Ruptured splenic abscess causing pneumoperitoneum: a rare cause revisited

Abstract

SUMMARYWe present a case report of splenic abscess causing pneumoperitoneum in a case of uncontrolled diabetes. The patient presented with chronic pain abdomen and fever which later evolved to acute abdomen during the course of hospital stay. An X-ray showed pneumoperitoneum and exploratory laparotomy was performed under a strong clinical suspicion of hollow viscus perforation. The patient was treated with antibiotics and had an uneventful recovery. BACKGROUND

Non-traumatic ruptured splenic abscess presenting with pneumoperitoneum in an immunocompetent patient: a diagnostic dilemma

“…The most common organisms isolated on bacteriological culture is case of splenic abscess are Gram-negative bacilli ( K. pneumoniae , Escherichia coli ) and Gram-positive cocci ( Staphylococcus aureus ), although a vast variety of microorganism have been described 10 11. Due to presence of gas-producing organisms in the splenic abscess, may cause pneumoperitoneum after burst into the abdomen 11 12. We also noted presence of gas-producing organism as a cause of pneumoperitoneum in our case.…”

“…In general, failure to respond to antibiotics with or without percutaneous drainage necessitates the splenectomy. Splenectomy is the final definitive management for ruptured, severely damaged spleen or in cases not responding to percutaneous drainage 5 12…”

Splenic abscess presenting as a case of pneumoperitoneum: a rare presentation

“…8 It may be due to hematogenous spread to a normal or abnormal spleen and also due to extension of abscess from adjacent organs like pancreas, diverticular abscess or subphrenic abscess. 11 The most commonly isolated organisms include gram negative bacteria (E. coli, Klebsiella), gram positive bacteria (streptococcus, staphylococcus), mycobacterium, fungi and parasites. 9 The non-specific presentation of splenic abscess makes it difficult to diagnose clinically.…”

Atraumatic splenic rupture secondary to abscess in a hemodialysis patient: a rare and fatal cause of acute abdomen diagnosed late

“…Leukocytosis is present in most patients (78%). When an abscess is ruptured, acute abdomen and generalized peritonitis ensues, when intraabdominal free air may develop [ 5 ]. Culhaci et al [ 6 ] reported that they operated all patients with splenic abscess due to clinical signs and symptoms of acute abdomen, and discovered splenic abscess rupture in two of them.…”