Dalak Patolojileri
Özet
Acil servis başvurularının en yaygın nedenlerinden biri olan karın ağrısı şikâyetinde, dalak kaynaklı patolojiler nadir görülmekle birlikte yüksek morbidite ve mortalite potansiyelleri nedeniyle kritik öneme sahiptir. Bu bölüm, acil tıp pratiğinde karşılaşılan temel dalak patolojilerini; anatomik ve fizyolojik temellerden başlayarak güncel tanı ve tedavi algoritmaları ışığında ele almaktadır. Dalağın yüksek vaskülarizasyonu, özellikle travmatik ve spontan rüptür durumlarında masif intraperitoneal kanamalara yol açarak acil cerrahi müdahale ihtiyacını doğurmaktadır. Travmatik yaralanmaların yanı sıra, bu çalışmada vasküler patolojiler özel bir başlık altında incelenmiştir. Splenik arter anevrizmaları, özellikle gebelik ve portal hipertansiyon gibi risk faktörleri varlığında rüptür riski taşıyan sinsi seyirli klinik antitelerdir. Benzer şekilde, pankreatit veya cerrahi müdahaleler sonrası gelişebilen splenik ven trombozu, sinistral portal hipertansiyon ve gastrik varis kanamaları gibi ciddi komplikasyonlara zemin hazırlamaktadır. Bölüm boyunca, bu patolojilerin acil servisteki yönetimi, radyolojik görüntüleme bulguları ve antikoagülasyon gerekliliği gibi tartışmalı konular literatürdeki en güncel verilerle (StatPearls, vaka serileri ve meta-analizler) sentezlenerek sunulmaktadır. Amaç, acil tıp hekimine bu nadir fakat hayati tabloları tanıma ve yönetme konusunda kapsamlı bir rehber sağlamaktır.
Abdominal pain is a predominant complaint in emergency department visits, where splenic pathologies represent a rare but life-threatening spectrum due to the organ's high vascularity and potential for massive hemorrhage. This chapter explores the primary splenic disorders encountered in emergency medicine, integrating anatomical and physiological foundations with contemporary diagnostic and therapeutic algorithms.Special emphasis is placed on vascular pathologies, including splenic artery aneurysms and splenic vein thrombosis. Splenic artery aneurysms, often linked to multiparity and portal hypertension, carry a significant risk of catastrophic rupture requiring immediate multidisciplinary intervention. Splenic vein thrombosis, frequently secondary to pancreatitis or post-splenectomy complications, is characterized as the leading cause of sinistral portal hypertension, posing a risk for isolated gastric variceal bleeding. Through a synthesis of recent literature, including case reports and clinical investigations, this section details emergency management strategies, the role of radiological imaging, and the nuances of anticoagulation therapy. This comprehensive review aims to equip emergency physicians with the necessary clinical insights to effectively diagnose and manage complex splenic emergencies.
Referanslar
Mahadevan V. Anatomy of the pancreas and spleen. Surgery (Oxford). 2019;3(6): 297–299. doi: 10.1016/j.mpsur.2019.04.008
Aldulaimi S, Mendez AM. Splenomegaly: Diagnosis and management in adults. Am Fam Physician. 2016;94(8): 628–634. PMID: 34523897
Pasternack MS. Prevention of infection in patients with impaired splenic function. UpToDate Waltham (MA): UpToDate Inc.; 2025.Accessed January 31, 2026.
Ziogaite B, Contreras ET, Horgan JE. Incidence of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy surgery at a surgical specialty clinic: 182 cases (2017-2021). PLoS One. 2024;19(12): e0314737. doi: 10.1371/journal.pone.0314737
Maung AA, Kaplan LJ. Surgical management of splenic injury in the adult trauma patient. UpToDate. Waltham (MA): UpToDate Inc.; 2024. Accessed January 31, 2026.
Naik-Mathuria B. Liver, spleen, and pancreas injury in children with blunt abdominal trauma. UpToDate. Waltham (MA): UpToDate Inc.; 2025.Accessed January 31, 2026.
Moya Sánchez E, Medina Benítez A. Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis. Rev Esp Enferm Dig. 2017;109(6): 477–478. doi: 10.17235/reed.2017.4597/2016
Søeborg MD, Mølgaard AK, Dale M, HäänInfo D, Torup H. Atraumatic splenic rupture. Ugeskr Laeger. 2024;186(11): V05230328. Danish. doi: 10.61409/V05230328
Ghalib N, Pophali P, Chamorro-Pareja N, Jayarangaiah A, Kumar A. Incidental Asymptomatic Splenic Infarct in a COVID-19 Patient. Cureus. 2021;13(2): e13065. doi: 10.7759/cureus.13065
Toti JMA, Gatti B, Hunjan I, Kottanattu L, Faré PB, Renzi S, et al. Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review. Swiss Med Wkly. 2023;153: 40081. doi: 10.57187/smw.2023.40081
Wang CF, Launico MV. Splenic rupture. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Accessed January 31, 2026.
Santarelli J, Alattar R, Elmore LR, Gritsiuta AI, Henwood JR. Atraumatic splenic rupture: a case report. AME Case Rep. 2024;8:94. doi: 10.21037/acr-24-64.
Ahbala T, Rabbani K, Louzi A, Finech B. Spontaneous splenic rupture: case report and review of literature. Pan Afr Med J 2020;37:36. doi: 10.11604/pamj.2020.37.36.25635
El Wakeel AM, Habib RM, Ali AN. Role of CT in evaluation of blunt abdominal trauma. Int J Med Imaging. 2015;3(5): 89–93. doi: 10.11648/j.ijmi.20150305.11
Marietta M, Patel PJ, Zemaitis MR. Splenic abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Accessed January 31, 2026.
Yousef Khan F, Elmudathir A, Abu Bakir M, Alsawaf B. Splenic Abscess in Qatar: A Single-Center Experience. Qatar Med J. 2022;2022(1): 16. doi: 10.5339/qmj.2022.16
Ajmera A, Thio J, Al-Mulaabed S, Bornstein JA. Salmonella splenic abscess. JPGN Rep. 2024;6(1): 71-73. doi: 10.1002/jpr3.12145.
Wang W, Zhai WH, Zhang Y, Tao L, Li Y, Jiang TX, et al. Splenic abscess secondary to COVID-19 acute infection: A case report and literature review. Medicine (Baltimore). 2024;103(31): e39194. doi: 10.1097/MD.0000000000039194
Wu XY, Lee WS. Splenic abscess complicating thoracic empyema: A rare complication of salmonellosis. J Microbiol Immunol Infect. 2023;56(3): 649-651. doi:10.1016/j.jmii.2023.01.004.
Tan Y, Wang J, Sun L, Ye Y. Repeated partial splenic artery embolization for hypersplenism improves platelet count. Open Med (Wars). 2022;17(1): 808-815. doi: 10.1515/med-2022-0479.
Sulaiman S, Hafeeq B, Aziz F, Gopinathan J, Narayanan R, Rahman S, et al. Splenectomy Before Kidney Transplantation for Hypersplenism: A Case Report. Indian J Nephrol. 2024;34(5): 510-511. doi: 10.25259/ijn_268_23.
Shrestha SM. Splenomegaly and hypersplenism in hepatic vena cava syndrome. Hepatol Forum. 2021;2(2): 69-75. doi: 10.14744/hf.2021.2021.0008.
Bucsics T, Lampichler K, Vierziger C, Schoder M, Wolf F, Bauer D, et al. Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis. Dig Dis Sci. 2022;67(12): 5693-5703. doi: 10.1007/s10620-022-07443-6.
Zhang EL, Zhang ZY, Huang ZY. Splenectomy may facilitate systemic therapy for advanced hepatocellular carcinoma with hypersplenism. Hepatobiliary Surg Nutr. 2023;12(1): 137-139. doi: 10.21037/hbsn-22-545.
Liu P, Zhu SS, Cao XG, Kongkam P, Ullah S, Guo CQ. Endoscopic ultrasound-guided partial splenic embolization for hypersplenism: a novel alternative. Endoscopy. 2024;56(S 01): E144-E145. doi: 10.1055/a-2244-4009.
Carvalho M, Mendes J, Pereira-Macedo J, Vinagreiro M, Lemos R. Spontaneous Rupture of Splenic Artery Aneurysm. Cureus. 2023;15(12): e50937. doi: 10.7759/cureus.50937.
Kassem MM, Gonzalez L. Splenic artery aneurysm. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Accessed January 31, 2026.
Mesbahi M, Zouaghi A, Zaafouri H, Hadded D, Benzarti Y, Riahi W, et al. Surgical management of splenic artery aneurysm. Ann Med Surg (Lond). 2021;69: 102712. doi: 10.1016/j.amsu.2021.102712.
Liu C, Zhang Y, Cui Z. Hypersplenism caused by Caroli's disease. Asian J Surg. 2023;46(3): 1531-1532. doi: 10.1016/j.asjsur.2022.09.067
Shabunin AV, Bedin VV, Tavobilov MM, Karpov АA, Alieva FF. Giant splenic artery aneurysm: case report. J Vasc Bras. 2023;22: e20230108. doi: 10.1590/1677-5449.20230108
Kapoor SR, Wicks J, Sharma AK. Navigating tortuous collaterals during splenic artery aneurysm embolization. J Vasc Surg Venous Lymphat Disord. 2023;11(6): 1285. doi: 10.1016/j.jvsv.2023.05.006.
Xu Y, Wu Z. A case of a pregnant woman with a special splenic artery aneurysm. Malawi Med J. 2022;34(3): 220-222. doi: 10.4314/mmj.v34i3.13.
Eltweri AM, Basamh M, Ting YY, Harris M, Garcea G, Kuan LL. A retrospective multicentre clinical study on management of isolated splenic vein thrombosis: risks and benefits of anticoagulation. Langenbecks Arch Surg. 2024;409(1): 116. doi: 10.1007/s00423-024-03295-y
Ejikeme C, Elkattawy S, Kayode-Ajala F, Al-Nasseri A, Naik A. Acute Pancreatitis Induced Splenic Vein Thrombosis. Cureus. 2021;13(6): e15714. doi: 10.7759/cureus.15714.
Villanueva J, Chavez M, Christian NA, Pierre L, Sedrak A. Acute Pediatric Pancreatitis Presenting with Splenic Vein Thrombosis. Cureus. 2022;14(9): e29462. doi: 10.7759/cureus.29462.
Benjamin C, Bryant M, Tran T, Atalay RT, Ayele GM, Michael MB. The Need to Anticoagulate Patients With Splenic Vein Thrombosis. Cureus. 2022;14(7): e26488. doi: 10.7759/cureus.26488.
Füssel LM, Müller-Wille R, Dinkhauser P, Schauer W, Hofer H. Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review. World J Gastroenterol. 2023;29(24): 3922-3931. doi: 10.3748/wjg.v29.i24.3922.
Saliba T, Salame H, Tack D. Splenic and Portal Vein Thrombosis after Splenectomy: A Case Report. J Belg Soc Radiol. 2022;106(1): 126. doi: 10.5334/jbsr.2947.
Ogawa S, Yamamoto A, Jogo A, Nakano MM, Kageyama K, Sohgawa E, et al. Splenic Vein Diameter is a Risk Factor for the Portal Venous System Thrombosis After Partial Splenic Artery Embolization. Cardiovasc Intervent Radiol. 2021;44(6): 921-930. doi: 10.1007/s00270-020-02751-8.
Péré G, Basselerie H, Maulat C, Pitocco A, Leblanc P, Philis A, et al. Splenic volume and splenic vein diameter are independent pre-operative risk factors of portal vein thrombosis after splenectomy: a retrospective cohort study. BMC Surg. 2021 ;21(1): 366. doi: 10.1186/s12893-021-01364-3.
Referanslar
Mahadevan V. Anatomy of the pancreas and spleen. Surgery (Oxford). 2019;3(6): 297–299. doi: 10.1016/j.mpsur.2019.04.008
Aldulaimi S, Mendez AM. Splenomegaly: Diagnosis and management in adults. Am Fam Physician. 2016;94(8): 628–634. PMID: 34523897
Pasternack MS. Prevention of infection in patients with impaired splenic function. UpToDate Waltham (MA): UpToDate Inc.; 2025.Accessed January 31, 2026.
Ziogaite B, Contreras ET, Horgan JE. Incidence of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy surgery at a surgical specialty clinic: 182 cases (2017-2021). PLoS One. 2024;19(12): e0314737. doi: 10.1371/journal.pone.0314737
Maung AA, Kaplan LJ. Surgical management of splenic injury in the adult trauma patient. UpToDate. Waltham (MA): UpToDate Inc.; 2024. Accessed January 31, 2026.
Naik-Mathuria B. Liver, spleen, and pancreas injury in children with blunt abdominal trauma. UpToDate. Waltham (MA): UpToDate Inc.; 2025.Accessed January 31, 2026.
Moya Sánchez E, Medina Benítez A. Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis. Rev Esp Enferm Dig. 2017;109(6): 477–478. doi: 10.17235/reed.2017.4597/2016
Søeborg MD, Mølgaard AK, Dale M, HäänInfo D, Torup H. Atraumatic splenic rupture. Ugeskr Laeger. 2024;186(11): V05230328. Danish. doi: 10.61409/V05230328
Ghalib N, Pophali P, Chamorro-Pareja N, Jayarangaiah A, Kumar A. Incidental Asymptomatic Splenic Infarct in a COVID-19 Patient. Cureus. 2021;13(2): e13065. doi: 10.7759/cureus.13065
Toti JMA, Gatti B, Hunjan I, Kottanattu L, Faré PB, Renzi S, et al. Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review. Swiss Med Wkly. 2023;153: 40081. doi: 10.57187/smw.2023.40081
Wang CF, Launico MV. Splenic rupture. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Accessed January 31, 2026.
Santarelli J, Alattar R, Elmore LR, Gritsiuta AI, Henwood JR. Atraumatic splenic rupture: a case report. AME Case Rep. 2024;8:94. doi: 10.21037/acr-24-64.
Ahbala T, Rabbani K, Louzi A, Finech B. Spontaneous splenic rupture: case report and review of literature. Pan Afr Med J 2020;37:36. doi: 10.11604/pamj.2020.37.36.25635
El Wakeel AM, Habib RM, Ali AN. Role of CT in evaluation of blunt abdominal trauma. Int J Med Imaging. 2015;3(5): 89–93. doi: 10.11648/j.ijmi.20150305.11
Marietta M, Patel PJ, Zemaitis MR. Splenic abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Accessed January 31, 2026.
Yousef Khan F, Elmudathir A, Abu Bakir M, Alsawaf B. Splenic Abscess in Qatar: A Single-Center Experience. Qatar Med J. 2022;2022(1): 16. doi: 10.5339/qmj.2022.16
Ajmera A, Thio J, Al-Mulaabed S, Bornstein JA. Salmonella splenic abscess. JPGN Rep. 2024;6(1): 71-73. doi: 10.1002/jpr3.12145.
Wang W, Zhai WH, Zhang Y, Tao L, Li Y, Jiang TX, et al. Splenic abscess secondary to COVID-19 acute infection: A case report and literature review. Medicine (Baltimore). 2024;103(31): e39194. doi: 10.1097/MD.0000000000039194
Wu XY, Lee WS. Splenic abscess complicating thoracic empyema: A rare complication of salmonellosis. J Microbiol Immunol Infect. 2023;56(3): 649-651. doi:10.1016/j.jmii.2023.01.004.
Tan Y, Wang J, Sun L, Ye Y. Repeated partial splenic artery embolization for hypersplenism improves platelet count. Open Med (Wars). 2022;17(1): 808-815. doi: 10.1515/med-2022-0479.
Sulaiman S, Hafeeq B, Aziz F, Gopinathan J, Narayanan R, Rahman S, et al. Splenectomy Before Kidney Transplantation for Hypersplenism: A Case Report. Indian J Nephrol. 2024;34(5): 510-511. doi: 10.25259/ijn_268_23.
Shrestha SM. Splenomegaly and hypersplenism in hepatic vena cava syndrome. Hepatol Forum. 2021;2(2): 69-75. doi: 10.14744/hf.2021.2021.0008.
Bucsics T, Lampichler K, Vierziger C, Schoder M, Wolf F, Bauer D, et al. Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis. Dig Dis Sci. 2022;67(12): 5693-5703. doi: 10.1007/s10620-022-07443-6.
Zhang EL, Zhang ZY, Huang ZY. Splenectomy may facilitate systemic therapy for advanced hepatocellular carcinoma with hypersplenism. Hepatobiliary Surg Nutr. 2023;12(1): 137-139. doi: 10.21037/hbsn-22-545.
Liu P, Zhu SS, Cao XG, Kongkam P, Ullah S, Guo CQ. Endoscopic ultrasound-guided partial splenic embolization for hypersplenism: a novel alternative. Endoscopy. 2024;56(S 01): E144-E145. doi: 10.1055/a-2244-4009.
Carvalho M, Mendes J, Pereira-Macedo J, Vinagreiro M, Lemos R. Spontaneous Rupture of Splenic Artery Aneurysm. Cureus. 2023;15(12): e50937. doi: 10.7759/cureus.50937.
Kassem MM, Gonzalez L. Splenic artery aneurysm. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Accessed January 31, 2026.
Mesbahi M, Zouaghi A, Zaafouri H, Hadded D, Benzarti Y, Riahi W, et al. Surgical management of splenic artery aneurysm. Ann Med Surg (Lond). 2021;69: 102712. doi: 10.1016/j.amsu.2021.102712.
Liu C, Zhang Y, Cui Z. Hypersplenism caused by Caroli's disease. Asian J Surg. 2023;46(3): 1531-1532. doi: 10.1016/j.asjsur.2022.09.067
Shabunin AV, Bedin VV, Tavobilov MM, Karpov АA, Alieva FF. Giant splenic artery aneurysm: case report. J Vasc Bras. 2023;22: e20230108. doi: 10.1590/1677-5449.20230108
Kapoor SR, Wicks J, Sharma AK. Navigating tortuous collaterals during splenic artery aneurysm embolization. J Vasc Surg Venous Lymphat Disord. 2023;11(6): 1285. doi: 10.1016/j.jvsv.2023.05.006.
Xu Y, Wu Z. A case of a pregnant woman with a special splenic artery aneurysm. Malawi Med J. 2022;34(3): 220-222. doi: 10.4314/mmj.v34i3.13.
Eltweri AM, Basamh M, Ting YY, Harris M, Garcea G, Kuan LL. A retrospective multicentre clinical study on management of isolated splenic vein thrombosis: risks and benefits of anticoagulation. Langenbecks Arch Surg. 2024;409(1): 116. doi: 10.1007/s00423-024-03295-y
Ejikeme C, Elkattawy S, Kayode-Ajala F, Al-Nasseri A, Naik A. Acute Pancreatitis Induced Splenic Vein Thrombosis. Cureus. 2021;13(6): e15714. doi: 10.7759/cureus.15714.
Villanueva J, Chavez M, Christian NA, Pierre L, Sedrak A. Acute Pediatric Pancreatitis Presenting with Splenic Vein Thrombosis. Cureus. 2022;14(9): e29462. doi: 10.7759/cureus.29462.
Benjamin C, Bryant M, Tran T, Atalay RT, Ayele GM, Michael MB. The Need to Anticoagulate Patients With Splenic Vein Thrombosis. Cureus. 2022;14(7): e26488. doi: 10.7759/cureus.26488.
Füssel LM, Müller-Wille R, Dinkhauser P, Schauer W, Hofer H. Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis: A case report and literature review. World J Gastroenterol. 2023;29(24): 3922-3931. doi: 10.3748/wjg.v29.i24.3922.
Saliba T, Salame H, Tack D. Splenic and Portal Vein Thrombosis after Splenectomy: A Case Report. J Belg Soc Radiol. 2022;106(1): 126. doi: 10.5334/jbsr.2947.
Ogawa S, Yamamoto A, Jogo A, Nakano MM, Kageyama K, Sohgawa E, et al. Splenic Vein Diameter is a Risk Factor for the Portal Venous System Thrombosis After Partial Splenic Artery Embolization. Cardiovasc Intervent Radiol. 2021;44(6): 921-930. doi: 10.1007/s00270-020-02751-8.
Péré G, Basselerie H, Maulat C, Pitocco A, Leblanc P, Philis A, et al. Splenic volume and splenic vein diameter are independent pre-operative risk factors of portal vein thrombosis after splenectomy: a retrospective cohort study. BMC Surg. 2021 ;21(1): 366. doi: 10.1186/s12893-021-01364-3.
