Splenic abscess is an uncommon entity. The preoperative diagnosis of splenic abscess is difficult in view of its rarity, obscure etiology, and nonspecific clinical presentation. Except for Gonococcus, every conceivable pyogenic organism has been incriminated as a cause of splenic abscess. The high mortality reported in the antibiotic era makes early diagnosis necessary.' Ultrasound and computed tomography (CT) have made early detection of splenic abscess possible.We present a case of amebic splenic abscess associated with multiple hepatic abscesses and peritonitis, demonstrated on ultrasound. To the best of our knowledge, amebic splenic abscess has not been described previously.
CASE REPORTA 40-year-old man, previously in good health, presented with a 20-day history of fever. Pain and distension of the abdomen were noticed 2 days prior to admission. There was no history of loose bowel movements in the recent past. The patient looked toxic and his general condition was poor. Physical examination revealed guarding and rigidity of the abdomen. Proper examination of the abdomen, to look for any organomegaly, could not be performed due to rigidity. Clinical diagnosis of peritonitis was made and conservative treatment was started. Routine laboratory tests showed only a slight increase in SGOT, SGPT, serum bilirubin, and serum alkaline phosphatase levels (22 mU/ml, 25 mU/ml, 2 mg%, 22 KA units, respectively; upper limit of normal, SGOT 18 mU/ml, SGPT 22 mU/ml, serum bilirubin 0.8 mg%, serum alkaline phosphatase 13 KA units). Blind needle aspiration from the right flank revealed 1500 ml chocolate- colored pus. After seeing the color of the pus, ultrasound was advised.Ultrasound examination of the abdomen, using an EDP 1200, Technicare, B-mode real-time scanner with a 5-MHz transducer, showed multiple, anechoic space-occupying lesions with posterior enhancement involving both lobes of the liver. The walls of the lesion were irregular (Fig. 1). There was also evidence of free echogenic fluid in the abdomen. Surprisingly, routine splenic examination revealed an echogenic lesion, with posterior enhancement (Fig. 2). It had an irregular wall and measured 5.2 cm x 6.2 cm x 6.3 cm. Needle aspiration, under sonoguidance of liver, peritoneum, and spleen revealed chocolate-colored pus, suggestive of amebic pathology. Pathologic examination of the pus confirmed the presence of Entamoeba histolytica. The patient was kept on specific antiamebic therapy, but succumbed to his illness.
DISCUSSION
