Splenic abscess

Abstract

With less than 1000 cases described globally, abscess of the spleen constitutes an infrequent disease. Difficult to diagnose, the disease carries a high morbidity and mortality rate when it remains undiagnosed, since it has a predisposition for immunocompromised patients. Furthermore, with the advent of non-operative management of splenic trauma, less splenectomies are performed using embolization, potentially giving rise to the formation of a splenic abscess. Therefore, it is important that surgeons are familiar with this disease and treat it accordingly. The aim of this article is to review the pathogenesis, epidemiology, diagnostic modalities and methods of treatment for this disease. Different imaging modalities facilitate diagnosis, with computed tomography being the cornerstone. Splenectomy remains the mainstay of treatment, although encouraging results of more conservative methods have been reported. Splenic abscess is relevant to the differential diagnosis of febrile surgical disease and should be suspected when the surgeon is confronted with patients complaining of fever and pain in the left subcostal region, especially when they are under some form of immunosuppression. PathophysiologyFungal splenic abscesses are multiloculated in 90%

Splenectomy for Aseptic Splenic Abscess

“…CT Scan and MRI are imaging modalities that have very high sensitivity. Splenic abscess typically shows a thick irregular edge with hypodense in the middle, but multiple abscesses may be difficult to recognize (Krokos et al 2011, Zavariz et al 2017. In this case report, we presented a rare case about splenic abscess according to the literature.…”

“…Abdominal ultrasound has very useful and added advantage for guideline of percutaneous needle aspirations, and catheter placement for continuous drainage. CT scan and MRI of the abdomen are more superior imaging modalities than others for splenic abscess evaluation (Hamarayan et al 2012, Krokos et al 2011.…”

“…In this case, the right decision for the patient was splenectomy, both with open and laparoscopic splenectomy. Significant splenomegaly (length >22 cm or weight >700 grams) was considered a contraindication, so that laparoscopic resection was performed, because it was difficult to manipulate and there was a risk of bleeding (Krokos et al 2011). There are only three therapeutic modalities, namely (a) antibiotics only, (b) antibiotics with percutaneous drainage, and (c) splenectomy.…”

“…The surgery combination and antibiotic therapy were considered the most suitable treatment method. However, broad spectrum antibiotics should be given to patients who cannot be operated on (Krokos et al 2011). Minimally, the invasive method has the advantages of surgical risk minor and hospitalization short duration (Fotiadis et al 2008).…”

“…The best therapeutic approach for splenic abscess is still a matter of debate (Lee & Lee 2018). Complications of splenic abscess include fistula formation, rupture (43% mortality) and sepsis (Krokos et al 2011).…”