Abscesos esplénicos: Comunicación de siete casos y revisión de la literatura

Abstract

Splenic abscesses. Report of seven cases Background: Splenic abscesses are uncommon, appear in subjects with predisposing factors such as systemic infections and have high mortality rates. Aim: To report seven patients with splenic abscesses. Material and Methods: Retrospective review of medical records of patients with a splenic abscess treated between 1987 and 2005. Results: The records of four women and three males aged 20 to 74 years, were reviewed. The most common presenting symptoms were fever and abdominal pain and all had predisposing factors. Six patients had a leukocyte count of 19,500 x mm 3. Mean erythrocyte sedimentation rate and C reactive protein values were 75 mm/h and 13.5 mg/dl. Diagnosis was made with ultrasound in two patients and CT scan in five. Six patients had an unique abscess and one patient had multiple lesions. A splenectomy was done in three patients as the first choice treatment and in one, due to medical treatment failure. In two patients, a CT guided percutaneous drainage was performed and one patient was subjected to medical treatment only. Abscess cultures were positive in 50% of patients subjected to percutaneous drainage and in 50% of splenectomized patients. No patient died and no complications were observed in the early or late postoperative period. Conclusion: Splenic abscesses are associated to predisposing conditions. The first choice is surgical treatment, but percutaneous drainage is also a therapeutic option (

Conservative management of splenic abscess septic emboli after tooth extractions

“…Sometimes it can be difficult to differentiate from a splenic infarction or splenic haematoma, as it happened initially in our case. On ultrasound, splenic abscesses manifest as irregular hypoechoic or anechoic lesions (3,4). Multiple abscesses are less common (31-38%) and less symptomatic but they have a worse prognosis for the increased risk of sepsis (3).…”

“…The most important predisposing factor is the systemic infection, usually by haematogenous spread of septic emboli from a bacterial endocarditis (68-73%) or another distant septic focus, although they have also been described due to contiguity extension, haemoglobinopathies or after a splenic trauma (3,4). Usually patients with splenic abscess are adult males who have some associated risk factor: immunocompromised states, diabetes mellitus or intravenous drug abuse (1,4).…”

“…The most commonly isolated pathogens are aerobic gram-positive microorganisms (streptococci and staphylococci) and gram-negative (Klebsiella, E. coli and pseudomonas) (3)(4)(5). They are less common anaerobic bacteria or fungi.…”

“…In recent years, it has been successfully developed a more conservative approach, trying to preserve the organ through an aggressive antimicrobial therapy and radiological guided percutaneous drainage in hemodynamically stable younger patients with unique abscesses, without walls and away from the splenic hilum and in patients with high surgical risk, associated comorbidity, important or serious deterioration of the general status due to the sepsis status (1,(3)(4)(5). Percutaneous drainage allows choosing the most appropriate antibiotic, avoids the risk of purulent peritoneal dissemination and potential complications of splenectomy, reduces hospital stay, it is better tolerated by the patient and the cost is minor (4,5).…”

“…Usually it is not taken into account in the initial diagnosis of patients with abdominal symptoms and the natural history is associated with a high mortality (1)(2)(3). It is usually accompanied by other pathologies that lead to an immunocompromised state (1)(2)(3), which together with its vague expressions makes diagnosis and treatment to be delayed. In recent years, the evolution of imaging techniques has helped to improve early diagnosis and develop non-surgical management of these patients (1).…”