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Seminars in Dialysis May 2021Peritoneal dialysis (PD)-related peritonitis is sometimes complicated with other infections; however, few cases of splenic abscess have been reported. We present the... (Review)
Review
Peritoneal dialysis (PD)-related peritonitis is sometimes complicated with other infections; however, few cases of splenic abscess have been reported. We present the case of a 64-year-old PD patient with complicated splenic abscesses diagnosed following relapsing sterile peritonitis. After PD induction, he presented with turbid peritoneal fluid and was diagnosed with PD-related peritonitis. A plain abdominal computed tomography (CT) did not reveal any intra-abdominal focus of infection. After empiric intravenous antibiotics, the peritoneal dialysate was initially cleared, with a decrease in dialysate white blood cells (WBC) to 20/µL. However, WBC and C-reactive protein (CRP) levels remained elevated. A contrast-enhanced abdominal CT showed two areas of low-density fluid with no enhancement in a mildly enlarged spleen, making it difficult to distinguish abscesses from cysts. Due to relapsing sterile peritonitis, we performed an abdominal ultrasonography, and suspected splenic abscesses due to rapid increase in size. Repeated imaging tests were useful in establishing a diagnosis of splenic abscesses. Considering the persistent elevation of WBC and CRP levels, imaging findings, and episodes of relapsing peritonitis, we comprehensively formed the diagnosis, and performed a splenectomy as a rescue therapy. We should consider the possibility of other infectious foci with persistent inflammation after resolving PD-related peritonitis.
Topics: Abscess; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Renal Dialysis; Splenic Diseases
PubMed: 33609413
DOI: 10.1111/sdi.12953 -
Acta Clinica Belgica Jun 2022Splenic abscesses are a rare medical entity with high mortality, with being an exceptional pathogen. We present the first case describing an abscess of the spleen in a... (Review)
Review
INTRODUCTION
Splenic abscesses are a rare medical entity with high mortality, with being an exceptional pathogen. We present the first case describing an abscess of the spleen in a patient undergoing treatment with adalimumab, an anti-tumour necrosis factor commonly used in inflammatory bowel diseases.
PATIENT
We describe the case of a 73-year-old woman, treated with adalimumab therapy, who was found to have a splenic abscess, caused by .
RESULT
After antibiotic treatment and percutaneous drainage, the patient recovered both clinically and radiographically.
DISCUSSION
We reviewed literature about splenic abscesses. In all cases identified, a splenectomy was performed. This is the first case description of splenic abscess caused by where a percutaneous drainage was performed, leading to complete recovery in our patient. This seems to indicate that a splenectomy is not necessary in all splenic abscesses.
Topics: Abscess; Adalimumab; Aged; Anti-Bacterial Agents; Clostridium perfringens; Drainage; Female; Humans; Splenic Diseases
PubMed: 34151751
DOI: 10.1080/17843286.2021.1940606 -
Yonsei Medical Journal Mar 2011The aim of this study was to review our experience with splenic abscesses, with respect to the relevant aspects of splenic abscesses and treatment outcomes. (Review)
Review
PURPOSE
The aim of this study was to review our experience with splenic abscesses, with respect to the relevant aspects of splenic abscesses and treatment outcomes.
MATERIALS AND METHODS
We reviewed the cases of 18 patients who had splenic abscesses and who were treated at our hospital from November 1993 to December 2008.
RESULTS
The most common symptom at presentation was abdominal pain in 12 patients (66.7%). The median duration from symptom onset until establishment of a diagnosis was 22 days. Streptococcus viridans was the most common pathogen (27.8%), follow by Klebsiella pneumoniae (22.2%). The mortality rate during the inpatient period and the previous 90 days was 16.6%. Three of four patients with Klebsiella pneumoniae showed a single abscess pocket. Four patients (22.2%) underwent percutaneous drainage, eight (44.5%) received antibiotic treatment only and six (33.3%) underwent splenectomy.
CONCLUSION
There is no gold standard for treating splenic abscesses. Treatment should be customized for each patient.
Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; Drainage; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Splenectomy; Splenic Diseases; Streptococcal Infections; Treatment Outcome; Viridans Streptococci; Young Adult
PubMed: 21319348
DOI: 10.3349/ymj.2011.52.2.288 -
Acta Chirurgica Belgica Oct 1998The records of five patients treated in our department for splenic abscess are analysed and the literature is reviewed. Computed tomography revealed the correct... (Review)
Review
The records of five patients treated in our department for splenic abscess are analysed and the literature is reviewed. Computed tomography revealed the correct diagnosis in all patients, while clinical presentation was often nonspecific. Spleen-preserving management was possible in two patients (40%). Outcome was uneventful for four patients. One patient with a splenic abscess caused by Mycobacterium tuberculosis and acquired immunodeficiency syndrome, died 4 months after splenectomy from sepsis. We discuss the clinical presentation of splenic abscess, its diagnostic approach, and treatment. Additionally, we studied whether spleen-preserving management is feasible or not.
Topics: AIDS-Related Opportunistic Infections; Abdominal Pain; Abscess; Adult; Aged; Cause of Death; Feasibility Studies; Female; Fever; Follow-Up Studies; Humans; Male; Middle Aged; Sepsis; Spleen; Splenectomy; Splenic Diseases; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Splenic
PubMed: 9830544
DOI: No ID Found -
Przeglad Lekarski 1999Splenic abscess consists a very rare pathology. There were less than 300 cases described in the literature in the last 10 years. We report a case of 68 year old women... (Review)
Review
Splenic abscess consists a very rare pathology. There were less than 300 cases described in the literature in the last 10 years. We report a case of 68 year old women with the splenic abscess with a history of blunt trauma of the left side chest wall two years earlier. The diagnosis was confirmed by USG and CT. The patient underwent splenectomy. The post operative course was uneventful.
Topics: Abscess; Aged; Female; Humans; Spleen; Splenic Diseases; Tomography, X-Ray Computed; Ultrasonography; Wounds, Nonpenetrating
PubMed: 10442017
DOI: No ID Found -
Canadian Journal of Surgery. Journal... May 1985Abscess of the spleen is a rare entity. It may develop after generalized infection, hematologic disorders and trauma. The authors report the case of a 7-year-old boy who...
Abscess of the spleen is a rare entity. It may develop after generalized infection, hematologic disorders and trauma. The authors report the case of a 7-year-old boy who presented with a 2-month history of spiking fever, anorexia, fatigue and weight loss. He had left subcostal tenderness and a palpable spleen. He had a history of trauma to the left flank 5 months before admission but a splenic scan obtained at that time appeared normal. A splenic abscess was diagnosed by gallium scanning, computerized tomography and ultrasonography. Although splenectomy has been advocated as the treatment of choice for splenic abscess, this patient was treated successfully with appropriate antibiotics and simple drainage, preserving the spleen. Cultures grew Staphylococcus aureus. Of all the diagnostic methods available, ultrasonography is the least invasive study that will make the diagnosis and is less expensive than some methods.
Topics: Abscess; Anti-Bacterial Agents; Child; Humans; Male; Splenic Diseases; Tomography, X-Ray Computed; Ultrasonography
PubMed: 3888357
DOI: No ID Found -
Splenic abscess in a tertiary care centre in India: clinical characteristics and prognostic factors.ANZ Journal of Surgery Sep 2021Splenic abscess has been an uncommon entity which is now being encountered more frequently due to increased prevalence of immunodeficiency disorders and chronic...
BACKGROUND
Splenic abscess has been an uncommon entity which is now being encountered more frequently due to increased prevalence of immunodeficiency disorders and chronic illnesses. This study was aimed to audit our experience with splenic abscesses at a tertiary care centre in India highlighting usefulness of an algorithmic approach.
METHODS
Retrospective analysis of data of patients (January 2014 to December 2019) with splenic abscess was done. Data were retrieved for clinical characteristics, radiological findings, organism spectra, abscess characteristics, therapeutic measures and clinical outcome.
RESULTS
The mean age of the study population (n = 36) was 41.3 ± 19.0 years with 50% males. Comorbidities were identified in 17 (47.2%) patients, with diabetes mellitus being the commonest. Fever and abdominal pain were the most common presenting features. Multiple splenic abscesses were present in 21 (58.3%) patients. Extra-splenic abscesses in liver were seen in five (13.9%) patients while nine (25%) patients had ruptured splenic abscess. Microorganisms were identified in 24 (66.7%) patients, with Salmonella typhi being the commonest (n = 9, 25%) followed by Escherichia coli (n = 7, 19.4%) and Staphylococcus aureus (n = 4, 11.1%). Six patients received only antimicrobials, 24 were managed with percutaneous aspiration or catheter drainage and six required surgery. Five (13.9%) patients died, with highest mortality being seen in those who received only antimicrobial (50%), compared to percutaneous aspiration or catheter drainage (8.3%) and surgery (0%), P = 0.017.
CONCLUSION
Using percutaneous aspiration or drainage in conjunction with antibiotics, followed by surgery in non-responder, patients with splenic abscesses can be managed successfully with acceptable mortality.
Topics: Abscess; Adult; Drainage; Female; Humans; India; Male; Middle Aged; Prognosis; Retrospective Studies; Splenic Diseases; Tertiary Care Centers; Young Adult
PubMed: 33369845
DOI: 10.1111/ans.16517 -
The American Surgeon Mar 2020
Topics: Abdominal Abscess; Adult; Aged; Drainage; Female; Humans; Male; Middle Aged; Retrospective Studies; Spleen; Splenic Diseases; Treatment Outcome
PubMed: 32223819
DOI: No ID Found -
Medicine Sep 2016The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset. (Review)
Review
BACKGROUND
The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset.
METHODS
We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction.
RESULTS
An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a Coloplast Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess.
CONCLUSION
This is the 13 case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear.
Topics: Abscess; Colonic Neoplasms; Digestive System Fistula; Drainage; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Intestinal Obstruction; Laparotomy; Male; Middle Aged; Spleen; Splenic Diseases; Tomography, X-Ray Computed
PubMed: 27661050
DOI: 10.1097/MD.0000000000004941 -
Acta Gastro-enterologica Belgica 2019Splenic abscess is a rare but potentially fatal entity, occurring mainly in patients with underlying risk factors. Mortality of the disease depends on the time of... (Review)
Review
Splenic abscess is a rare but potentially fatal entity, occurring mainly in patients with underlying risk factors. Mortality of the disease depends on the time of diagnosis and treatment. Due to low sensitivity and specificity of clinical symptoms and laboratory markers, imaging plays the vital role in the diagnostic work-up. The aim of this article is to give a concise overview of the methods of splenic abscess diagnosis.
Topics: Abscess; Bacterial Infections; Humans; Intraabdominal Infections; Risk Factors; Splenic Diseases; Time Factors
PubMed: 31566331
DOI: No ID Found