We report our experience of percutaneous drainage of. Fungal splenic abscesses respond much more favorably to antifungal therapy. Splenic abscess quick answers surgery accesssurgery. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm. Splenic abscess complicating infectious endocarditis.
Isolated splenic abscess due to salmonella berta in a healthy. The surgical management of splenic abscess is determined by patient factors, anatomy, and pathology. Sep 03, 2017 splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. By continuing to use our website, you are agreeing to our use of cookies. Fever is present in 90% of patients, but only 66% present with the classical triad of fever, left upper quadrant pain and splenomegaly. Which individuals are at greater risk of developing splenic abscess.
Unstable patients undergo laparotomy and splenectomy. Natural history, complications and prognosis natural history. Clinical presentation includes fever, leucocystosis, and abdominal pain. Computerized tomography allowed for accurate diagnosis in all cases. It often presents with either vague or nonspecific signs, thus making clinical diagnosis. At one teaching institution, only 11 cases were found in a 30year period 1. Bacteremia is the most common predisposing risk factor. Infected aneurysms are rare and may present with rupture or sepsis. We herein describe a 19yearold female patient with a 2month history of inter. This post from alec pawlukiewicz provides you with pearls and pitfalls in the evaluation and management of this condition. In the last 30 years at the johns hopkins hospital, only 11 patients have. Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy lsg. Splenic involvement in rheumatic diseases seminars in arthritisand rheumatism vol 27, no 3 december 1997 splenic involvement in rheumatic diseases daniel fishman and david a.
Splenic abscess causes, symptoms, diagnosis, treatment. Of the 53 cases, 30 cases 57% were benign and 23 cases 43% were. In africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease. Infective endocarditis, embolic stroke and splenic abscess. Regular prescribed medication was frusemide 40 mg daily, ramipril 5 mg twice daily, and aspirin 75 mg daily. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. Author links open overlay panel giovanna ferraioli a enrico brunetti a rosario gulizia a giuseppe mariani a piero marone b carlo filice a. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as the size and topography of the abscess. Splenic abscesses are uncommon, and their incidence in various autopsy series is estimated at 0. Splenic abscess in cancer chemotherapy bmc research. Embolism to the spleen can result in splenic infarction in 40% of patients, with splenic abscess occurring in 5% of these patients. Though splenic abscesses are very rare complications of nontyphoidal salmonella infections, nontyphoidal salmonella has been isolated in about 15% of patients with a splenic abscess while splenectomy or percutaneous drainage with antibiotics are considered preferred treatments, there is an increasing number of case reports in which conservative management with antibiotics. Followup ultrasonography of the abdomen showed a complete resolution of the abscesses.
Despite the large number of organ transplants performed yearly, to date there have been no reports of candidal splenic abscess. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. Mar 01, 2011 splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. The sonographic findings of 53 cases of verified focal splenic lesions, excluding posttraumatic haematomas and phleboliths, were retrospectively analysed. Although rare, blastomycosis should be considered as one of differential diagnosis in patients with splenic abscess who have a history of travel or residence in a region endemic for blastomycesdermatitidis. The abscess was drained, and the patient was treated with sulfasalazine and antibiotics. Splenic abscess is rare with potentially lifethreatening evolution. Causative pathogens are various and anaerobic pathogens are rarely reported. Splenic abscesses are rare, with a predicted frequency of less than 0. However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the mortality can be reduced to less than 1%. Splenic abscess by itself is an unusual entity, with a reported frequency ranging from 0. Right axial cect in a patient with a recent history of traumatic injury to the spleen and a new fever demonstrates a rimenhancing fluid collection with an airfluid level, consistent with a splenic abscess. Extension into adjacent structures is rarely reported.
Most splenic abscesses are due to aerobial microorganisms. Subtotal splenectomy for splenic abscess article pdf available in canadian journal of surgery. Splenic abscesses generally occur in patients with neoplasia, immunodeficiency, trauma, metastatic infection, splenic infarct or diabetes 2. Splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Splenic abscess has been associated with endocarditis, metastatic infection from other foci, trauma, and underlying immunodeficiency, and it has been found in intravenous drug abusers with or without endocarditis. We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole. Splenic abscess usually arises from hematogenous spread. Here we report a case of splenic abscess caused by lactobacillus paracasei. Etiology, clinical spectrum and therapy 39 the only laboratory abnormality that is frequently present is leukocytosis, which is seen in 60% to 80% of cases 2. It may arise either from the spread of infection from a neighboring organ that is, a diverticular abscess or a ruptured gastric ulcer or from hematogenous spread in patients with infective endocarditis. Stable patients with lower grade injuries are treated conservatively.
Infective endocarditis ie complicated by septic emboli is a challenging clinical problem. Splenomegaly in children see approach to the child with an enlarged spleen. The mortality rate is as high as 50% when antimicrobial therapy is the only treatment used for a pyogenic splenic abscess. Images in splenic abscess as a rare presentation of blastomycosis. The classic triad fever, pain of the left hypochondrium, and sensitive mass left is only present in onethird of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss. The incidence of splenic abscess in various autopsy series has been estimated to be between 0. Multiple aseptic splenic abscesses in a 15 year old patient. He postulated that 1 of 3 courses was followed by a patient with a splenic abscess. Ultrasound guided percutaneous treatment for splenic. Splenic abscess detection and monitoring using sonography.
To our knowledge, this is the first report of a combined case of multiple liver abscesses with splenic abscess in a patient with ulcerative colitis. Splenic abscess is a rare clinical condition with a high mortality rate. Infective endaortitis with a splenic abscess is an extremely rare and fatal complication of coarctation of the aorta. Infections caused by lactobacilli, which are usually one of the constituents of normal flora of human gut and vagina, are also very uncommon. Spleen abscess often coexists with several risk factors, but the major one is the patients immunodeficiency. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Aseptic splenic abscess as precursory extraintestinal. Documented diagnoses included controlled angina, atrial fibrillation, and cardiac failure. Bacterial endocarditis is one of the classic causes of infected aneurysm. A splenic abscess can be a difficult disease to diagnose. Candidal splenic abscess in a renal transplant patient. We present a case of a woman with xanthogranulomatous emphysematous pyelonephritis accompanied by massive perinephric abscess, resulting in celiac and splenic artery mycotic aneurysms via direct invasion. Disseminated tuberculosis causing isolated splenic vein. T1 splenic abscess presentation, diagnosis, and treatment.
Splenic abscess complicating infectious endocarditis jama. The journal of the association of physicians of india. The frequency may be rising due to a rise in the use of immunosuppressive agents and prevalence of immunosuppressive states, higher survival of leukemic patients, and high incidence of drug abuse,15. We read with interest the letter to the editor concerning splenic abscess in infectious endocarditis published in the february archives. Splenic abcess is an uncommon complication for cancer treatment. The second most common manifestation after pneumonia is skin disease, and splenic abscess due to blastomycosis has been rarely reported. A previously well 84yearold white man was admitted with a 48 h history of malaise, confusion, fever and rigors. We describe here the first case of candidal splenic abscess in a renal transplant recipient treated successfully by splenectomy and amphotericin b. There are a number of splenic lesions and anomalies. Of the 600 cases of splenic abscess documented in the current literature, most have been described as air confined to the left upper quadrant on chest xray. Tuberculosis is a common infectious cause of splenic enlargement in developing countries, but tubercular splenic abscesses are a rare presentation, f we use cookies to enhance your experience on our website. Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Access to paid content on this site is currently suspended due to excessive activity being detected from your ip address 40. Establishing a diagnosis of splenic abscess on clinical grounds is difficult.
Splenic involvement in rheumatic diseases pdf free download. Splenic abscess is most effectively diagnosed by ct or mri. Apr 21, 2020 splenic abscess is a rare entity, with a reported frequency of 0. Splenic abscess associated with infective endocarditis. Splenic abscess caused by lactobacillus paracasei sciencedirect. With the advancement in imaging technology and the growth in the number of patients with immune insufficiency, trauma, and tumor, the incidence of splenic abscess has gradually increased in recent years 911.
We report the thirteen case of a splenic abscess after lsg. Splenic abscesses are polymicrobial in 36% of cases. Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. Surgical management of splenic abscess in endocarditis jama. They uncommonly affect the spleen due to its efficient reticuloendothelial system phagocytic activity and, consequently, are more likely seen in immunosuppressed patients. Splenic abscess as a rare presentation of blastomycosis bmj. In approximately 50% of patients, blood cultures are positive. There are no guidelines regarding its diagnosis and management. We report our experience of percutaneous drainage of splenic abscess under ultrasound. Congenital anomalies accessory spleen wandering spleen asplenia polysplenia splenogonadal fusion retrorenal spleen mass lesions benign mass lesions splenic cyst mnemonic splenic ps.
In the last 30 years at the johns hopkins hospital, only 11 patients have been treated for clinically overt splenic abscess. Splenic abscess definition of splenic abscess by medical. Review of proximal splenic artery embolization in blunt. We report a young patient with a ruptured splenic abscess resulting in an acute abdomen and pneumoperitoneum. Infected splenic artery aneurysm with associated splenic. Pylephlebitis with splenic abscess following transrectal. The patient was treated with percutaneous drainage and antibiotics. Because of its rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications. The spleen is the most commonly injured organ in blunt abdominal trauma. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately.
Management of splenic abscess after splenic arterial. A retrospective study of 75 cases of splenic abscess ncbi. Ct scan has a very high sensitivity and is the imaging modality of choice. Splenic abscess, although not described in the literature as a direct complication of pylephlebitis, may occur as the septic thrombi in the splenic vein, which reach the spleen. Solitory abscess present with delayed onset of presentation with history of trauma. The finding of a splenic abscess is rare, with only 500 to 600 cases ever having been reported internationally. Etiology, clinical spectrum and therapy 38 patients, recent series have showed greater numbers of fungal isolates, including candida albicans, aspergillusspp, and agents of mucromycosis. The purpose of this study was to analyse the sonographic findings of focal splenic lesions with an attempt to differentiate benign lesions from malignancies. Splenic abscesses, like abscesses elsewhere, are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. Pneumoperitoneum as a result of a ruptured splenic abscess zachary bauman.
Ultrasonographic findings and differentiation of benign. The most common etiology is hematogenous seeding of bacteria from a secondary site e. Apr 21, 2020 abscesses of the spleen have been reported periodically since the time of hippocrates. Perinephric abscess causing mycotic celiac and splenic. Streptococci accounted for 18 abscesses, with six containing enterococci. Splenic abscess presentation, diagnosis, and treatment. Splenic abscess is an uncommon entity with a reported frequency in autopsy series between 0. Splenectomy was successful, and pathology confirmed the splenic abscess. Successful surgical management of coarctation of the aorta. Few case series have specifically looked at patients with sterile splenic abscesses. However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the. May 21, 2008 abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far.
Splenic abscess is not a frequent clinical problem. Today with the availability of a ct scan, the condition is not only rapidly diagnosed, but it also helps with treatment by aspirating the collection. Splenic abscess ooi 1992 australian and new zealand. The most common clinical signs are concurrent external abscesses, anorexia, fever, lethargy, weight loss, and signs of respiratory. Sometimes, splenic infarction is purposely induced as a treatment method for other medical ailments such as portal hypertension or damages to the. Pneumoperitoneum as a result of a ruptured splenic abscess. Causative pathogens were clostridium perfringens and streptococcus gallolyticus. We report our experience of percutaneous drainage of splenic abscess under ultrasound us guidance. Surgical treatment is often required to prevent catastrophic sequelae.
Isolated splenic abscess due to salmonella berta in a. Two widely used embolization approaches are proximal and. Usguided fine needle aspiration was the first line treatment in patients with. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. It occurs more frequently in immunocompromised patients.
Predisposing factors, such as diabetes mellitus, malignancies, immunosuppressive medications, or immunodeficiency disorders, often play a role in the development of splenic abscess and should be considered when a splenic abscess is found 8, 21, 22, 2426. Splenic abscess is a rare abdominal disease, and the literature has reported that the incidence of it in autopsied cases was 0. Splenic abscess is a rare entity, with a reported frequency of 0. Abdominal ultrasound showed a complex cystic lesion within the spleen. Splenic abscess from fusobacterium nucleatum annals of. Splenic abscess as a rare presentation of blastomycosis. Combined hepatic and splenic abscesses in a patient with. Other wellknown predisposing conditions are splenic trauma and hemoglobinopathies. Splenic abscess is an uncommon disease, with a reported incidence of 0.
In the majority of abscesses, streptococci or staphylococci are present. Computed tomography ct scan is highly sensitive and specific 95% and 92%, respectively in the diagnosis of splenic abscess. Please contact the publisher to request reinstatement. The reported occurrence of splenic abscess in autopsy series is less than 1% and rarely is an antemortem diagnosis made 1. Splenic abscess is a rare cause of abdominal abscesses, but lifethreatening. Experience with splenic abscess from southern india. Multiple splenic abscesses, rather than a solitary abscess, are present in immunocompromised states including hematological. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy.
Article pdf available in the journal of the association of physicians of india 388. Splenic abscesses represent up to 5% of all intraabdominal infections and have a mortality of 47100%. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. Abscesses of the spleen have been reported periodically since the time of hippocrates. May 25, 2007 it has been shown that splenic abscesses respond poorly to antibiotics alone. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. Pneumoperitoneum as a result of a ruptured splenic abscess, journal of surgical case reports, volume 20, issue 12, december 20, rjt111. A splenic abscess typically has a thick, irregular rim with a hypodense center, but multiple or miliary abscesses may be difficult to identify. Classically, endocarditis is associated with splenic abscess but any cause of bacteremia, ranging from typhoid fever, to line infection, to urinary tract infection, may result in.
Splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. We report the case of a 50yearold male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia. Once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Prior to the advent of sonography and computed tomography, the survival rate for an individual with a splenic abscess was 0%. Ultrasoundguided diagnostic needle aspiration showed the abscess content was bloody turbid fluid, and the culture of aspirated fluid grew salmonella berta. Despite a lengthy illness, the patient recovered with preservation of renal function. A left pleural effusion combined with unexplained leukocytosis in a septic patient suggests a splenic abscess in some patients, unexplained sepsis, progressive splenic enlargement, and abdominal pain are the presenting manifestations gas in the spleen on radiographic imaging is. It should be considered as the first line of treatment although splenectomy remains the final definitive procedure if percutaneous drainage fails.
180 1372 451 1504 342 838 649 310 1242 1113 44 539 33 1170 1147 836 1332 1512 1446 1308 1319 218 133 1057 1098 1409 1203 1223 1253 164 340 511 509 608 1334 1079 531 1283 601 396 710 672 815 963