Splenic abscess and sickle cell disease

Abstract

This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease (SCD). All presented with fever and abdominal pain and were found to have a tender enlarged spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation. Although both ultrasound and CT-scan of the abdomen were of diagnostic value, we found CT-scan more accurate and reliable in the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be used routinely in the evaluation of SCD patients who present with fever and abdominal pain, especially if they have a tender enlarged spleen. Diagnostic aspiration under CT-scan or ultrasound guidance should be used in doubtful cases to differentiate between splenic abscess and a large splenic infarct. All our patients were managed by peri operative antibiotics and splenectomy with no mortality. Salmonella was the commonest causative organism. Although CT-guided aspiration of splenic abscess is being advocated recently, we feel splenectomy should be the treatment of choice in patients with SCD as there is no point in preserving a non-functioning spleen that is present in the majority of patients. CT-guided aspiration may be employed as a temporary measure for those patients who are at high surgical risk with unilocular abscess. Am.

Indications and complications of splenectomy for children with sickle cell disease

“…Persistence of splenomegaly in our patients, however, predisposes them to the development of splenic infarction. The early development of functional asplenia in these patients makes them liable to systemic infections and, in the presence of splenic infarction, predisposes them to the development of SA [7]. Seven of our patients had splenectomy for SA, which remains a diagnostic challenge.…”

Splenic Complications of Sickle Cell Anemia and the Role of Splenectomy

“…It is commonly enlarged during the first decade of life but then undergoes progressive atrophy as a result of repeated attacks of vasoocclusion and infarction leading to autosplenectomy (Figure 1). This, however, is not the case always and sometimes splenomegaly persists into an older age group or even into adulthood necessitating splenectomy for a variety of reasons including acute splenic sequestration crisis, hypersplenism, massive splenic infarction and splenic abscess [8–14]. Splenic complications of SCA are associated with an increased morbidity and in some it may lead to mortality.…”

Splenic Syndrome due to Sickle Cell Trait amongst Indian Soldiers Serving in Kashmir

“…Acute splenic sequestration crisis, hypersplenism, and massive splenomegaly are surgical complications of sickle cell trait as well as disease [10]. Splenic abscess may complicate an infarct and may lead to septicemia and rupture, more so with sickle cell disease [11][12][13][14][15]. All the spleens removed from our patients revealed vascular occlusion by aggregates of sickled red blood cells with evidence of infarction.…”