Splenic abscess in children: A report of three patients

Abstract

Splenic abscess is uncommon in paediatric age group. It usually occurs in conditions of disseminated infective focus. Conventional treatment of abscess is incision and drainage, although splenectomy or splenic conservation is alternative. In this report, we are presenting case summaries of three patients suffering from splenic abscess. A retrospective review of three children was managed for splenic abscess in our institution.All three patients presented with pyrexia, weight loss, and recurrent abdominal pain for more than six weeks. Human immunodeficiency virus (HIV) antibody detection test (ELISA) was nonreactive in all of them. The first patient was managed by splenectomy because of multiple splenic abscesses involving the entire spleen; the second one had exploratory laparotomy and drainage of splenic abscess with preservation of the spleen; and the third patient had successful ultrasonic guided aspiration of abscess. The follow-up ultrasonography done after three and six months in two patients, with splenic conservation, did not reveal any recurrence of abscess. In children with splenic abscess, ultrasound guided aspiration of abscess should be the first line of treatment, when this fails either because of multiple abscesses or dense adhesions around the spleen then splenectomy or open drainage may become necessary.

Pneumococcal Sepsis Complicated by Splenic Abscesses and Purpura Fulminans in a 15-Month-Old Child

“… 3 Early recognition is crucial because the mortality rate in patients with splenic abscesses left untreated can reach up to 100%. 2 Common findings include fever, left-upper-quadrant or diffuse abdominal pain, splenomegaly, and leukocytosis. 3 Our patient had splenomegaly, abdominal tenderness, and persistent fevers despite being on adequate antibiotic therapy.…”

“…The predisposing factors for splenic abscesses include malignant or contagious spread, hematological disorders such as sickle cell disease, immunodeficiency, and direct splenic trauma. 2 Alcoholism was identified as a risk factor for developing intra-abdominal abscesses in adults with IPD. 4 There was no history of splenic trauma, and neither was there evidence of immune dysfunction found on laboratory evaluation that would have made her more susceptible to IPD.…”

“…Splenic-preserving therapies such as partial splenectomy or interventional radiological guide needle aspiration are now preferred over splenectomy in the pediatric age group to avoid overwhelming postsplenectomy infections. 2 We elected to treat with prolonged antibiotic therapy to avoid the possibility of these infections. In addition, the presence of multiple abscesses made needle aspiration difficult because this would likely require multiple interventions, increasing the risk of complications such as bleeding or seeding infection into the pleural space.…”

“…1 Splenic abscesses are rare in the pediatric population. 2 Early recognition and intervention are critical because of the high mortality rate associated with delayed diagnosis. 3 Splenic abscesses and purpura fulminans (PF) are rare complications of IPD.…”

Aseptic Splenic Abscess as Precursory Extraintestinal Manifestation of Inflammatory Bowel Disease

“…The signs and symptoms of splenic abscess are nonspecific and may include fever, abdominal pain, and leukocytosis [9, 17, 21, 22]. The causative organisms in most reports are aerobic bacteria such as Streptococcus , Staphylococcus , and Enterococcus or anaerobic bacteria such as Escherichia coli [9–12].…”