S6320 Outcomes of Partial Splenic Embolization for Severe Thrombocytopenia in Decompensated Cirrhosis: A Single Center Case Series

Introduction: Thrombocytopenia in decompensated cirrhosis increases risk for bleeding which can delay critical procedures. Treatment options include platelet transfusion, partial splenic embolization (PSE), and splenectomy. While PSE is minimally invasive, there are complications, most commonly post-embolization syndrome. In this case series of 4 cirrhotic patients who underwent PSE, all 4 developed peritonitis and 2 developed abscesses. Case Description/Methods: We describe 4 decompensated cirrhotic patients with ascites who underwent PSE for thrombocytopenia at our institution between 1/1/2025 and 3/1/2025. Case 1: A 55-year-old man with hepatitis C virus (HCV) cirrhosis was admitted for worsening ascites. Initial platelet count was 6,000/µL and did not improve with platelet transfusion. He underwent PSE and platelets improved to 431,000/µL. However, he developed new peritonitis post-PSE. He was treated with antibiotics and discharged after a 30-day hospital stay. Case 2: A 62-year-old man with autoimmune cirrhosis and prior transjugular intrahepatic portosystemic shunt (TIPS) was admitted with hematemesis treated with banding of esophageal varices (EV). Initial platelet count was 56,000/µL. He underwent unsuccessful traversal of TIPS due to chronic occlusion as well as PSE. Platelets improved to 315,000/µL. However, he developed new persistent peritonitis post-PSE, with enterococcus faecalis growth. Imaging showed infarcted spleen with a large fluid collection, requiring drainage. He died 1 day after discharge to hospice. Case 3: A 78-year-old woman with metabolic dysfunction-associated steatohepatitis cirrhosis and hepatocellular carcinoma was admitted for abdominal pain after liver lesion cryoablation and PSE. Platelet count prior to PSE was 15,000/µL, which improved to 296,000/µL. Paracenteses confirmed peritonitis, which persisted despite prolonged antibiotic treatment. She was discharged after a 22-day hospital stay. Case 4: A 43-year-old man with HCV cirrhosis was admitted for hematemesis treated with EV banding. Initial platelet count was 55,000/µL. He underwent PSE 1 day prior to discharge. He then had repeat PSE for persistent thrombocytopenia and was readmitted with peritonitis. Platelets were 288,000/µL. 16S rRNA sequencing on ascitic fluid was positive for Robinsoniella peoriensis. One month later he developed large intraperitoneal abscess, requiring drainage. Discussion: This case series demonstrates that while PSE is effective in resolving thrombocytopenia in patients with decompensated cirrhosis and ascites, peritonitis is a serious complication that may limit its use in this specific patient population.