Multiple splenic abscesses are very rarely encountered in surgical practice with a reported high mortality rate in neglected and. Combined hepatic and splenic abscesses in a patient with. As noted previously, the autopsy incidence of splenic abscess ranges from 0. The splenic abscess was aseptic and treated with steroids and cyfig.
In the last 30 years at the johns hopkins hospital, only 11 patients have been treated for clinically overt splenic abscess. Subphrenic abscess may be rightsided between right hemidiaphragm and liver or leftsided between left hemidiaphragm and spleen, most often is rightsided 1. The patient was treated with percutaneous drainage and antibiotics. If the splenic vein is compromised, this can lead to a splenic abscess, an extremely rare complication of pylephlebitis. Although splenic abscess remains a rare entity, it is uniformly fatal if unrecognized or untreated. Splenic abscesses caused by a reptileassociated salmonella. Oct 10, 20 after splenectomy, the patients condition improved and there were no further episodes of fever. Here we present a fourth case of splenic abscess due to. Splenic abscess is an uncommon disease, with a reported incidence of 0. It has been mostly reported in immunocompromised patients or following penetrating foreign bodies. These complications included three splenic abscesses, two symptomatic splenic infarcts, and three coil migrations in 2 patients who.
Pdf background splenic abcess is an uncommon complication for cancer treatment. Images in splenic abscess as a rare presentation of blastomycosis. The computed tomographic ct appearance of splenic infarction has classically been described as peripheral, wedgeshaped, and low in density. Multiple splenic abscesses in a rather healthy woman. In the first mentioned case, a search to find common risk factors was negative, while the second case had history of enteric fever. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. Splenic abscesses, like abscesses elsewhere, are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. After splenectomy, the patients condition improved and there were no further episodes of fever. Microscopic anatomy the spleen is divided into two compartments, namely, the red and white pulps, separated by the marginal zone. The patient responded to combined therapy with antibiotics plus splenectomy.
After several days, a nodule on the left medial thigh developed crusting secondary to necrosis with surrounding erythema b. Splenic abscess in cancer chemotherapy bmc research notes. Violaceous nodule with central erosion of less than 24 hours duration on the left foot in a patient with sweet syndrome with aseptic splenic abscesses and multiple myeloma a. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. Diagnostic problems with parasitic and nonparasitic splenic. The incidence of splenic abscess in typhoid is reported between 0. 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. Diagnosis and treatment of splenic fungal abscesses in the. The mri revealed sharply demarcated lesions measuring 20 and 30 mm in diameter at the superior pole of spleen. Multiple splenic abscesses with pleural effusion and free fluid in peritoneum with incidentally detected mild fatty infiltration of liver, cholelithiasis and vesical calculus. 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.
Remarkably, the veins have numerous anastomoses, while the arteries hardly have anastomose at all. The microbiological report referred to the presence of staphylococci, a rather common finding in splenic abscesses. Mri of focal splenic lesions without and with dynamic gadolinium enhancement june 2006, volume 186 number 6. Two investigations were designed to determine the appearance of splenic infarcts. The spleen is delivered to the midline by means of blunt and sharp dissection of the areolar plane between the kidney and the pancreas. We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patients clinical condition and inflammatory parameters. Splenic abscesspresentation, diagnosis, and treatment. Few case series have specifically looked at patients with sterile splenic abscesses. Since this is not included in documentation a code is not used. Article info abstract we present a case of splenic abscess causing pneumoperitoneum in a patient with diabetes mellitus. Case report multiple splenic abscesses in a rather healthy.
We report a case of splenic abscess, caused by salmonella typhi, and coinfection with leptospira in a previously healthy young male. Diseases and injuries, look for abscessspleen and you are referred to d73. Jul 23, 2009 splenic abscess is an unusual and potentially lifethreatening disease with a diagnostic challenge due to the nonspecific clinical picture. Typhi and found 8 2% splenic abscess cases of which only one had multiple splenic abscesses with two abscess areas 0. Splenic abscess is an unusual and potentially lifethreatening disease. Jul 20, 2018 abscesses of the spleen have been reported periodically since the time of hippocrates.
Multiple aseptic splenic abscesses in a 15 year old. The journal of the association of physicians of india. Clinical data and peripheral enhancement on enhanced mri sequences led to diagnosis of splenic abscess. The second most common manifestation after pneumonia is skin disease, and splenic abscess due to blastomycosis has been rarely reported. In an 18month period candidal splenic abscesses were diagnosed and treated in eight patients. Splenic abscess is one of the rarest complications of the uvc in a newborn and it is hypothesized that it could be due to an infection or trauma caused by a catheter. Conservative management of splenic abscess septic emboli after. A rare case of splenic abscess with septic peritonitis in. Splenic abscess should be suspected in febrile patients with left upper quadrant tenderness and leukocytosis, and diagnosis confirmed based mostly on imaging studies. Due to the symptomatic nature of the lesion, the patient was advised to.
This report aims to add to the current veterinary literature on recommended diagnostic tools for splenic abscess, as well as to provide followup findings after successful surgical. Spleen abscess often coexists with several risk factors, but the major one is the patients immunodeficiency. The abscess was drained, and the patient was treated with sulfasalazine and antibiotics. We report our experience of percutaneous drainage of splenic abscess under ultrasound us guidance. Splenic abscess is one of the abdominal complications of untreated typhoid fever, developing frequently in the third or fourth week of infection. Splenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. This report describes a patient with crohns disease of the colon who presented with a rare extraintestinal complication.
However, if the diagnosis is missed, splenic abscess does carry very high mortality reaching more than 70% with appropriate treatment, the. Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Multiple splenic abscesses are very rarely encountered in surgical practice with a reported high mortality rate in neglected and untreated cases. Splenic abscess presentation, diagnosis, and treatment. Splenic abscesses are extremely rare complications of ibd. We report a case of splenic abscess with multiple brain abscesses caused by streptococcus intermedius in a healthy young man without any identifiable risk factors, which resolved with percutaneous drainage and antibiotics. Splenic abscess is a rare clinical finding, with a reported prevalence between 0.
Documentation dissection operative report preoperative diagnoses. Sweet syndrome with aseptic splenic abscesses and multiple. May 25, 2007 it has been shown that splenic abscesses respond poorly to antibiotics alone. The severity of the injury, suggested by grade ct grade, neurologic status, age 55 and or the presence of associated injuries are not contraindications to a trial of nop management. Common pathogens isolated include streptococcus spp, staphylococcusspp, mycobacteria,fungi,parasites, and burk holder iapseudomalleiisolates in melioidosis endemic regions. Splenic abscess owing to cancer at the splenic flexure. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions. Twentyfour patients with splenic cysts have undergone surgery in our department over the last 9 years. The presentation was initially vague and later evolved to an acute abdomen. An x not reveal pneumoperitoneum which was performed. 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. In most of these patients, hemoglobinopathies or some other underlying immunocompromised state is usually present. 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. Multiple, partly merging hypodense lesions in the grossly enlarged spleen.
Congenital anomalies accessory spleen wandering spleen asplenia polysplenia splenogonadal fusion retrorenal spleen mass lesions benign mass lesions splenic cyst mnemonic splenic ps. The splenic vein was freed as it courses along the pancreas, and transected as close to the hilus of the spleen as possible, and the spleen was removed. The frequency of splenic abscess has recently increased due to the higher number of immunocompromised patients, as those with hematologic disorders e. 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. A spleen abscess or splenic abscess occurs when bacteria or fungi from elsewhere in the body travel via the blood stream into the spleen tissue where they multiply. They uncommonly affect the spleen due to its efficient reticuloendothelial system phagocytic activity and, consequently, are more likely seen in immunosuppressed patients. Diseases and injuries, look for abscess spleen and you are referred to d73. Abscess of the spleen is a rare discovery, with about 600 cases reported in the international literature so far. Splenic abscess is an uncommon entity among immunocompetent adults. Splenic abscess caused by salmonella typhi and coinfection. Pdf postsplenectomy portal, mesenteric, and splenic vein. Splenic infarction and abscess in the setting of infective endocarditis. We report a case of splenic abscess caused by brucella spp.
The case that is being reported presented with abdominal distension and recurrent desaturation with suspicion of neonatal sepsis versus necrotizing enterocolitis. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. Splenic abscess and multiple brain abscesses caused by streptococcus intermedius in a young healthy man jepsin maliyil, md, william caire, md, rajasree nair, md, and debbie bridges, md from the department of family medicine maliyil, caire, nair and the division of infectious diseases, department of internal medicine bridges, baylor medical center at garland, garland, texas. Multiple aseptic splenic abscesses in a 15 year old patient. With an increasing incidence of immunosuppressive diseases and medications, splenic abscesses have become more common. The splenic artery is slightly superior to the vein. Spontaneous atraumatic splenic rupture complicating anticoagulant treatment for splenic infarction. T1 splenic abscess presentation, diagnosis, and treatment. May 29, 2009 in the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and nonparasitic splenic cysts together with their long term follow up progresses. A spleen abscess can cause a fever and left upper abdominal pain. In the presented case, the cause of splenic abscess was not identified since the patient had no history that fit into one of the five categories above. Salmonella infectionsplenic abscesssurgery, splenic abscess. 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. With the spleen retracted medially, the phrenicocolic ligament is.
To study the aerobic and anaerobic microbiology of liver and spleen abscesses and correlate the results with predisposing factors, potential causes and routes of infection, clinical and laboratory. We report a case of multiple splenic abscesses caused by e. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, longterm use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with candida. A rare case of splenic abscess with septic peritonitis in 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 abscess definition of splenic abscess by medical. Once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Ctguided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen. Splenic abscess is an uncommon entity that can be treated percutaneously. A report of three patients article pdf available in african journal of paediatric surgery 62.
Aseptic splenic abscess as precursory extraintestinal. Review of 29 cases ishun chiang, tzengjih lin, 1 ichan chiang, 2 and meesun tsai 1 department of emergency medicine, jiann ren hospital, and departments of 1 emergency medicine and 2 radiology, kaohsiung medical university, kaohsiung, taiwan. There are a number of splenic lesions and anomalies. Splenic abscesses may be associated with other conditions such as torsion of the vascular pedicle, which can compromise vascular supply or drainage of the spleen, resulting in congestion, hypoxia, and necrosis of the splenic parenchyma with potential abscess formation.
Pdf splenic abscess is an uncommon disease, with a reported incidence of 0. Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot. Jul 20, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. However, the authors do not discard a possible trauma not seen by the owner. Subsequently, percutaneous aspiration of the lesion was performed and the material was sent for culture. Splenic abscesses are potentially fatal complication of typhoid fever.
Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. Splenic abscess due to acute brucellosis is a rare event. The common signs and symptoms described of a splenic abscess include the triad of fever, left upper quadrant tenderness, and leukocytosis is present only in onethird of the cases. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as on the size and topography of the abscess. Traditional treatment for splenic abscess has been splenectomy and antibiotic therapy but imageguided percutaneous aspiration and drainage can also be considered. An instructional note at k65 says to use an additional code b95b97 to identify the infectious organism. The mortality rate is as high as 50% when antimicrobial therapy is the only treatment used for a pyogenic splenic abscess. Mri of focal splenic lesions without and with dynamic. In this context, this article reports a case of splenic abscess diagnosed. Splenic abscess is an unusual and potentially lifethreatening disease with a diagnostic challenge due to the nonspecific clinical picture and diagnosis confirmed based mostly on imaging studies.
Multiple splenic abscesses in a child as a complication of. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. In general, there is infradiaphragmatic localized collection of fluid with air bubbles or airfluid level which has an enhancing wall. Splenic abscess as a rare presentation of blastomycosis.
Until recently, three cases of splenic abscess caused by propionibacterium acnes were reported. Fever is the most common symptom of splenic abscess, followed by abdominal pain and a tender mass on palpation of the left upper quadrant of the abdomen. Additional features of this case were the association of multiple extraintestinal manifestations of crohns disease, including iritis, ankylosing spondylitis, and pericholangitis, and polymicrobial bacteremia. 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. Most splenic abscesses are due to aerobial microorganisms. The patients had a clinical profile of nontoxic appearance with a. In 2005, haan and colleagues 37 reported complications in the largest singlecenter study of splenic artery embolization for blunt splenic trauma. The splenic vein was then brought down to an appropriate site on the anterosuperior aspect of the. Splenic abcess is an uncommon complication for cancer treatment.
There are no specific clinical findings for a splenic abscess. Abscesses of the spleen have been reported periodically since the time of hippocrates. Splenic abscess is an uncommon lesion with high mortality rates, because of delayed detection and treatment 14, 15. Enterococcus hirae is a known member of the intestinal flora of several domestic animal species but rarely encountered in humans. However, the final diagnosis was splenic abscess as a complication. The largest series of splenic abscesses reported in the literature is that of chang et al. The incidence of such a complication does not occur on a daily basis and the ability of the clinician to correlate the different signs and symptoms together with relevant diagnostic tools comes with experience. Splenic abscess and multiple intraabdominal abscess, related to hiv, aids, and hepatitis c. Mri of focal splenic lesions without and with dynamic gadolinium enhancement.
Splenic abscess is an unusual disease and may be present either as a localized area of infection in the spleen or as a part of generalized sepsis. Splenic abscess is a rare disease with only few reports in smallanimal practice as well as in human medicine. 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. Splenic abscess is more common in patients with endocarditis, immunocompromised and in patients with immunodeficiency virus infection. Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction tissue death due to oxygen shortage in the organ. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one third of the cases. Splenic abscess and multiple brain abscesses caused by. Splenic abscess in immunocompetent patients managed. May 21, 2008 abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far.
1514 817 889 1317 747 20 735 1363 915 341 1515 1549 129 664 464 426 383 1542 668 1252 1562 1167 828 1298 1154 658 682 424 256 1061 62 605 880 1480 1078 278 324