Spontaneous atraumatic splenic rupture complicating anticoagulant treatment for splenic infarction. Abnormalities of the chest radiograph were found in nine 56. However, if the diagnosis is missed, splenic abscess does carry very high. In view of the extreme rarity of this condition and of the lack of symptoms indicating splenic trouble it is believed a full report of the case would be. Abscesses may develop in the subcutaneous cellular tissue, in muscles, bones, and so forth, as well as in organs such as the liver, lungs, spleen, and brain or between them interintestinal abscesses, subphrenic abscesses, and so on. Splenic scan is diagnostic modality to identify abscesses which relies upon splenic uptake of the radionuclide 99m technetium which shows abscess as a negative or filling defect. This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease scd. Ultrasoundguided diagnostic needle aspiration showed the abscess content was bloody turbid fluid, and the culture of aspirated fluid grew salmonella berta. The presentation was initially vague and later evolved to an acute abdomen. Many surgeons had reported that splenectomy is a better way for treatment of splenic abscess 35,810.
We report a case of splenic abscess, caused by salmonella typhi, and coinfection with leptospira in a previously healthy young male. T1 splenic abscess presentation, diagnosis, and treatment. Appropriate antibiotics and adequate surgical drainage can contribute to a. Further, splenic abscess often occurs in the patients with underlying diseases48. Instances of splenic abscesses are relatively increased among intravenous drug addicts. Splenic abscess, though a rare entity in children, needs quick assessment and treatment owing to the associated mortality and morbidity. Historically, splenectomy has been the treatment of choice for abscesses.
Enterococcus hirae is a known member of the intestinal flora of several domestic animal species but rarely encountered in humans. Splenic abscess definition of splenic abscess by the free. Isolated splenic abscesses are rare, and this represents the second case in the literature of splenic abscess caused by streptococcus intermedius. While many advocate imageguided drainage 9,10, several publications suggest that splenectomy has a better outcome than percutaneous drainage or intravenous antibiotics alone 3,4. Most of patients were with recognized risk factors including conditions that compromise the immune system, trauma and intravenous drug abuse in addicts. Pulmonary arteriovenous malformations complicated by splenic infarction and abscess. The patients had a clinical profile of nontoxic appearance with a. Splenic abscess owing to cancer at the splenic flexure. In our patient there was free perforation of gastric ulcer in to the lesser sac resulting in thrombosis of the splenetic artery and splenic abscess. We report the first case of splenic abscess caused by streptococcus gallolyticus subsp.
The frequency may be rising due to a rise in the use of immunosuppressive agents and prevalence of immunosuppressive states, higher survival of leukemic patients, and high incidence of drug abuse,15 clinical presentation. Diagnosis and treatment of splenic fungal abscesses in the. Splenic abscess as a rare presentation of blastomycosis bmj. Early institution of parenteral antibiotics and usg or ctguided aspiration would help in preventing splenectomy in children. He postulated that 1 of 3 courses was followed by a patient with a splenic abscess. Jul 11, 2017 splenic abscess is a rare entity, especially in developed countries. Splenic abscess from fusobacterium nucleatum annals of. Splenic abscesses are potentially fatal complication of typhoid fever. During a recent 5year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound us examination. The most important signs and symptoms are shown in table 2. In contrast, only 19% of bacterial abscesses were multilocular.
Splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Ultrasonography alone may not be beneficial in reaching a diagnosis of splenic abscess as conditions like cyst, nodular hyperplasia, necrosis and hematoma may result in similar ultrasound findings. Splenic abscess in immunocompetent patients managed. Ulcer complications and their nonoperative treatment. Jul 23, 2009 abscess of the spleen is a rather clinical rarity with reported mortality rate up to 47%. Apr 21, 2020 splenic abscess is a rare entity, with a reported frequency of 0.
Splenic abscess and multiple brain abscesses caused by. A pus culture from the infection site is the only diagnostic method for visceral abscess melioidosis. We present 29 cases of splenic abscess treated in our hospital from 1990 to 2001. Once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. In an 18month period candidal splenic abscesses were diagnosed and treated in eight patients. To access free multiple choice questions on this topic, click here. At one teaching institution, only 11 cases were found in a 30year period 1. Patient characteristics, including age, sex, predisposing factors, and number and size of splenic abscesses are shown in table 1. Streptococci accounted for 18 abscesses, with six containing enterococci. Splenic abscess is a rare cause of abdominal abscesses, but lifethreatening. The incidence of splenic abscess is thought to be growing due to the increasing number of at risk patients for this disease, and also due to the advancement in the. There was no intraperitoneal soilage or free perforation. Splenic abscesses caused by streptococcus bovis are rarely reported in the literature and are mainly seen in patients with endocarditis and associated colonic neoplasiacarcinoma.
The left sided pleural effusion was due to inflammatory reaction adjacent to left hemi diaphragm. A spleen abscess or splenic abscess occurs when bacteria or fungi from elsewhere in the body travel via the blood stream into the spleen tissue where they multiply. Sonography of pyogenic splenic abscess article pdf available in american journal of roentgenology 83. A spleen abscess can cause a fever and left upper abdominal pain. In the presented case, the cause of splenic abscess was not identified since the patient had no history that fit into one of the five categories above. It is transmitted to humans via percutaneous inoculation while working in these areas without protective clothing and footwear giving rise to the disease which has a high case fatality rate. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, longterm use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with candida. Splenic abscess is a rare clinical finding, with a reported prevalence between 0. We report our experience of percutaneous drainage of splenic abscess under ultrasound us guidance. B pseudomallei is a potential causative organism of splenic abscess in patients with risk factors who reside in endemic areas and do not respond to standard antibiotics. Splenic abscess has been associated with endocarditis, metastatic infection from other foci, trauma, and underlying immunodeficiency, and it has been found in intravenous drug abusers with or without endocarditis. Most splenic abscesses are due to aerobial microorganisms. The timely and widespread use of imaging methods facilitates early diagnosis and guides treatment, thus improving the prognosis.
Splenic abscess is a rare entity, with a reported frequency of 0. Though splenic abscesses are very rare complications of nontyphoidal salmonella infections, nontyphoidal salmonella has been isolated in about 15% of patients with a splenic abscess while splenectomy or percutaneous drainage with antibiotics are considered preferred treatments, there is an increasing number of case reports in which conservative management with antibiotics. From an epidemiological point of view, they are more frequently detected in middleaged and older individuals, with no obvious preference for either sex 1 3. Sep 03, 2017 splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Images in splenic abscess as a rare presentation of blastomycosis. Pneumoperitoneum as a result of a ruptured splenic abscess. All presented with fever and abdominal pain and were found to have a tender enlarged spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation.
Splenic definition of splenic by the free dictionary. Because of its rarity, splenic abscess usually diagnosed at the late stages or after the onset of complications. Abscesses of the spleen have been reported periodically since the time of hippocrates. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. May 21, 2008 perhaps the most interesting parameter in our three cases of splenic abscess, however, is the lack of any obvious risk factors in any of the individuals22,23. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions. Isolated splenic abscess due to salmonella berta in a healthy. Splenic abscess represent either a local or multifocal lesion. Streptococcus intermedius, a member of the streptococcus anginosus group, is a common commensal organism of the oral cavity and gastrointestinal tract, and it is a known. If patient showing high suspicion of splenic abscess and scan supports the diagnosis, then splenectomy can be performed.
Multiple splenic abscesses are very rarely encountered in surgical. Standard surgical treatment for splenic abscess is antibiotics and drainage. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was. Splenic abscess in immunocompetent patients managed primarily. In the last 30 years at the johns hopkins hospital, only 11 patients have been treated for clinically overt splenic abscess. Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation.
Splenic abscesses are uncommon, and their incidence in various autopsy series is estimated at 0. Case report of successful partial splenectomy for a splenic abscess. We report a case of multiple splenic abscesses caused by e. In 2005, haan and colleagues 37 reported complications in the largest singlecenter study of splenic artery embolization for blunt splenic trauma. Splenic abscess should be suspected in febrile patients with left upper quadrant tenderness and leukocytosis, and diagnosis confirmed based mostly on imaging studies, microbiologic andor pathologic evidence, or by response to antibiotic or antifungal treatment. Natural history, complications and prognosis natural history. Splenic abscess presentation, diagnosis, and treatment. It may arise either from the spread of infection from a neighboring organ that is, a diverticular abscess or a ruptured gastric ulcer or from hematogenous spread in patients with infective endocarditis. An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0.
Etiology, clinical spectrum and therapy 39 the only laboratory abnormality that is frequently present is leukocytosis, which is seen in 60% to 80% of cases 2. The patient responded to combined therapy with antibiotics plus. Splenic abscess is a rare entity, especially in developed countries. Splenic abscess caused by salmonella typhi and coinfection.
It is suggested that a diagnosis of splenic abscess could be reached only based. Because of its insidious symptoms, a spleen abscess remains a diagnostic challenge in developing countries, where ultrasounds and computed tomographic scans are not easily accessible. In general, there is infradiaphragmatic localized collection of fluid with air bubbles or airfluid level which has an enhancing wall. This case presented a variety of symptoms which, as far as the spleen itself was concerned, were absolutely negative and it was not until autopsy that a large splenic abscess was discovered. Broad spectrum antibiotics with the supportive treatment. Recognized risk factors in such patients include conditions such as infective endocarditis, diabetes. He was again admitted 2 months later for intestinal obstruction. Splenic abscess definition of splenic abscess by medical.
Recognized risk factors in such patients include conditions such as infective endocarditis, diabetes mellitus, trauma. Fungal splenic abscesses were present in 28% of our cases, and all were multilocular. We report our experience of percutaneous drainage of. However, the authors do not discard a possible trauma not seen by the owner. Patients with multiple splenic abscesses msa or immunodeficiency are considered to have a poor prognosis and high mortality4,5,9. The surgical treatment by splenectomy is usually the first choice of treatment. Solitory abscess present with delayed onset of presentation with history of trauma. Treatment of splenic abscess is traditionally divided into two groups of. Cureus systemic melioidosis with ruptured splenic abscess. Abdominal ultrasound showed a complex cystic lesion within the spleen. An x not reveal pneumoperitoneum which was performed. Staining of round yeast approximately 8 mm in diameter, budding on a broad base, is helpful. Article info abstract we present a case of splenic abscess causing pneumoperitoneum in a patient with diabetes mellitus. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality rates.
Multifocal abscesses were noted in seven patients, three of them were. Indeed, a detailed medical history and clinical examination were performed initially and postdiagnosis, in an attempt to reveal any of the factors known to be associated with the. Splenic abscess secondary to perforation of gastric ulcer. On the other hand, splenic abscesses are most uncommon in the general population. The reported occurrence of splenic abscess in autopsy series is less than 1% and rarely is an antemortem diagnosis made 1. Splenic rupture knowledge for medical students and physicians. Conservative management of splenic abscess septic emboli after. Clinical characteristics and prognostic factors of splenic. Appropriate management can lower mortality to less than 10%. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as the size and topography of the abscess.
Report of a case of splenic abscess jama jama network. Splenic abscess caused by streptococcus gallolyticus subsp. Splenic abscesses caused by salmonella infection usually occur on preexisting lesions 4 and have been increasingly reported recently 9. Melioidosis is a severe systemic disease caused by the bacterium burkholderia pseudomallei, commonly found in soil, ground water, and ponds of endemic regions. Subphrenic abscess may be rightsided between right hemidiaphragm and liver or leftsided between left hemidiaphragm and spleen, most often is rightsided 1. A case of multiple splenic abscesses due to enterococcus. Splenic abscess as a rare presentation of blastomycosis. The incidence of splenic abscess is a clinically uncommon disease with current literature reporting a 0. Antibiotic treatment of splenic abscess annals of internal. Multiple splenic abscesses in a rather healthy woman. Her past medical history was free from any chronic debilitating diseases or.
Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. Splenic infarction and abscess in the setting of infective endocarditis. The surgical management of splenic abscess is determined by patient. Pathology having a disease or disorder of the spleen splenic.
We report a case of splenic abscess with multiple brain abscesses caused by streptococcus intermedius in a healthy young man without any identifiable risk factors, which resolved with percutaneous drainage and antibiotics. Isolated splenic abscess due to salmonella berta in a. Splenic abscess article about splenic abscess by the. The clinical presentation of splenic abscess is insidious, often with constitutional symptoms. Splenic abscess complicating infectious endocarditis jama. Splenic abscess is an uncommon disease, with a reported incidence of 0. In most of these patients, hemoglobinopathies or some other underlying immunocompromised state is usually present.
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