We present 7 cases of splenic abscess collected in our hospital from 1980 to 1988 as well as a review of 227 cases of the world literature. The signs and symptoms are nonspecific in all of them, fever being the most constant. Computed tomography scan followed by sonography were demonstrated to be the best methods of diagnosis. The treatment carried out on all of our patients was splenectomy followed by antibiotic coverage. Two of them died 15 days after the operation due to persistence of the septic state. In our review of the literature, we observe a rise in the population at risk for splenic abscess due to an increase in the use of immunosuppressive agents, to the higher survival of leukemic patients, and to the great incidence of drug abuse among others. Nevertheless, the advances in the use of sonography and computed tomography scan have made possible a more accurate diagnosis, therefore making possible an earlier treatment and a better prognosis. We believe that the treatment of choice is splenectomy with conservative treatment used only in specific cases where surgery represents a high risk for the patient.
Hypothesis: Analysis of the type and characteristics of complications after laparoscopic splenectomy may permit the identification of clinical factors with predictive value for the development of complications. Design: Univariate and multivariate analysis of factors related to complications in a prospective series of laparoscopic splenectomies. Setting: A large tertiary referral university-teaching general hospital. Patients: One hundred twenty-two nonselected consecutive patients, in whom laparoscopic splenectomy was attempted between February 1993 and July 1999. Intervention: Laparoscopic splenectomy. Main Outcome Measures: Immediate complications classified according to the Clavien score. Univariate and multivariate analyses were performed of complications related to age, sex, body mass index, and malignant nature of the hematologic disease; preoperative hematocrit and platelet count; operative time; operative position; need of accessory incision; transfusion status; learning curve; and existence of comorbid diseases. Clinical Outcome Value* Operative time, min 153 ± 59 (60-240) Transfusion, % 18 Morbidity, % 18 Hospital stay, d 4 ± 2 (2-14) Spleen weight, g 493 ± 588 (60-3200) Accessory spleen, % 12 Accessory incision, % 36 *Data are given as mean ± SD (range) unless otherwise indicated. No conversions were related to intraoperative complications. Twenty
In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, who usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.
The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of remnant pancreatic function after pancreatoduodenectomy.
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