Splenic Absces - Diagnostics and Treatment

• Authors: Radosław Bilski , Andrzej Szczepanik , Adam Wiszniewski , Alfred Meissner , Jerzy Ratajczak
• Languages of publication: EN

Abstracts

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.

Keywords

EN

abscess; spleen; splenectomy; drainage; perisplenitis

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 9
• Pages: 392-399

Dates

published

1 - 9 - 2009

online

4 - 9 - 2009

Contributors

author

Radosław Bilski

• Department of General and Hematological Surgery, Institute of Haematology and Transfusion Medicine, Warsaw

author

Andrzej Szczepanik

• Department of General and Hematological Surgery, Institute of Haematology and Transfusion Medicine, Warsaw

author

Adam Wiszniewski

• Department of General and Hematological Surgery, Institute of Haematology and Transfusion Medicine, Warsaw

author

Alfred Meissner

• Department of General and Hematological Surgery, Institute of Haematology and Transfusion Medicine, Warsaw

author

Jerzy Ratajczak

• Department of Anaesthesiology and Intensive Care, Institute of Haematology and Transfusion Medicine, Warsaw

References

• Nelken N, Ignatius J, Skinner M et al.: Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. Am J Surg 1987; 154: 27-34.
• Chun CH, Raff MJ, Contreras L: Splenic abscess. Medicine 1980; 59: 50-65.[WoS][PubMed]
• Reid SD, Land SJ. Abscess of the spleen. Am J Surg 1954; 88: 912.[Crossref][PubMed]
• Phillips GS, Radosevich MD, Lipsett PA: Splenic abscess. Another look at an old disease. Arch Surg 1997; 132: 1331-35.
• Nallthambi MN, Ivatury RR, Lankin DH et al.: Pyogenic splenic abscess in intravenous drug addition. Am Surg 1987; 53: 342-46
• Ho HS, Wisner DH: Splenic abscess in the intensive care unit. Arch Surg 1993; 128: 842-48.
• Ooi LLP, Leong SS: Splenic abscess from 1987 to 1995. Am J Surg 1997; 174: 87-93.
• Neki NS, Batra KS, Sharma RK et al.: Isolated tubercular splenic abscess. J Assoc Physicians India 2001; 49: 759-60.[PubMed]
• Ghadage DP, Bal AM: Isolation of Salmonella enterica serotype Worthington from a splenic abscess in a patient with chronic myeloid leukemia. Braz J Infect Dis 2002; 6: 88-90.
• Bessho H, Ichihara I, Takii M: A case of splenic abscess due to Chlamydia pneumoniae. Diagn Microbiol Infect Dis 2001; 39: 261-64.[Crossref][PubMed]
• Chen CY, Chen YC, Tang JL et al.: Splenic actinomycotic abscess in a patient with acute myeloid leukemia. Ann Hematol 2002; 81: 532-34.
• Contini S, Lewis HR: Spleen abscess as malaria complication. Emerg Infect Dis 2006; 12: 529-31.[PubMed][Crossref]
• Cavuti D, Fogli M, Quinton R et al.: Splenic abscess with Vibrio cholerae masking pancreatic cancer. Diagn Microbiol Infect Dis 2002; 43: 311-13.[Crossref]
• Paris S, Weiss SM, Ayers WH et al.: Splenic Abscess. Am Surg 1994; 60: 358-61.
• Helton WS, Carrico CJ, Zaveruha A et al.: Diagnosis and treatment of splenic fungal abscesses in the immunesuppresed patient. Arch Surg 1986; 121: 580-86.[Crossref]
• Green BT: Splenic abscess: report of six cases and review of the literature. Am Surg 2001; 67: 80-85.
• Teich S, Oliver GC, Canter JW: The early diagnosis of splenic abscess. Am Surg 1986; 52: 303-07.[PubMed]
• Johnson JD, Raff MJ: Fungal splenic abscess. Arch Intern Med 1984; 144: 1987-92.
• Nikolaidis N, Giouleme O, Gkisakis D et al.: Posttraumatic splenic abscess with gastrosplenic fistula. Gastrointest Endosc 2005; 61: 771-72.[PubMed][Crossref]
• Balasubramanian SP, Mojjada PR, Bose SM: Ruptured staphylococcal splenic abscess resulting in peritonitis: report of a case. Surg Today 2002; 32: 566-67.[Crossref][PubMed]
• Ishigami K, Decker GT, Bolton-Smith JA et al.: Ruptured splenic abscess: a cause of pneumoperitoneum in a patient with AIDS. Emerg Radiol 2003; 10: 163-65.[Crossref]
• Chang KC, Chuah Sk, Changchien CS et al.: 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: 260-64.
• Fotiadis C, Lavranos G, Patapis P, et al.: Abscesses of spleen: Raport of three cases. World J Gastroenterol 2008; 14: 3088-91.[Crossref][WoS]
• Tung CC, Chen FC, Lo Cj et al.: Splenic abscess: an easily overlooked disease? Am Surg 2006; 72: 322-25.[PubMed]
• Greek BT: Splenic abscess: report of six cases and review of the literature. Am Surg 2001; 67: 1014-15.
• Smyrniotis V, Kehagias D, Voros D et al.: Splenic abscess. An old disease with new interest. Dig Surg 2000; 17: 354-57.[PubMed][Crossref]
• Kang M, Saxena AK, Gulati M et al.: Ultrasound-guided percutaneous catheter drainage of splenic abscess. Pediatr Radiol 2004; 34: 271-73.[Crossref]
• Chou TH, Tiu CM, Chipu HJ et al.: Ultrasoudguided interventional procedures in splenic abscesses. Eur J Radiol 1998; 28: 167-70.[Crossref][PubMed]
• Hadas-Halpren I, Hiller N, Dolberg M: Percutaneus drainage of splenic abscesses: an effective and safe procedure. Br J Radiol 1992; 65: 968-70.[Crossref]
• Chou YH, Hsu CC, Tiu CM et al.: Splenic abscess: Sonografic diagnosis and percutaneus drainage. Gastrointest Radiol 1992; 17: 262-66.[Crossref]
• Farres H, Felsher J, Banbury M et al.: Managment of splenic abscess in a critically ill patient. Surg Laparosc Endosc Percutan Tech 2004; 14: 49-52.[Crossref]
• Choudhury SR, Rajiv C, Pitamber S et al.: Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg 2006; 41: 53-56.[Crossref]

Identifiers

DOI

10.2478/v10035-009-0066-1