In approximately 50% of patients, blood cultures are positive. Natural history, complications and prognosis natural history. 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. Splenic abscess detection and monitoring using sonography. Splenic abscess presentation, diagnosis, and treatment. Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Combined hepatic and splenic abscesses in a patient with. 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. Aseptic splenic abscess as precursory extraintestinal. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. We report our experience of percutaneous drainage of splenic abscess under ultrasound us guidance. Perinephric abscess is a known complication of urologic infection, sometimes requiring surgical debridement. 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.
Splenic abscess associated with infective endocarditis. Surgical treatment is often required to prevent catastrophic sequelae. Experience with splenic abscess from southern india. Multiple splenic abscesses, rather than a solitary abscess, are present in immunocompromised states including hematological. Followup ultrasonography of the abdomen showed a complete resolution of the abscesses.
We read with interest the letter to the editor concerning splenic abscess in infectious endocarditis published in the february archives. Splenic abscesses are uncommon, and their incidence in various autopsy series is estimated at 0. Which individuals are at greater risk of developing splenic abscess. Other wellknown predisposing conditions are splenic trauma and hemoglobinopathies. 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. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Infective endaortitis with a splenic abscess is an extremely rare and fatal complication of coarctation of the aorta.
The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. Establishing a diagnosis of splenic abscess on clinical grounds is difficult. A previously well 84yearold white man was admitted with a 48 h history of malaise, confusion, fever and rigors. Splenectomy was successful, and pathology confirmed the splenic abscess. Splenic abscess from fusobacterium nucleatum annals of. The second most common manifestation after pneumonia is skin disease, and splenic abscess due to blastomycosis has been rarely reported. 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. We describe here the first case of candidal splenic abscess in a renal transplant recipient treated successfully by splenectomy and amphotericin b. Splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. Despite a lengthy illness, the patient recovered with preservation of renal function. Perinephric abscess causing mycotic celiac and splenic. Documented diagnoses included controlled angina, atrial fibrillation, and cardiac failure. Splenic abscess as a rare presentation of blastomycosis bmj. The mortality rate is as high as 50% when antimicrobial therapy is the only treatment used for a pyogenic splenic abscess.
The sonographic findings of 53 cases of verified focal splenic lesions, excluding posttraumatic haematomas and phleboliths, were retrospectively analysed. The surgical management of splenic abscess is determined by patient factors, anatomy, and pathology. At one teaching institution, only 11 cases were found in a 30year period 1. 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 involvement in rheumatic diseases seminars in arthritisand rheumatism vol 27, no 3 december 1997 splenic involvement in rheumatic diseases daniel fishman and david a. The finding of a splenic abscess is rare, with only 500 to 600 cases ever having been reported internationally. Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy lsg. Here we report a case of splenic abscess caused by lactobacillus paracasei. However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the.
Infective endocarditis, embolic stroke and splenic abscess. Of the 53 cases, 30 cases 57% were benign and 23 cases 43% were. Multiple aseptic splenic abscesses in a 15 year old patient. Because of its rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications. Extension into adjacent structures is rarely reported. Pylephlebitis with splenic abscess following transrectal. Clinical presentation includes fever, leucocystosis, and abdominal pain.
Computerized tomography allowed for accurate diagnosis in all cases. Splenic abscesses are rare, with a predicted frequency of less than 0. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. He postulated that 1 of 3 courses was followed by a patient with a splenic abscess. 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%. May 21, 2008 abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. 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.
Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. Splenic abscess usually arises from hematogenous spread. Causative pathogens are various and anaerobic pathogens are rarely reported. A splenic abscess can be a difficult disease to diagnose. Prior to the advent of sonography and computed tomography, the survival rate for an individual with a splenic abscess was 0%. 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. Infected aneurysms are rare and may present with rupture or sepsis. Isolated splenic abscess due to salmonella berta in a. Splenic abscess is rare with potentially lifethreatening evolution. We report a young patient with a ruptured splenic abscess resulting in an acute abdomen and pneumoperitoneum. There are no guidelines regarding its diagnosis and management. 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.
It should be considered as the first line of treatment although splenectomy remains the final definitive procedure if percutaneous drainage fails. Fungal splenic abscesses respond much more favorably to antifungal therapy. Splenic abscess as a rare presentation of blastomycosis. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as the size and topography of the abscess. Once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. In the majority of abscesses, streptococci or staphylococci are present. Mar 01, 2011 splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. The patient was treated with percutaneous drainage and antibiotics. Management of splenic abscess after splenic arterial. 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.
Computed tomography ct scan is highly sensitive and specific 95% and 92%, respectively in the diagnosis of splenic abscess. T1 splenic abscess presentation, diagnosis, and treatment. Pneumoperitoneum as a result of a ruptured splenic abscess. 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. Splenic abscess in cancer chemotherapy bmc research. Splenic abscess is not a frequent clinical problem. Splenic abscesses generally occur in patients with neoplasia, immunodeficiency, trauma, metastatic infection, splenic infarct or diabetes 2. Causative pathogens were clostridium perfringens and streptococcus gallolyticus.
Splenic abscess definition of splenic abscess by medical. We herein describe a 19yearold female patient with a 2month history of inter. The abscess was drained, and the patient was treated with sulfasalazine and antibiotics. Splenic abscess is an uncommon entity with a reported frequency in autopsy series between 0. 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. Ultrasonographic findings and differentiation of benign. Splenic abscess quick answers surgery accesssurgery. 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. The reported occurrence of splenic abscess in autopsy series is less than 1% and rarely is an antemortem diagnosis made 1. Author links open overlay panel giovanna ferraioli a enrico brunetti a rosario gulizia a giuseppe mariani a piero marone b carlo filice a. Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. Images in splenic abscess as a rare presentation of blastomycosis. In the last 30 years at the johns hopkins hospital, only 11 patients have been treated for clinically overt splenic abscess.
Splenic abscess caused by lactobacillus paracasei sciencedirect. Splenic abscess is an uncommon disease, with a reported incidence of 0. We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole. Etiology, clinical spectrum and therapy 38 patients, recent series have showed greater numbers of fungal isolates, including candida albicans, aspergillusspp, and agents of mucromycosis.
Candidal splenic abscess in a renal transplant patient. Embolism to the spleen can result in splenic infarction in 40% of patients, with splenic abscess occurring in 5% of these patients. Splenic abscess causes, symptoms, diagnosis, treatment. Fever is present in 90% of patients, but only 66% present with the classical triad of fever, left upper quadrant pain and splenomegaly. 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. Spleen abscess often coexists with several risk factors, but the major one is the patients immunodeficiency.
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. Stable patients with lower grade injuries are treated conservatively. We report our experience of percutaneous drainage of. Splenic abscess complicating infectious endocarditis. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. Splenic abscess by itself is an unusual entity, with a reported frequency ranging from 0. 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. Streptococci accounted for 18 abscesses, with six containing enterococci. There are a number of splenic lesions and anomalies. This post from alec pawlukiewicz provides you with pearls and pitfalls in the evaluation and management of this condition. Surgical management of splenic abscess in endocarditis jama. The spleen is the most commonly injured organ in blunt abdominal trauma. Regular prescribed medication was frusemide 40 mg daily, ramipril 5 mg twice daily, and aspirin 75 mg daily.
We report the thirteen case of a splenic abscess after lsg. Bacteremia is the most common predisposing risk factor. Despite the large number of organ transplants performed yearly, to date there have been no reports of candidal splenic abscess. It often presents with either vague or nonspecific signs, thus making clinical diagnosis. Few case series have specifically looked at patients with sterile splenic abscesses. The incidence of splenic abscess in various autopsy series has been estimated to be between 0.
Abdominal ultrasound showed a complex cystic lesion within the spleen. Article pdf available in the journal of the association of physicians of india 388. 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. 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. Pneumoperitoneum as a result of a ruptured splenic abscess zachary bauman. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. Splenic abcess is an uncommon complication for cancer treatment. Access to paid content on this site is currently suspended due to excessive activity being detected from your ip address 40. Bacterial endocarditis is one of the classic causes of infected aneurysm. Splenic abscess is a rare cause of abdominal abscesses, but lifethreatening. Successful surgical management of coarctation of the aorta. Splenic abscess is a rare clinical condition with a high mortality rate. Two widely used embolization approaches are proximal and.
The most common clinical signs are concurrent external abscesses, anorexia, fever, lethargy, weight loss, and signs of respiratory. Please contact the publisher to request reinstatement. 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 abscesses represent up to 5% of all intraabdominal infections and have a mortality of 47100%. Splenic involvement in rheumatic diseases pdf free download. Usguided fine needle aspiration was the first line treatment in patients with. Splenic abscesses are polymicrobial in 36% of cases. Sometimes, splenic infarction is purposely induced as a treatment method for other medical ailments such as portal hypertension or damages to the. Subtotal splenectomy for splenic abscess article pdf available in canadian journal of surgery. 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. The journal of the association of physicians of india.
Ct scan has a very high sensitivity and is the imaging modality of choice. Apr 21, 2020 abscesses of the spleen have been reported periodically since the time of hippocrates. Infective endocarditis ie complicated by septic emboli is a challenging clinical problem. A retrospective study of 75 cases of splenic abscess ncbi. We report the case of a 50yearold male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia.
Splenic abscess ooi 1992 australian and new zealand. 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. Most splenic abscesses are due to aerobial microorganisms. The most common etiology is hematogenous seeding of bacteria from a secondary site e. Ultrasoundguided diagnostic needle aspiration showed the abscess content was bloody turbid fluid, and the culture of aspirated fluid grew salmonella berta. Review of proximal splenic artery embolization in blunt. Splenic abscess is a rare abdominal disease, and the literature has reported that the incidence of it in autopsied cases was 0.
Splenic abscesses, like abscesses elsewhere, are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. Splenic abscess is most effectively diagnosed by ct or mri. Isolated splenic abscess due to salmonella berta in a healthy. 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. Splenic abscess complicating infectious endocarditis jama. We report our experience of percutaneous drainage of splenic abscess under ultrasound. A splenic abscess typically has a thick, irregular rim with a hypodense center, but multiple or miliary abscesses may be difficult to identify. Disseminated tuberculosis causing isolated splenic vein. They uncommonly affect the spleen due to its efficient reticuloendothelial system phagocytic activity and, consequently, are more likely seen in immunosuppressed patients. It occurs more frequently in immunocompromised patients. Ultrasound guided percutaneous treatment for splenic. Infected splenic artery aneurysm with associated splenic.