, and Radiological Findings and Treatment Outcomes of the Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en ( %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Age (median, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50,9 (53, 19\u0026ndash;86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale/Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 / 24 (%64,2 / %35,8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresenting Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (%100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever (\u0026gt;\u0026thinsp;38\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (%40,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea or vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (%31,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical Examination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft upper quadrant tenderness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (%100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSplenomegaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (%80,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory Tests\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocytosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (%62,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (%64,2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombocytopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (%53,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated LDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (%73,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombophilia panel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJAK2 gene mutation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(%6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImaging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasonography (USG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(%29,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDynamic CT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (%100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupportive treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (%89,6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSplenectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (%10,4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,1 (1\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (%6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedical History and Risk Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factors\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHematologic diseases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21( %31,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Acute myeloid leukemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Polycythemia vera\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Chronic myelomonocytic leukemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Myelodysplastic syndrome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Chronic myeloid leukemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Myelofibrosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Paroxysmal nocturnal hemoglobinuria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e-Sickle cell anemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (%11,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Atrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Aortic coarctation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther systemic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (%32,8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Liver cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Alcoholic hepatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Pancreatic cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Acute pancreatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Sepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnknown etiology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (%23,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study revealed that splenic infarction is most frequently observed in middle-aged and older individuals, with a slight male predominance. Similar patterns have been reported in the literature, where splenic infarction is more commonly diagnosed in older male patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is noteworthy that all patients presented with left upper quadrant abdominal pain as their initial complaint. This symptom represents the most characteristic clinical manifestation of splenic infarction, often accompanied by splenomegaly, fever, and gastrointestinal symptoms. These findings underscore the importance of considering splenic infarction in the differential diagnosis of abdominal pain. However, the low specificity of these symptoms may lead to diagnostic delays. Particularly in patients presenting with acute abdomen, the clinical picture may mimic more common conditions such as appendicitis, pancreatitis, or renal colic. Indeed, previous studies have reported that splenic infarction can be diagnostically challenging and, in some cases, may even remain asymptomatic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, etiologic analysis showed that approximately one-third of the cases were associated with hematologic diseases, while a smaller proportion had underlying cardiovascular conditions. Notably, no identifiable etiology was found in about one-fourth of the patients. This suggests that splenic infarction does not always conform to a typical etiologic framework, and in some cases, the underlying mechanism may remain unclear. It is possible that unrecognized or clinically elusive predisposing factors may contribute to these unexplained cases [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies on the etiology of splenic infarction indicate that the condition is linked to a broad and heterogeneous range of causes. Hematologic disorders, thromboembolic events, and cardiac-origin emboli are among the most frequently reported factors in various patient series. These findings highlight the need for a comprehensive clinical assessment that extends beyond the hematologic or cardiovascular systems to include potential systemic diseases. Moreover, some studies have identified autoimmune diseases and infections as significant contributors to splenic infarction. This etiologic diversity suggests that splenic infarction is not confined to a specific patient profile and can present across a wide clinical spectrum [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Etiological Factors in Different Patient Series\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEn Sık Saptanan Etiyolojiler\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNores et al. (1998)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHematologic disorders (n\u0026thinsp;=\u0026thinsp;35), thromboembolic disorders (n\u0026thinsp;=\u0026thinsp;17), other causes (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAntopolsky et al. (2009)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ehypercoagulability (n\u0026thinsp;=\u0026thinsp;22), cardiac causes (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLawrence et al. (2010)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHematologic malignancies (n\u0026thinsp;=\u0026thinsp;6), cardiac thrombus and endocarditis (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSchattner et al. (2015)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCardioembolic events (n\u0026thinsp;=\u0026thinsp;20), autoimmune (n\u0026thinsp;=\u0026thinsp;4), infectious causes (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eChieh Ching Yen et al. (2021)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypertension (n\u0026thinsp;=\u0026thinsp;60), atrial fibrillation (n\u0026thinsp;=\u0026thinsp;32), diabetes mellitus (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCox et al. (2016)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMalignancy (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBewersdorf et al. (2021)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThromboembolic events (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther systemic diseases (n\u0026thinsp;=\u0026thinsp;22; e.g., DM, cirrhosis, sepsis, malignancy), hematologic diseases (n\u0026thinsp;=\u0026thinsp;21), unknown etiology (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe association between malignancy and splenic infarction is one of the most frequently emphasized aspects in the literature. Several studies have reported that malignant diseases can affect splenic circulation both directly and indirectly, primarily through hypercoagulability. Clinical observations support this as well\u0026mdash;splenic infarctions accompanying malignancies often present with minimal or no symptoms and have a low risk of recurrence. These findings suggest that malignancies may increase the risk of complications not only as primary diseases but also through their systemic effects, thus requiring careful evaluation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe biochemical findings observed in our study indicate that splenic infarction is not merely a vascular event, but also may be closely related to inflammatory processes. Elevated leukocyte counts may reflect not only infection but also tissue necrosis or inflammation. Furthermore, the presence of JAK2 mutations in certain cases stands out as a diagnostically valuable marker, particularly in the context of myeloproliferative diseases. This mutation has been associated with increased thrombotic risk in the literature, emphasizing the potential role of genetic predisposition in the etiology of splenic infarction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe diagnostic value of contrast-enhanced abdominal CT was evident in all cases in our study. Especially the detection of wedge-shaped hypodense areas has made CT an indispensable imaging modality in the diagnosis of splenic infarction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although ultrasonography is often the initial imaging method in clinical practice, its limited sensitivity frequently results in early lesions being overlooked.\u003c/p\u003e \u003cp\u003eIn terms of treatment approaches, conservative management was sufficient in the vast majority of cases. These patients, whose clinical conditions stabilized with supportive care, demonstrate that splenic infarction is often a self-limiting condition that does not require invasive intervention. However, in cases involving splenic rupture, infected infarcts, abscess formation, or persistent symptoms, surgical treatment may become necessary. This approach is also supported by existing literature, and each case should be evaluated individually with careful assessment of the risk for complications [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, four patients developed mortality during clinical follow-up, and all had significant underlying systemic illnesses such as malignancy or sepsis. This clearly highlights the impact of comorbidities on patient prognosis.\u003c/p\u003e \u003cp\u003eOne of the strengths of this study is the inclusion of a diverse patient population over an extended period in a regional referral center. This enabled the evaluation of a wide range of clinical presentations. Additionally, the use of dynamic abdominal CT to confirm the diagnosis in all cases enhanced the reliability of the findings and strengthened the methodological foundation of the study.\u003c/p\u003e \u003cp\u003eNonetheless, several limitations should be acknowledged. The retrospective design limited access to certain patient data, and some clinical details were incomplete. Furthermore, the absence of long-term follow-up data made it difficult to assess prognosis. The relatively small sample size may also limit the generalizability of the findings. Therefore, multicenter, preferably prospective studies are needed to support these findings and enable stronger conclusions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAlthough splenic infarction is a rare condition, it is an important clinical entity that can occur particularly in association with systemic diseases and requires careful diagnostic evaluation. The findings of our study emphasize the pivotal role of contrast-enhanced CT in diagnosis and identify hematologic and systemic diseases associated with thrombotic predisposition as the most frequent etiological factors. As observed in clinical practice, splenic infarction is often overlooked; thus, early clinical suspicion and the effective use of diagnostic tools are essential. This approach is not only crucial for accurate diagnosis but also for the prevention of complications and avoidance of unnecessary interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Clinical Research Ethics Committee of Dicle University Medical Faculty (Approval No: 157; May 17, 2023). Due to the retrospective design of the study and the use of anonymized medical records, the requirement for informed consent was waived by the Ethics Committee of Dicle University Faculty of Medicine. All procedures were conducted in accordance with the ethical standards of institutional and national research committees and the Declaration of Helsinki (1964).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, U.K. and B.E. ; methodology, R.Y. and Y.U.; formal analysis, F.Y.O.; investigation, B.E.. and M.K. ; resources, U.K. and B.E. and R.Y. ; data curation, R.Y. and Y.U. ; writing-original draft preparation, U.K.; writing review and editing, U.K. and B.E. and F.Y.O. and R.Y.. and Y.U. and M.K.; visualization, U.K.; supervision, B.E.; project administration R.Y. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eWang Q, Zhuo N, Li J.\u003c/strong\u003e Splenic infarction secondary to multi-site thrombosis in lung adenocarcinoma with EGFR-L858R mutation: A case report. Oncol Lett. 2025 Jul 1;30(3):417. doi: 10.3892/ol.2025.15163\u003c/li\u003e\n\u003cli\u003eTarrazo C, Barrag\u0026aacute;n Mateos A. Splenic infarctions in acute Epstein‑Barr virus infection: a rare but possibly underdiagnosed complication in adults. Eur J Case Rep Intern Med.2025 Sep 1;12(9):005497.\u003c/li\u003e\n\u003cli\u003eBrett A.S. , Azizzadeh N, Miller E.M., Collins R.J., Seegars M.B., Marcus M.A. Assessment of clinical conditions associated with splenic infarction in adult patients JAMA Intern Med, 180 (2020), pp. 1125-1128\u003c/li\u003e\n\u003cli\u003eHakoshima M, Kitakaze K, Adachi H, Katsuyama H, Yanai H, Clinical. Hematological, biochemical and radiological characteristics for patients with Splenic infarction: case series with literature review. J Clin Med Res. 2023;15(1):38\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eAnnan GK, Rauf M, Obeng-Kyei S, et al. \u003cstrong\u003eSplenic Infarction at the Crossroads of Hematologic and Cardioembolic Risk.\u003c/strong\u003e Cureus. 2025;17(1):e41253. doi:10.7759/cureus.41253\u003c/li\u003e\n\u003cli\u003eWyttynck A, Bismut M, Belhomme N, Perlat A, Ballerie A, Lescoat A. Les causes des infarctus spl\u0026eacute;niques : une revue quasi syst\u0026eacute;matique de la litt\u0026eacute;ratureThe causes of splenic infarction: An almost systematic review of the literature. La Revue de M\u0026eacute;decine Interne Volume 45, Issue 5, May 2024, Pages 264-270\u003c/li\u003e\n\u003cli\u003eKocher KE, Meurer WJ, Fazel R, et al. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58:452\u0026ndash;462.\u003c/li\u003e\n\u003cli\u003eLin 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. 2025;124(4):375\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eArant K, Agaisse T, Vassilopoulos A, Ghanem S, Santos M. Splenic Infarction in Babesiosis: A Case Series. J Brown Hosp Med.2025 Oct 1;4(4):142207. doi: 10.56305/001c.142207\u003c/li\u003e\n\u003cli\u003eNores M, Phillips EH, Morgenstern L, Hiatt JR. The clinical spectrum of splenic infarction. Am Surg 1998; 64 (2): 182-8\u003c/li\u003e\n\u003cli\u003eAhmed M, Nasir M, Negash A, Haile K. Wandering spleen with splenic torsion: unusual cause of acute abdomen. Int Med Case Rep J. (2022) 15:625\u0026ndash;30. 10.2147/imcrj.S388271\u003c/li\u003e\n\u003cli\u003ePerez-Rosillo MA, Gomez-Huertas M, Salmeron-Ruiz A, Lainez-Ramos-Bossini AJ. Acute abdomen secondary to torsion and infarction of a wandering spleen. Gastroenterol Hepatol. (2021) 44(8):585\u0026ndash;6. 10.1016/j.gastrohep.2020.05.013\u003c/li\u003e\n\u003cli\u003eAntopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27 (3) :262-5\u003c/li\u003e\n\u003cli\u003eLawrence, Y. R. et al. Splenic infarction: An update on William Osler\u0026rsquo;s observations. Isr. Med. Assoc. J. 12, 362\u0026ndash;365 (2010)\u003c/li\u003e\n\u003cli\u003eSchattner Ami, Adi Meital et al, Acute Splenic Infarction at an Academic General Hospital Over 10 Years, Medicine 94(36):e1363, DOI:10.1097/MD.0000000000001363\u003c/li\u003e\n\u003cli\u003eYen 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. doi: 10.1038/s41598-021-00897-0.\u003c/li\u003e\n\u003cli\u003eCox M, Li Z, Desai V, et al. Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients. Emerg Radiol 2016;23(2):155‐160\u003c/li\u003e\n\u003cli\u003eBewersdorf JP, Parmar N, et al. Clinical characteristics and outcomes of splenic infarction in cancer patients: a retrospective single-center report of 206 cases. \u003cstrong\u003eJ Thromb Thrombolysis.\u003c/strong\u003e 2021;52:854-862.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMoreira GS, Feij\u0026oacute;o NdAP, Tinoco‑da‑Silva IB, et al.\u003c/strong\u003e Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses. \u003cem\u003eTrop. Med. Infect. Dis.\u003c/em\u003e 2024, \u003cem\u003e9\u003c/em\u003e(4), 83; https://doi.org/10.3390/tropicalmed9040083\u003c/li\u003e\n\u003cli\u003eUeda J, Mamada Y, Taniai N, Yoshioka M, Matsushita A, Mizutani S, et al. Evaluation of Splenic infarction ratio and platelet increase ratio after partial Splenic artery embolization. J Int Med Res. 2023;51(8):3000605231190967\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Splenic infarction, thrombosis, embolism, computed tomography","lastPublishedDoi":"10.21203/rs.3.rs-9146172/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9146172/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Splenic infarction is a rare clinical condition that usually develops secondary to underlying systemic diseases. This study aimed to evaluate the demographic characteristics, clinical findings, etiological factors, diagnostic methods, and treatment approaches in patients diagnosed with non-traumatic splenic infarction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A retrospective analysis was conducted on 67 patients diagnosed with splenic infarction by dynamic abdominal computed tomography at Dicle University Medical Faculty Hospital between January 2014 and December 2023. Demographic characteristics, presenting symptoms, laboratory and radiological findings, comorbid conditions, etiological factors, treatment strategies, and length of hospital stay were evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings: \u003c/strong\u003eThe mean age of the patients was 50.9 ± 16.3 years, and 64.2% were male. Abdominal pain was the most common presenting symptom (100%). Etiological evaluation revealed hematologic diseases as the most frequent cause (31.3%), followed by cardiovascular diseases (11.9%), while no identifiable etiology was detected in 23.9% of the patients. Diagnosis was confirmed in all cases using contrast-enhanced abdominal computed tomography. Conservative management was sufficient in 89.6% of patients, whereas 10.4% required surgical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Splenic infarction is often a manifestation of an underlying systemic condition and requires careful clinical assessment. Contrast-enhanced CT remains the gold standard for diagnosis, and conservative management is effective in the majority of cases. Early recognition and appropriate etiological investigation are essential to guide treatment strategies and prevent potential complications associated with delayed diagnosis.\u003c/p\u003e","manuscriptTitle":"Splenic Infarction as a Rare Cause of Abdominal Pain: A Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 17:50:56","doi":"10.21203/rs.3.rs-9146172/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T17:41:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148210736810345123394406616341512009770","date":"2026-05-12T17:30:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T07:49:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234160698313235748321171561077582128829","date":"2026-05-06T04:50:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201051091707887505400508737174295208647","date":"2026-05-06T01:33:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-05T21:01:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T12:16:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-19T13:44:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-19T13:43:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-03-17T08:22:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7a157676-6963-4813-9829-8ff6782b2bf1","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T17:41:11+00:00","index":55,"fulltext":""},{"type":"reviewerAgreed","content":"148210736810345123394406616341512009770","date":"2026-05-12T17:30:17+00:00","index":54,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T07:49:49+00:00","index":38,"fulltext":""},{"type":"reviewerAgreed","content":"234160698313235748321171561077582128829","date":"2026-05-06T04:50:38+00:00","index":36,"fulltext":""},{"type":"reviewerAgreed","content":"201051091707887505400508737174295208647","date":"2026-05-06T01:33:13+00:00","index":35,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-05T21:01:10+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T17:50:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 17:50:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9146172","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9146172","identity":"rs-9146172","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}