Post-Splenectomy Abdominal Distension in Elderly Patient

Case at a Glance

A 75-year-old female presents with severe, recurrent abdominal bloating and distension occurring three years post-splenectomy, significantly impacting her mobility and quality of life.

Patient's Story

The patient underwent splenectomy three years prior due to an autoimmune condition. Post-operatively, she developed severe and recurrent abdominal bloating with visible distension. The bloating causes significant discomfort and has severely impacted her ability to ambulate. The patient weighs 140 pounds and has a medical history significant for atrial fibrillation diagnosed one year ago. She reports that the bloating symptoms preceded the cardiac arrhythmia diagnosis.

Initial Assessment

Physical examination revealed visible abdominal distension during episodes of bloating. The patient appeared uncomfortable and reported difficulty with ambulation during symptomatic periods. Vital signs were stable, and the patient was alert and oriented.

The Diagnostic Journey

Magnetic resonance imaging (MRI) of the abdomen was performed but failed to identify a clear etiology for the patient's symptoms. Multiple medical consultations were sought, including attempted referral to a tertiary care center, but no definitive diagnosis was established. The temporal relationship between the splenectomy and onset of symptoms was noted but remained unexplained.

Final Diagnosis

Post-splenectomy abdominal distension of unknown etiology. The exact pathophysiological mechanism remains unclear despite extensive evaluation.

Treatment Plan

Symptomatic management was initiated. The patient continues on anticoagulation therapy and antiarrhythmic medication for atrial fibrillation management. Further evaluation of bowel function and motility was recommended to assess for potential gastrointestinal causes of the distension.

Outcome and Follow-up

The patient continues to experience episodes of severe abdominal bloating with associated functional impairment. Long-term follow-up is planned to monitor symptom progression and reassess diagnostic options. Investigation into bowel movement patterns and gas passage was initiated as part of the ongoing evaluation.