Splenic Abscess: An Easily Overlooked Disease?

Abstract

Splenic abscess is an uncommon but potentially life-threatening disease. Recent advances in radiology have affected the diagnosis and management of this disease entity. The purpose of this study was to review our experience in managing these patients. We retrospectively reviewed the medical records of 51 patients with splenic abscess as seen in a tertiary medical center between 1998 and 2003. We analyzed the demographics, clinical manifestations, etiology, predisposing factors, diagnostic modalities, bacteriologic profile, treatment, and outcome of these patients. The mean age was 59.9 ± 14.2 years (ranging from 21–89 years). The male:female ratio was 29:22. Common symptoms included fever (82%), abdominal pain (71%), and nausea and vomiting (46%). The majority of these patients (83%) had leukocytosis. Thirty-six patients had associated parenchymal liver diseases and 26 patients had diabetes mellitus. Abdominal sonogram or computed tomography was performed to establish the diagnosis. Most cultures from the abscess cavities grew gram-negative enteric bacilli. Patients were treated with antimicrobial therapy only (n = 33), additional percutaneous drainage with a pigtail catheter (n = 11), or splenectomy (n = 7), and the survival rates were 48 per cent, 45 per cent, and 100 per cent, respectively. Splenic abscess should be considered in a patient with fever, left upper abdominal pain, and leukocytosis. Splenectomy appears to have better treatment outcome than percutaneous drainage or intravenous antibiotics alone.

Delayed splenic abscess after blunt abdominal trauma in the 24- year-old woman: diagnostic difficulties and dilemma

“…For making the correct diagnosis of splenic abscess taking a good history and performing physical examination are necessary but not sufficient and reliable, however they certainly help for differential diagnosis. Elevated left hemi-diaphragm, pleural effusion and abnormal chest radiographs were reported in literature, but in our patient in the first chest X-ray no pleural effusion or elevation of diaphragm were reported [6,8]. Plain Abdominal X-ray could demonstrate gas collection in the left upper quadrant, as in our patient this finding was reported after first laparoscopy.…”

“…Percutaneous drainage has been suggested as the first line of treatment to avoid splenectomy [6]. Although multilocular abscesses, necrotic debris and illdefined cavities seems to be not responsive to percutaneous drainage and surgery intervention is necessary [6][7][8][9][10].In our patient ambiguity in the accurate detection of splenic abscess leads to early surgery intervention. Open splenectomy is a standard choice of treatment of splenic abscess with a mortality rate of 0-17%, but laparoscopic splenectomy is also a safe method in selected patients [5,6].…”

“…Open splenectomy is a standard choice of treatment of splenic abscess with a mortality rate of 0-17%, but laparoscopic splenectomy is also a safe method in selected patients [5,6]. After splenectomy, treatment by broad-spectrum antibiotics is effective for full recovery from the disease [6,8]. Fig-1: Aggregation of omentum in the left upper quadrant of abdomen with venous congestion and also colonic inflammation.…”

Organ preservation in splenic abscess

“…3 Most cases, unlike our patient, are seen in adults and the mean age reported in one study was 59.9 AE 14.2 years (ranging from 21 to 89 years). 4 While splenic abscesses may arise occasionally from contiguous spread of infection or from direct trauma to the spleen, hematogenous spread of infection is more common. Bacterial endocarditis is the most common associated infection.…”

Isolated splenic tuberculosis presenting with splenomegaly and pyrexia of unknown origin

“…Splenic abscess is associated with parenchymal liver disease and diabetes mellitus and affects age group >50 years 3 . PUO as a result of tuberculosis is more common in patients >65 years old and those with HIV infection 4 . Despite rapid advances in detection facility of tuberculosis, invasive techniques, for example, biopsy by endoscopy or operation, are needed in many cases to establish the diagnosis.…”