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1
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Elshair M, Hara K, Kuwahara T, Okuno N, Haba S, Soliman G, Massoud A. Utility of stent-in-stent technique in management of post-pancreatitis splenic abscess using forward-viewing echoendoscope. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:e40-e41. [PMID: 34053195 DOI: 10.1002/jhbp.1002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Moaz Elshair
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Gamal Soliman
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ahmed Massoud
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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2
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Pavlidis ET, Martzivanou EK, Symeonidis NG, Psarras KK, Marneri AG, Stavrati KE, Pavlidis TE. A case of acute abdomen caused by spontaneous rupture of a splenic abscess secondary to cancer of the splenic flexure. J Surg Case Rep 2021; 2021:rjab048. [PMID: 33868635 PMCID: PMC8043107 DOI: 10.1093/jscr/rjab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 02/05/2023] Open
Abstract
Splenic abscesses are rare, difficult to diagnose, difficult to treat and usually appear in immunosuppressed patients. We present the case of a 64-year-old patient with left pleuritic chest pain, anorexia and fever with rigors diagnosed with splenic abscess due to splenic flexure colon cancer. The abscess spontaneously ruptured and the patient was operated on for acute abdomen. Splenectomy and Hartmann's hemicolectomy were performed. The patient was discharged from the hospital and referred to the oncologic department. Continuous spread of infection and especially initiating from a cancer lesion is a usual mechanism of splenic abscess formation. Although computed tomography-guided percutaneous drainage is the treatment of choice, an exploratory laparotomy was necessary in this case because of the rupture of the abscess. It is important for the clinicians to include splenic abscesses and their complications in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Efstathios T Pavlidis
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Eirini K Martzivanou
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Kyriakos K Psarras
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Alexandra G Marneri
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Kalliopi E Stavrati
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
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3
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Bhullar AA, Canders CP, Rouhani A, Lai S. Splenic abscess leading to spontaneous splenic rupture. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous, atraumatic rupture of the spleen is an uncommon but potentially fatal cause of acute abdominal pain. Splenic abscesses are equally rare and can be a risk factor for spontaneous splenic rupture. We present a 45-year-old man with no past medical or surgical history who presented with acute worsening of left upper abdominal pain that had been present for months, who was discovered to have a ruptured spleen. Splenic abscess was discovered intra-operatively and was thought to have developed after dental work. Recognizing presenting features of spontaneous splenic rupture and understanding its potential causes, such as splenic abscesses, may prevent delayed or missed diagnosis and guide treatment, which typically includes emergent splenectomy.
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4
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Alnasser SA, Mindru C, Preventza O, Rosengart T, Cornwell L. Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis. Ann Thorac Surg 2018; 107:e235-e237. [PMID: 30326233 DOI: 10.1016/j.athoracsur.2018.08.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
The spleen is the most common abdominal site for systemic septic emboli that often complicate infective endocarditis. Management of an embolic splenic abscess usually involves surgical splenectomy or image-guided drainage, but the natural history of splenic abscess without drainage is unknown. We describe the successful conservative treatment of a large complex splenic abscess with antibiotics alone in a patient with aortic valve infective endocarditis who required an emergent valve replacement surgical procedure. Previous complex abdominal wall operation with the presence of a synthetic mesh made abdominal surgical intervention unfavorable. The splenic abscess resolved completely with no recurrence of infection at the 3-year follow-up.
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Affiliation(s)
- Saleh A Alnasser
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Cezarina Mindru
- Department of Internal Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Todd Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas
| | - Lorraine Cornwell
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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5
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Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne 2017; 38:614-618. [PMID: 28196700 DOI: 10.1016/j.revmed.2016.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/23/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.
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Affiliation(s)
- B Davido
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - A Dinh
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Rouveix
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - P Crenn
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Service de gastro-entérologie, nutrition transversale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - J Salomon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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6
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Tuğcu M, Ruhi Ç, Boynueğri B, Kasapoğlu U, Can Ö, Kiliçoğlu G, Şahin G, Titiz M. Successful Ultrasound-Guided Percutaneous Drainage of Multiple Splenic Abscesses in a Kidney Transplant Patient With Encapsulated Sclerosing Peritonitis: A Case Report. Transplant Proc 2016; 47:1531-3. [PMID: 26093760 DOI: 10.1016/j.transproceed.2015.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Differential diagnosis of post-transplant infections should include rare/uncommon foci and pathogens. We present a rare case of life-threatening infection, a splenic abscess in a 53-year-old woman who was transplanted with a cadaveric kidney 5 months previously. The patient was admitted to our clinic with chills, shivering, and fever. She required a kidney transplant because of end-stage renal disease secondary to systemic lupus erythematosus, which had previously been treated by means of peritoneal dialysis for 7 years, until encapsulated sclerosing peritonitis developed, at which time therapy was changed to hemodialysis for 1 year. On physical examination, the patient was slightly lethargic and had tenderness in the left upper quadrant of the abdomen. Laboratory evaluation revealed leukocytosis and high acute phase reactant. Abdominal ultrasonography (US) revealed multiple abscesses in the spleen, but splenectomy was not recommended because of her history of sclerosing peritonitis. Percutaneous drainage catheters were placed under US guidance. Culture of blood and fluid drained from the abscess revealed imipenem-sensitive Escherichia coli and Klebsiella spp. Imipenem (500 mg IV q6hr) was initiated, and the drainage volume was 40 to 50 mL/day in the first week and gradually decreased through the third week. The abscess was completely drained over a period of 6 weeks, as confirmed by computed tomography; percutaneous catheters were then removed. Although splenic abscesses are life-threatening, especially for immunocompromised patients, this case suggests that percutaneous drainage guided by US or computed tomography is an efficient treatment alternative to splenectomy.
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Affiliation(s)
- M Tuğcu
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | - Ç Ruhi
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - B Boynueğri
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Kasapoğlu
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ö Can
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - G Kiliçoğlu
- Radiology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - G Şahin
- Nephrology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - M Titiz
- General Surgery and Transplantation Department, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
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7
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Ismail E, El Barni R, Lahkim M, Rokhsi R, Atmane E, El Fikri A, Bouchama R, Achour A, Zyani M. Splenic abscess in cancer chemotherapy. BMC Res Notes 2015; 8:665. [PMID: 26559779 PMCID: PMC4641425 DOI: 10.1186/s13104-015-1655-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Splenic abcess is an uncommon complication for cancer treatment. It occurs more frequently in immunocompromised patients. They are characterized by high mortality. The classic triad (fever, pain of the left hypochondrium, and sensitive mass left) is only present in one-third of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss, abdominal pain left, splenomegaly. Treatment options are limited, but must be discussed and adapted to the patient profile. CASE PRESENTATION We report the case of a 62-year-old Arabic male, diagnosed with metastatic lung adenocarcinoma, who, after several cycles of chemotherapy, presented symptoms and signs of splenic abcess. CONCLUSION Splenic abcess is rare situation, which must be actively researched, to have access to an optimal therapeutic approach.
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Affiliation(s)
- Essadi Ismail
- Medical Oncology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Rachid El Barni
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Mohamed Lahkim
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Redouane Rokhsi
- Radiology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Elmehdi Atmane
- Radiology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | | | - Rachid Bouchama
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Abdessamad Achour
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Mohamed Zyani
- Internal Medicine Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
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8
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Faruque AV, Qazi SH, Arshad M, Anwar N. Isolated splenic abscess in children, role of splenic preservation. Pediatr Surg Int 2013; 29:787-90. [PMID: 23811935 DOI: 10.1007/s00383-013-3336-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Splenic abscess (SA) is rare life threatening clinical condition in children. Diagnosis is delayed because of its non-specific clinical presentation. It has a high mortality rate even in the era of antibiotics. This study aim to determine the role of splenic preservation in the management of isolated splenic abscess in children, and to compare different treatment modalities for it. METHODS A retrospective cross-sectional study of 20 years was conducted including all children <14 years of age with the principal diagnosis of "Splenic abscess". We have excluded all splenic abscesses occurring after penetrating or blunt abdominal trauma. RESULTS Total of 17 children were managed during the study period. Most of our patients were older than 10 years of age. Majority of patients had a significant delay in presentation. Fever, abdominal pain, and vomiting were the main mode of presentation. Splenomegaly on abdominal examination was present in 12 patients. 15 (88 %) children were managed conservatively; however, 2 children required surgical intervention. CONCLUSION Splenic abscess in children is a rare disease and its diagnosis is often delayed. Delay in diagnosis of SA in children can lead to life threatening complications. A high index of suspicion is needed to reduce delay in diagnosis. Children presenting with non-specific high grade fever vomiting and abdominal pain should be evaluated for SA. Timely ultrasound and CT scan will lead to earlier diagnosis. A conservative approach with intravenous antibiotics and early percutaneous drainage especially in immunocompetent children can preserve spleen to continue immune function.
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9
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Tatsumi G, Watanabe M, Kaneko H, Hirata H, Tsudo M. Multiple splenic abscesses in 2 patients with myelodysplastic syndrome. Intern Med 2012; 51:1573-7. [PMID: 22728493 DOI: 10.2169/internalmedicine.51.7267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Splenic abscess is a rare clinical condition with a high mortality rate. Multiple splenic abscesses, rather than a solitary abscess, are present in immunocompromised states including hematological malignancies. As symptoms of splenic abscesses, fever and abdominal pain, are non-specific, timely and adequate use of imaging studies is crucial for early diagnosis. We report the cases of 2 patients with myelodysplastic syndrome and multiple splenic abscesses. Notwithstanding the higher mortality rate of patients with multiple splenic abscesses as compared with those with a solitary splenic abscess, we successfully treated the 2 patients by using antibiotic therapy and fine needle aspiration.
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Affiliation(s)
- Goichi Tatsumi
- Department of Hematology, Osaka Red Cross Hospital, Japan.
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10
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Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G. A retrospective study of 75 cases of splenic abscess. Indian J Surg 2011. [PMID: 23204694 DOI: 10.1007/s12262-011-0370-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Splenic abscess is an uncommon and life-threatening condition. Due to its nonspecific clinical picture, it remains a diagnostic challenge. Multiple radiological modalities are used for the diagnosis. In this retrospective study we analyzed 75 patients treated between 1999 and 2009. The patients were divided into three groups depending on the treatment received. Group I (n = 14) consisted of patients treated with only antibiotics, Group II (n = 19) patients were treated with percutaneous drainage and Group III (n = 42) with splenectomy. We tried to establish epidemiologic and clinical features and therapeutic options in splenic abscess. Our study suggests that percutaneous drainage is a safe and effective alternative to surgery especially in unilocular or bilocular abscesses thus allowing preservation of the spleen. It should be considered as the first line of treatment although splenectomy remains the final definitive procedure if percutaneous drainage fails.
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Affiliation(s)
- H Sreekar
- Department of Plastic Surgery, Christian Medical College, Vellore, 632004 India
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11
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Piplani S, Nandi B, Ganjoo RK, Madan R, Chander BN. Two Cases of Salmonella Splenic Abscess. Med J Armed Forces India 2011; 62:77-8. [PMID: 27407854 DOI: 10.1016/s0377-1237(06)80167-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 07/26/2005] [Indexed: 11/17/2022] Open
Affiliation(s)
- S Piplani
- Classified Specialist (Med) and Oncologist, Command Hospital, Air Force, Bangalore
| | - B Nandi
- Classified Specialist (Med) and Gastroenterologist, Command Hospital, Air Force, Bangalore
| | - R K Ganjoo
- Air Officer Commanding, AFCME, New Delhi
| | - R Madan
- Graded Specialist (Pathology) and Oncopathologist, Command Hospital, Air Force, Bangalore
| | - B N Chander
- Senior Advisor (Radiodiagnosis), Command Hospital, Air Force, Bangalore
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12
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Al-Salem AH. Splenic complications of sickle cell anemia and the role of splenectomy. ISRN HEMATOLOGY 2010; 2011:864257. [PMID: 22084706 PMCID: PMC3200071 DOI: 10.5402/2011/864257] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 10/10/2010] [Indexed: 01/29/2023]
Abstract
Sickle cell disease is one of the common hemoglobinopathies in the world. It can affect any part of the body and one of the most common and an early organ to be affected in SCA is the spleen. It is commonly enlarged during the first decade of life but then undergoes progressive atrophy leading to autosplenectomy. This however is not the case always and sometimes splenomegaly persist necessitating splenectomy for a variety of reasons including acute splenic sequestration crisis, hypersplenism, massive splenic infarction and splenic abscess. Splenic complications of SCA are known to be associated with an increased morbidity and in some it may lead to mortality. To obviate this, splenectomy becomes an essential part of their management. This review is based on our experience in the management of 173 children with various splenic complications of SCA necessitating splenectomy.
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Affiliation(s)
- Ahmed H. Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, P.O. Box 61015, Dammam, Qatif 31911, Saudi Arabia
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13
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Breuer C, Janssen G, Laws HJ, Schaper J, Mayatepek E, Schroten H, Tenenbaum T. Splenic infarction in a patient hereditary spherocytosis, protein C deficiency and acute infectious mononucleosis. Eur J Pediatr 2008; 167:1449-52. [PMID: 18604554 DOI: 10.1007/s00431-008-0781-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Revised: 05/28/2008] [Accepted: 06/03/2008] [Indexed: 12/01/2022]
Abstract
Splenic infarction is a common cause of left upper quadrant pain and must be suspected in patients with hematologic or thromboembolic conditions and signs of localized or systemic inflammation. Although several mechanisms have been proposed for splenic infarction in patients with various hematologic disorders, hereditary spherocytosis (HS) is usually not associated with an increased risk for thromboembolic events. We report a 13-year-old male with HS who was referred to our hospital with a 4-day history of fever and left upper quadrant pain. Ultrasound scans and magnetic resonance imaging showed lesions suggestive of splenic infarction. Initially, antibiotic treatment was started because secondary infection was suspected. However, 1 week after admission the patient developed typical clinical signs of acute infectious mononucleosis. Further laboratory work up confirmed the diagnosis of acute Epstein-Barr virus infection and additionally revealed protein C deficiency. This association has not been reported previously and may have contributed to the development of splenic infarction. Since infectious mononucleosis is a common cause for clinical consultations in adolescence, physicians caring for children with hematologic disorders should be particularly aware of those possible complications.
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Affiliation(s)
- Christian Breuer
- Pediatric Infectious Diseases, Department of General Pediatrics, University Children's Hospital, Heinrich-Heine-University, Dusseldorf, Germany
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14
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Ng CY, Leong EC, Chng HC. Ten-year Series of Splenic Abscesses in a General Hospital in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n9p749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Splenic abscess is an uncommon clinical problem. Traditionally, the “gold standard” treatment has been splenectomy. However, there is increasing use of non-operative treatments worldwide.
Materials and Methods: A 10-year (1996-2005) retrospective review of case records from a single centre (an 800-bed general hospital) was performed. Information regarding demographics, clinical presentation, aetiological agents and management was gathered and analysed.
Results: There were 21 cases from 1996 to 2005. Nineteen (90%) had multiple abscesses. Disseminated melioidosis was the most common aetiological agent (15 cases, 71%). Only 3 patients underwent splenectomy. The remainder were treated conservatively with antibiotics. Almost all the patients (19, 90%) also suffered from diabetes mellitus.
Conclusions: The most common aetiological agent encountered was Burkholderia pseudomallei. Diabetes mellitus may be an important co-factor in the pathogenesis of splenic abscesses. The majority of our patients were managed conservatively and splenectomy was only occasionally required.
Key words: Burkholderia pseudomallei, Splenectomy
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15
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Abstract
Splenic abscess is not an uncommon complication of patients with sickle-cell disease. Here we describe an 18 year-old boy with sickle cell disease and left upper quadrant abdominal pain. Computerized axial tomography revealed left sided free flowing pleural effusion and splenomegaly with liquefaction and possible gas formation. The splenic fluid grew an unusual organism known as Bacteroides distasonis. The patient received antimicrobial therapy and underwent a splenectomy with full recovery. The spleen was cystically infarcted and measured 22 x 16 x 5 cm. The capsule was thickened and covered by fibrinous exudate. Histopathologic examination of the spleen showed complete necrosis with reparative fibrosis. This case presents an unusual cause of splenic abscess due to Bacteroides distasonis with a subacute to chronic course. The presence of fever and left sided pleuritic chest pain in patients with sickle cell disease should raise the suspicion of splenic abscess.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Internal Medicine Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia.
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16
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Delis SG, Maniatis PN, Triantopoulou C, Papailiou J, Dervenis C. Splenic abscess in a patient with fecal peritonitis. World J Gastroenterol 2007; 13:1626-7. [PMID: 17461461 PMCID: PMC4146911 DOI: 10.3748/wjg.v13.i10.1626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Splenic abscess is a rare entity normally associated with underlying diseases. We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation. The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis. Splenic abscess has a high rate of mortality when it is diagnosed late. Computed tomography resolved any diagnostic doubt, and subsequent surgery confirmed the diagnosis.
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Affiliation(s)
- Spiros G Delis
- Liver Surgical Unit, First Department of Surgery, General Hospital Konstantopoulio Agia Olga, Agias Olgas 3-5, New Ionia 14233, Athens, Greece
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17
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Abstract
BACKGROUND Sickle cell anemia (SCA), which is characterized by high hemoglobin (Hb) F level and persistent splenomegaly into the older age group (up to 18 years of age) or even adults, is one of the commonest hemoglobinopathies in the Eastern Province of Saudi Arabia. This makes them liable to develop splenic complications requiring splenectomy. This is a review of our experience in the management of 134 children with SCA who had splenectomy as part of their management at our hospital, with emphasis given to the indications and complications of splenectomy. PATIENTS AND METHODS The medical records of all children who had splenectomy at our hospital were retrospectively reviewed for the following: age at splenectomy, sex, Hb electrophoresis, indication for splenectomy, preoperative investigations, type of surgery, spleen weight, histology, perioperative management, and postoperative complications. RESULTS From 1990 to 2004, 170 children with various hematologic disorders had splenectomy at our hospital. Of these, 134 had SCA (118 had sickle cell disease and 16 had sickle-beta-thalassemia). Recurrent acute splenic sequestration crisis (ASSC) was the commonest indication for splenectomy in 103 (76.9%) patients, followed by hypersplenism in 18 (13.4%). Seven (5.2%) of our patients had splenectomy for splenic abscess (SA) and 2 had splenectomy for massive splenic infarction; 103 (61 boys, 42 girls) patients with a mean age of 7.6 years (range, 1.8-13 years) had splenectomy for ASSC. Their mean Hb F level was 20.5% (range, 9.2%-39.6%). Thirty-two of them had major attacks. Their Hb levels at the time of admission ranged from 1.4 to 4.1 g/dL (mean, 2.5 g/dL). The remaining 71 had minor recurrent attacks. Eighteen had splenectomy for hypersplenism and all had a significant increase in their blood parameters after splenectomy. Seven had splenectomy for SA. In 5 patients, Salmonella was the causative organism; in 1, it was Enterobacter sakazaki, whereas in 1, no organisms were identified. Two of our patients had splenectomy for massive splenic infarction because of persistent left upper quadrant abdominal pain, and 1 had splenectomy for splenomegaly with a nonfunctioning spleen. Twenty-eight (21%) of our patients had splenectomy and cholecystectomy. In 4 patients, this was because of symptomatic gallstones, whereas in the other 24, it was because of asymptomatic gallstones discovered on ultrasound. There was no mortality, but 8 (6%) developed postoperative complications. CONCLUSIONS With good perioperative management, splenectomy in children with SCA is not only safe, but also beneficial in treating SA, reducing the patients' transfusion requirements, eliminating the risks of ASSC, and eliminating the discomfort and mechanical pressure of the enlarged spleen. Abdominal ultrasound should be done routinely preoperatively for all children with SCA undergoing splenectomy, and if gallstones are discovered, they should undergo concomitant cholecystectomy. This is even so for asymptomatic gallstones. The addition of cholecystectomy to splenectomy does not increase the morbidity, but eliminates the subsequent complications of gallstones and simplifies their future management in case of abdominal crisis as the possibility of cholecystitis is eliminated.
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Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, Chen YS, Wang CC, Lin JW, Lee CM, Hu TH. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006; 12:460-4. [PMID: 16489650 PMCID: PMC4066069 DOI: 10.3748/wjg.v12.i3.460] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years.
METHODS: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE II scores, and mortality rates were analyzed.
RESULTS: There were 41 males and 26 females with the mean age of 54.1 ± 14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixty-seven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%), with leading pathogen of Klebsiella pneumoniae (22.4%), followed by gram positive coccus (GPC) infection (31%). Splenectomy was performed in 26 patients (38.8%), percutaneous drainage or aspiration in 21 (31.3%), and antibiotic therapy alone in 20 patients (29.9%). Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC (P = 0.036). Patients with GNB infection (P = 0.009) and multiple abscesses (P = 0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE II score of 12 expired patients (16.3 ± 3.2) was significantly higher than that of the 55 survivals (7.2 ± 3.8) (P < 0.001).
CONCLUSION: MSA, GNB infection, and high APACHE II scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.
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Affiliation(s)
- Kuo-Chin Chang
- Division of Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, 833, Taiwan, China
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Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg 2006; 41:e53-6. [PMID: 16410091 DOI: 10.1016/j.jpedsurg.2005.10.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics. MATERIALS AND METHODS Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. Ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. Ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew Escherichia coli in 1 case, Salmonella paratyphi A in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks. RESULTS All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy. CONCLUSION Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.
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Affiliation(s)
- Roy Choudhury S
- Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India.
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20
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Martins ACDA, Vieira LFDF, Ferraz ÁAB, Santos Júnior MAD, Ferraz EM. Abscesso esplênico: mudanças nos fatores de risco e nas opções de tratamento. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000600011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: A origem dos abscessos esplênicos está relacionada a episódios de bacteremia após infarto esplênico. Recentemente, a SIDA, a tuberculose, a imunossupressão e as neoplasias têm mudado a apresentação clínica desse abscesso. Tradicionalmente, o tratamento de escolha é a esplenectomia. Entretanto, a drenagem percutânea pode ser uma alternativa útil em casos selecionados O objetivo desse trabalho foi determinar o perfil dos pacientes com abscesso esplênico tratados em um hospital terciário. MÉTODO: Dados referentes aos pacientes atendidos no Serviço de Cirurgia Geral HC-UFPE no período de novembro de1993 a fevereiro de 2004 foram analisados. Sete pacientes dentre os 73094 tratados no período constituíram o objeto desse estudo. RESULTADOS: Cinco pacientes foram tratados inicialmente com esplenectomia e dois por drenagem percutânea. Quatro pacientes (57%) apresentavam abscessos secundários à imunossupressão, tuberculose ou doença neoplásica. Três (43%) apresentavam abscessos decorrentes de infecção metastática (endocardite). A drenagem percutânea foi o único tratamento utilizado em um caso. CONCLUSÕES: Houve uma mudança no padrão clássico, e quase que exclusivo, de origem hematogênica do abscesso esplênico para abscessos decorrentes de uma condição de imunossupressão (câncer, tuberculose, transplantes etc.). Em casos selecionados, a drenagem percutânea pode ser a única forma de tratamento invasivo utilizada.
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21
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Carbonell AM, Kercher KW, Matthews BD, Joels CS, Sing RF, Heniford BT. Laparoscopic splenectomy for splenic abscess. Surg Laparosc Endosc Percutan Tech 2005; 14:289-91. [PMID: 15492661 DOI: 10.1097/00129689-200410000-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Splenic abscess is a rare clinical entity, and splenectomy remains the treatment of choice. We sought to determine the safety and efficacy of laparoscopic splenectomy in this setting. Using a prospective database of laparoscopic splenectomy, we identified 4 patients who underwent surgery for splenic abscess (3 male, 1 female). Mean age was 55.5 (range 42-78) years. Patient symptoms included: fever and abdominal pain in 4 patients, pleural effusions in 2, and nausea and leukocytosis in 1. Risk factors for splenic abscess included septic emboli from bacterial endocarditis in 2 patients and acquired immune deficiency syndrome in 1. All patients underwent successful laparoscopic splenectomy. Mean operative time was 200 (range 160-220) minutes, and blood loss was 220 (range 100-450) mL. There were no postoperative complications or deaths; postoperative length of stay averaged 14 (range 2-26) days. Despite the difficulty of the operation, the laparoscopic approach appears to be a safe and effective treatment of splenic abscess.
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Affiliation(s)
- Alfredo M Carbonell
- Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
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22
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Abstract
Splenic abscess is a rare disease but with increasing frequency. The authors present 9 patients with splenic abscess treated at the Institute of Digestive System Diseases, Clinical Centre of Serbia, in a period from January 1, 1986 to May 15, 2004. Splenic abscess was the complication of septic endocarditis in 4, trauma in 2, dental infection in 1, while in 2 cases it was the complication of chemotherapy in myeloproliferative disorders. All 9 patients had fever, 7 - abdominal pain, 4 - left shoulder pain, and 1 patient had nausea and vomiting. Higher white blood count was found in 6 patients, pleural effusion in 4, elevated left hemidiaphragm in 1 and basal pneumonia in 1 patient as well. Ultrasonography and CT were the most reliable diagnostic procedures. CT was superior in diagnosis of multiple small abscesses. Culture of the pus recovered the Enterococcus in 3 cases, Streptococcus a hemolyticus in 1, Staphylococcus epidermidis and Candida albicans in 1, Staphylococcus aureus, E. Coli and Candida albicans in 1, Staphylococcus aureus and Salmonella enteritidis in 1 case. Eight patients underwent splenectomy and 1 was cured by combined antibiotics in high doses. One patient died postoperatively due to septic endocarditis that had been present before surgery. The authors believe that splenectomy and antibiotics administered according to drug susceptibility test as well as management of underlying disease are the method of choice for splenic abscess treatment. Conservative antibiotic treatment is indicated in selected cases only.
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Affiliation(s)
- Nikica Grubor
- Institute of Digestive System Diseases, Clinical Centre of Serbia, Belgrade
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23
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Farres H, Felsher J, Banbury M, Brody F. Management of splenic abscess in a critically ill patient. Surg Laparosc Endosc Percutan Tech 2004; 14:49-52. [PMID: 15287600 DOI: 10.1097/00129689-200404000-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Because of the increased number of immunocompromised patients within the general population, the incidence of splenic abscesses has increased over the last decade. This cohort of immune-deficient patients with splenic abscesses engenders a distinct evolution in the pathogenesis and microbiology of the disease process. Moreover, the morbidity and mortality rates for splenic abscesses are increased in this unique population. Clinically, these patients do not have a characteristic presentation. Diagnostically, computed tomography of the abdomen is the test of choice. Antibiotics and splenectomy remain the standard of care in most clinical settings. However, percutaneous drainage is reported with solitary and unilocular abscesses and in poor operative candidates. An unusual case of a patient with a splenic abscess awaiting heart transplantation is presented. This patient was successfully treated with percutaneous drainage and antibiotics. The literature regarding the presentation, diagnosis, pathogenesis, and treatment of splenic abscesses is reviewed as well.
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Affiliation(s)
- Houssam Farres
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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24
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Green BT. Splenic Abscess: Report of Six Cases and Review of the Literature. Am Surg 2001. [DOI: 10.1177/000313480106700118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Splenic abscesses are rare but appear to be increasing in frequency. Recent advances in radiologic techniques have affected the diagnosis and management. The purpose of this study was to evaluate these effects. The medical records of one institution were retrospectively reviewed and six cases of splenic abscesses seen between 1989 and 1999 were identified. All patients had predisposing conditions with metastatic hematogenous infection in three and one each with trauma, immunodeficiency, and a contiguous site of infection. Fever was present in all patients with chills and vomiting in five and three patients, respectively. Left upper quadrant tenderness appeared in four patients and leukocytosis was found in every patient except one with the acquired immunodeficiency syndrome. Chest roentgenograms were abnormal in five patients with a left pleural effusion most common. Ultrasound revealed the defect in both patients it was utilized in and computed tomography was diagnostic in all cases. The causative organisms were anaerobes in two cases and Candida albicans, Streptococcus viridans, Escherichia coli, and Citro-bacter freundii each present in one case. Radiology guided percutaneous drainage was attempted in four patients but was only successful in one. Splenectomy with antibiotics was curative in the remainder with a 100 per cent survival. These data suggest that percutaneous drainage may be appropriate for certain patients initially, but the high failure rate demonstrates that splenectomy remains the standard treatment.
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Affiliation(s)
- Bryan T. Green
- From the Division of Infectious Diseases, University of South Alabama, Mobile, Alabama
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25
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Al-Salem AH, Naserullah Z, Qaisaruddin S, Al-Abkari H, Al-Faraj A, Yassin YM. Splenic complications of the sickling syndromes and the role of splenectomy. J Pediatr Hematol Oncol 1999; 21:401-6. [PMID: 10524454 DOI: 10.1097/00043426-199909000-00012] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the authors' experience with splenectomy for sickling disorders and evaluate the indications, complications, and outcome. PATIENTS AND METHODS Over a period of 10 years (1987-1997), 113 patients with sickling disorders (100 with sickle cell disease and 13 with sickle-beta-thalassemia) had splenectomy at the authors' hospital as part of their management. The indications for splenectomy were hypersplenism (26 patients), major splenic sequestration crisis (MSSC) (23 patients), minor recurrent splenic sequestration crisis (MRSSC) (50 patients), splenic abscess (12 patients), and massive splenic infarction (2 patients). RESULTS Splenectomy in patients with sickle cell disease (SCD) and sickle-beta-thalassemia (S-beta-Thal) was beneficial in reducing their transfusion requirements and its attendant risks, eliminating the discomfort from mechanical pressure of the enlarged spleen, and avoiding the risks of acute splenic sequestration crisis. It also was curative for patients with splenic abscess and massive splenic infarction. Twenty-four patients with SCD (24%) had splenectomy and cholecystectomy caused by concomitant gallstones. There was no mortality, and the postoperative morbidity was 7%. CONCLUSIONS With careful perioperative management, splenectomy is both safe and beneficial in a select group of patients with SCD and S-beta-Thal.
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Affiliation(s)
- A H Al-Salem
- Division of Pediatric Surgery, Qatif Central Hospital, Saudi Arabia, USA
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26
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Al-Salem AH, Naserullah Z, Qaisaruddin S, Al-Dabbous I, Al Abkari H, Al-Jam'a A, Al-Faraj A, Yassin YM. Splenectomy for hematological diseases: The Qatif Central Hospital experience. Ann Saudi Med 1999; 19:325-30. [PMID: 17277533 DOI: 10.5144/0256-4947.1999.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the Eastern Province of Saudi Arabia, an area known for various hemoglobinopathies, splenectomy is performed rather frequently. This study is an analysis of our experience with splenectomy performed for various hematological disorders between 1988 and 1997, outlining the indications, complications and outcome. PATIENTS AND METHODS This is a retrospective analysis of all patients who had splenectomy at our hospital during this period. One hundred and forty-three patients were treated for various hematological disorders at our hospital. These disorders included sickle cell disease (SCD) (100 patients), sickle ss-thalassemia (S-ss-thal) (13 patients), ss-thalassemia major (15 patients), Hb H disease (3 patients), idiopathic thrombocytopenic purpura (ITP) (5 patients), Gaucherâs disease (2 patients), hereditary spherocytosis (1 patient), autoimmune hemolytic anemia (1 patient), thalassemia intermediate (2 patients) and chronic myeloid leukemia (1 patient). RESULTS The indications for splenectomy in those with SCD and S-ss-thal were: hypersplenism (26 patients), major splenic sequestration crisis (23 patients), minor recurrent splenic sequestration crisis (50 patients), splenic abscess (12 patients), and massive splenic infarction (2 patients). Splenectomy in these patients was beneficial in reducing their transfusion requirements and its attendant risks, eliminating the discomfort from mechanical pressure of the enlarged spleen, avoiding the risks of acute splenic sequestration crisis, and managing splenic abscess. For those with thalassemia, total splenectomy was beneficial in reducing their transfusion requirements, while partial splenectomy was beneficial only as a temporary measure, as regrowth of splenic remnant in these patients subsequently led to increase in their transfusion requirements. Those with ITP, hereditary spherocytosis, and autoimmune hemolytic anemia showed excellent response following splenectomy. There was no mortality, and the postoperative morbidity was 5.6%. CONCLUSION With careful perioperative management, splenectomy is both safe and beneficial in a selected group of patients with hematological diseases.
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Affiliation(s)
- A H Al-Salem
- Division of Pediatric Surgery, Department of Surgery, and Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
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Alterman P, Vigder C, Shabun A, Feldman J, Spiegel D, Yaretzky A. Splenic abscess in geriatric care. J Am Geriatr Soc 1998; 46:1481-3. [PMID: 9809778 DOI: 10.1111/j.1532-5415.1998.tb06025.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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.
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Affiliation(s)
- A H Al-Salem
- Department of Surgery, Qalif Central Hospital, Saudi Arabia
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29
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Peters FP, Erdkamp FL. Extraordinary localisation of Mycobacterium tuberculosis infection. Infection 1996; 24:336. [PMID: 8875289 DOI: 10.1007/bf01743376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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30
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31
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Herman P, Oliveira e Silva A, Chaib E, D'Albuquerque LC, Pugliese V, Machado MC, Pinotti HW. Splenic abscess. Br J Surg 1995; 82:355. [PMID: 7796007 DOI: 10.1002/bjs.1800820323] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Herman
- Department of Gastroenterology, Hospital das Clinicas University of São Paulo, Brazil
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32
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Alonso Cohen MA, Galera MJ, Ruiz M, Puig la Calle J, Ruis X, Artigas V, Puig la Calle J. Splenic abscess. World J Surg 1990; 14:513-6; discussion 516-7. [PMID: 2200213 DOI: 10.1007/bf01658678] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We present 7 cases of splenic abscess collected in our hospital from 1980 to 1988 as well as a review of 227 cases of the world literature. The signs and symptoms are nonspecific in all of them, fever being the most constant. Computed tomography scan followed by sonography were demonstrated to be the best methods of diagnosis. The treatment carried out on all of our patients was splenectomy followed by antibiotic coverage. Two of them died 15 days after the operation due to persistence of the septic state. In our review of the literature, we observe a rise in the population at risk for splenic abscess due to an increase in the use of immunosuppressive agents, to the higher survival of leukemic patients, and to the great incidence of drug abuse among others. Nevertheless, the advances in the use of sonography and computed tomography scan have made possible a more accurate diagnosis, therefore making possible an earlier treatment and a better prognosis. We believe that the treatment of choice is splenectomy with conservative treatment used only in specific cases where surgery represents a high risk for the patient.
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Affiliation(s)
- M A Alonso Cohen
- Department of Surgery, Hospital of La Santa Creu i Sant Pau, Barcelona, Spain
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33
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Caslowitz PL, Labs JD, Fishman EK, Siegelman SS. Nontraumatic focal lesions of the spleen: assessment of imaging and clinical evaluation. Comput Med Imaging Graph 1990; 14:133-41. [PMID: 2185877 DOI: 10.1016/s0895-6111(05)80048-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fifty-nine cases of nontraumatic splenic disease were reviewed to evaluate the roles of clinical findings, computed tomography, ultrasound, and radionuclide scanning in diagnosis and management. Patient groups included lymphoma (30 patients), infarct (11 patients), abscess (9 patients), cyst (5 patients), hemangioma (3 patients), and hamartoma (1 patient). In no case were clinical findings alone sufficient to diagnose a splenic lesion. Clinical and laboratory manifestations were nonspecific in all groups. Moreover, no radiologic study reliably diagnosed splenic lymphoma or leukemia. All other focal splenic lesions were consistently diagnosed noninvasively. Cross-sectional imaging was more useful than radioisotope scanning, and often provided adjunctive diagnosis of extrasplenic pathology. The superior detail, spatial resolution, and sensitivity of computed tomography made it the single most valuable diagnostic modality.
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Affiliation(s)
- P L Caslowitz
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Abstract
Despite the large number of organ transplants performed yearly, to date there have been no reports of candidal splenic abscess. We describe here the first case of candidal splenic abscess in a renal transplant recipient treated successfully by splenectomy and amphotericin B. Despite a lengthy illness, the patient recovered with preservation of renal function.
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Affiliation(s)
- D K Nemec
- Renal Section, Baylor College of Medicine, Houston, TX
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35
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Abstract
Thirteen cases of splenic abscess were reviewed retrospectively from pathologic and medical records from 1978 through 1986. Splenic abscess is uncommon, but the diagnosis has been made more frequently in recent years due to the increasing number of living immunosuppressed patients and to the use of more sophisticated radiologic diagnostic techniques. Five patients had a solitary abscess (SA) and eight had multiple abscesses (MA). Seventy-five percent of the patients with MA were immunosuppressed, most had no symptoms from the splenic abscess, and none died. Only one patient (with SA) died, a mortality of 10% overall. Previously the mortality has been 40 to 70%. The decreased mortality may in part be attributable to the more rapid diagnosis (3.8 days for SA, 1.8 days for MA) of the splenic abscess, prompting early treatment. Improved radiologic studies reduce the time to diagnosis and thereby improve the prognosis. Computed tomography (CT) was diagnostic for splenic abscess in 4 of 7 patients and suggestive of abscess in the other 3. Computed tomography was the diagnostic modality of choice in suspected splenic abscess, as it provided more information than the other radiologic studies used.
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Affiliation(s)
- P L Caslowitz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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