This article presents a combined literature overview and a three-case clinical series highlighting the diagnostic complexity and therapeutic decision-making in splenic arterial and venous thrombosis. Although splenic infarction is a rare cause of acute abdominal pain, the article emphasizes its high clinical significance and its association with systemic thromboembolic disease, atrial fibrillation, hematologic disorders, hypercoagulable states, pancreatitis, and splanchnic venous thrombosis. The literature summarized by the authors underscores the modern shift toward non-operative management in hemodynamically stable patients without rupture or infectious complications. Contemporary multicenter data demonstrate a substantial survival benefit from anticoagulation in splenic infarction, without an associated increase in bleeding risk. Conversely, surgery is now reserved for complicated cases, including splenic rupture, abscess formation, or secondary peritonitis. Regarding isolated splenic vein thrombosis, the authors discuss evolving evidence showing high rates of spontaneous or anticoagulation-related recanalization and low rates of variceal bleeding, suggesting that routine splenectomy is no longer indicated except in cases complicated by infection. The article’s three clinical cases exemplify these principles. It is concluded that the decisive factor in treatment selection is not the presence of thrombosis alone, but the development of complications, especially abscess, rupture, sepsis, and peritonitis. In uncomplicated cases, anticoagulation remains safe and effective, while surgery should be used selectively for life-threatening sequelae.
Tomadze et al. (Fri,) studied this question.