Bilateral Popliteal Arterial Occlusion Following Splenectomy in a High-Risk Patient: A Case Report

Splenectomy is performed for various indications, including trauma, hematologic disorders, infections, and malignancies, and is associated with risks such as infection and sepsis.Increasing evidence suggests that splenectomy may also predispose patients to thromboembolic complications through systemic inflammation, postoperative hypercoagulability, and reactive thrombocytosis.While venous thromboembolic events are well recognized, acute peripheral arterial thrombosis after splenectomy is rare.We report a 63-year-old woman with uncontrolled type 2 diabetes mellitus, hypertension, and obesity (body mass index 38.3kg m -2 ) who was diagnosed with a multifocal splenic abscess and underwent emergency splenectomy due to inadequate source control.Standard postoperative care, including prophylactic enoxaparin and early mobilization, was initiated; however, inflammatory markers remained elevated.On postoperative day four, the patient developed acute bilateral lower extremity pain with sensory and motor deficits and absent distal pulses.Computed tomography angiography revealed bilateral popliteal artery occlusion.Emergency bilateral popliteal embolectomy restored arterial perfusion.Cardiac evaluation excluded intracardiac thrombus, infective endocarditis, patent foramen ovale, and atrial fibrillation.Platelet counts showed mild reactive thrombocytosis.This case highlights a rare presentation of acute bilateral peripheral arterial thrombosis following splenectomy and underscores the importance of vigilance for arterial thromboembolic complications in high-risk patients.