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Splenic Absces - Diagnostics and Treatment

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Bilski R., Szczepanik A., Wiszniewski A., Meissner A., Ratajczak J.
Polish Journal of Surgery
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2009
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vol. 81
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issue 9
392-399
EN
Splenic abscess is a rare condition often difficult to diagnose and always fatal, if untreated. It is frequently concomitant with immunodeficiency, especially in hematological disorders.The aim of the study was to share our own experience in the treatment of splenic abscess and to present the review of current literature on the subject.Material and methods. In the period January-June 1997, 8 patients were treated for splenic abscess at the Department of General and Hematological Surgery of the Institute of Hematology and Transfusion Medicine in Warsaw; (6 men and 2 women; mean age 51.3 years). Six patients reported immunodeficiency disorders in medical interview (immunoglobulin deficiency, alcoholism, leukopenia, agranulocytosis, lymphoproliferative disorders).Prior to operation, chest X-rays as well as US and CT imaging were performed for all patients; all were qualified for splenectomy.Results. In all cases, imaging studies revealed splenomegaly and characteristics suggestive of splenic abscess, in chest X-ray of 6 patients typical abscess changes were also found. Classic splenectomy was performed in all 6 cases. The total mass of spleen removed was 365 g-1560 g, mean of 962 g. Procedure duration was 72 to 135 min, mean of 88,3 min. Patients were transfused 1 to 4 units of red blood cell concentrate, mean of 2.1 units. In patients with perisplenitis, priooperative blood loss was greater and the procedure was extended. In the postoperative period, such complications as deep vein thrombosis of lower extremities, portal vein thrombosis, aggrevation of chronic renal insufficiency and circulatory insufficiency evoked by paroxysmal atrial fibrillation were observed in 4 patients. No deaths were reported. Six patients were discharged in a satisfactory state; 2 were transferred to the hematological department for further treatment due to persisting septic state.Conclusion. Despite a high incidence rate of periooperative complications, classic splenectomy still remains the procedure of choice for splenic abscess treatment.
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Recommendations for the Management of Trauma or Surgery-Related Massive Blood Loss

45%
Paluszkiewicz P., Mayzner-Zawadzka E., Baranowski W., Bręborowicz G., Brzeziński M., Durek G., Dziki A., Czupryńska M., Lipińska-Gediga M., Łętowska M., Mital A., Nowacka E., Pychyńska-Pokorska M., Ratajczak J., Rogowski J., Rybicki Z., Sobieszczyk S., Trzciński R., Wawrzynowicz-Syczewska M., Windyga J., Wujtewicz M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
465-476
EN
Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation.The aim of the study was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding.Material and methods. The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile.Results. It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml / kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g / L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII.Conclusions. Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.
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