Splenic abscess is infrequently encountered. This paper reports on the diagnosis and management of six cases from Southern Saudi Arabia. Common presenting features were diffuse abdominal pain and fever. Signs localized to left upper quadrant of the abdomen were present in only two patients. The difficulty of diagnosis is signified by the fact that two cases were overlooked during initial surgery. The computed tomographic (CT) scan was quite accurate in three cases while ultrasound was reliable in five patients. Known causes of splenic abscess were present in four of the six patients. Two patients had gangrenous bowel and one each had bacterial endocarditis and sickle cell trait. All patients were managed by perioperative antibiotics and splenectomy. Review of the literature shows that splenectomy remains the treatment of choice while CT-guided aspiration is being increasingly employed especially for the poor-risk patients with unilocular abscesses.MA Cheema, AA Al-Saigh, ABA Latif, Splenic Abscess: Presentation, Diagnosis and Management. 1992; 12(6): 552-554 The clinical presentation of splenic abscess may be difficult to recognize because the condition is uncommon. A majority of patients present with diffuse abdominal pain sometimes related to the left upper quadrant of the abdomen and have pyrexia. Clinical suspicion of splenic abscess can be confirmed by an ultrasound examination or more precisely by an abdominal computed tomographic (CT) scan. When left untreated, the splenic abscess becomes fatal [1] and its early detection can result in prompt treatment usually by splenectomy or percutaneous drainage. We report six patients with splenic abscess which presented over a period of four years.We also present a review of literature in order to familiarize clinicians of the usual methods of presentation of the patients with splenic abscess in the hope that a high index of suspicion will result in early diagnosis and timely treatment of these patients.
Patients, Methods and ResultsDuring August 1987 to April 1991, six patients were treated for splenic abscess by splenectomy in Asir Central Hospital. Their presenting features, predisposing factors, difficulties in diagnosis and management are presented in the following case reports.
Patient 1A 32-year-old Saudi female presented with fever, rigors, vomiting, hematuria, and left hypochondrial pain for seven days. She had a normal delivery six weeks prior to admission. The patient was not a known diabetic. On examination, her temperature was 39.8°C and abdomen showed a tender enlarged liver and spleen.