1
|
Ooi DQH, Ooi JQC, Ooi LLPJ. Splenic abscesses in the new millenium - a systematic review. ANZ J Surg 2024. [PMID: 39051445 DOI: 10.1111/ans.19178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Isolated splenic abscesses are rare, but increasingly reported with newer organisms and changes in mechanisms involved. We conducted a comparative review of publications from 1900-1977, 1977-1986, 1987-1995, and 1996-2022. METHODS A systematic search in Embase and PubMed resulted in 522 publications (1111 cases). Data was tabulated, analysed, and compared. RESULTS Patient demographics and symptoms remain unchanged although more Asian patients were reported. Metastatic infections remain the main cause, but COVID-19-linked and iatrogenic causes post bariatric surgery and splenic artery embolization are increasingly reported. Aerobic organisms remain the commonest (68%), with a variety of exotic organisms reported. Splenectomy remains the definitive treatment, although antibiotics only and percutaneous aspiration/catheter-drainage are increasingly used with reasonable outcomes, with salvage splenectomy for therapeutic failures not having significantly higher mortality than upfront splenectomy. CONCLUSIONS Isolated splenic abscesses continue to be uncommon, with diagnosis requiring a high degree of suspicion. Non-surgical options for treatment can sometimes be definitive.
Collapse
Affiliation(s)
- Daniel Quan Hui Ooi
- School of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joshua Quan Chen Ooi
- School of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - London Lucien Peng Jin Ooi
- Department of Hepatopancreatobiliary & Transplant Surgery, Singapore General Hospital, Singapore
- Office of Education, Duke-NUS Medical School, Singapore
| |
Collapse
|
2
|
Arora N, Dhawan S. Splenic Abscesses in the Pediatric Population: A Literature Review of an Uncommon Entity. Cureus 2024; 16:e65607. [PMID: 39205713 PMCID: PMC11350243 DOI: 10.7759/cureus.65607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Splenic abscess in the pediatric population is a rare but serious condition. Its incidence is reported to be between 0.05% and 0.7%. Splenic abscess is an infectious suppurative process with a discernible macroscopic filling defect in the subcapsular space or spleen parenchyma. Causes include bacterial infection through the hematogenous route or from locoregional spread such as the gastrointestinal tract, septic emboli, trauma, sickle cell anemia, and malarial infestation. Diagnosis is often delayed due to non-specific signs and symptoms. Symptoms include fever, abdominal pain, and palpable left upper abdominal swelling. Ultrasound and cross-sectional imaging such as CT scans are useful for the diagnosis of splenic abscess but contrast-enhanced CT scans are considered the gold standard because of their high sensitivity and specificity. Treatment options range from antimicrobial therapy, percutaneous drainage, and aspiration to surgical interventions such as splenectomy. As it has a high mortality rate, prompt diagnosis and appropriate treatment are essential for optimal outcomes.
Collapse
Affiliation(s)
- Nikhil Arora
- Pediatrics, Government Medical College, Patiala, Patiala, IND
| | - Shefali Dhawan
- Radiodiagnosis, Government Medical College, Patiala, Patiala, IND
| |
Collapse
|
3
|
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
4
|
Jørgensen ASS, Arsic I, Pedersen N, Kristensen LH, Nielsen MF, Balslev T. Splenic Abscess in an Adolescent due to Salmonella enterica Conservatively Treated with Ultrasound-Guided Fine-Needle Aspiration. Case Rep Pediatr 2023; 2023:8802760. [PMID: 36949862 PMCID: PMC10027457 DOI: 10.1155/2023/8802760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
Background Splenic abscesses are rare and potentially fatal. Diagnosis is often delayed due to vague symptoms, and laboratory findings are varying and often nonspecific. Ultrasound and computed tomography have a high sensitivity in detecting splenic abscesses. Splenectomy was previously considered the gold standard for treatment, but in recent years, a shift has been seen towards a more conservative approach, i.e., ultrasound-guided aspiration or drainage in combination with adequate antibiotics in selected cases. Case Report. A previously healthy adolescent complained of left-sided chest pain, pain in the left clavicular region for three weeks, and recent fever. Ultrasound and computed tomography demonstrated an intrasplenic abscess. The patient was successfully treated with two percutaneous fine-needle punctures and adequate antibiotics for six weeks. Salmonella enterica serotype Poona was grown from the aspirate. At one-year follow-up, the patient remained healthy without signs of recurrence. Conclusion The present case report demonstrates that ultrasound-guided aspiration and subsequent treatment with antibiotics may be an effective alternative to splenectomy in patients with a splenic abscess.
Collapse
Affiliation(s)
| | - Ivan Arsic
- 2Department of Radiology, Viborg Regional Hospital, Viborg, Denmark
| | - Niels Pedersen
- 2Department of Radiology, Viborg Regional Hospital, Viborg, Denmark
| | | | - Michael F. Nielsen
- 4Department of Surgery, University Hospital of Southern Denmark, Odense, Denmark
| | - Thomas Balslev
- 1Department of Paediatrics, Viborg Regional Hospital, Viborg, Denmark
| |
Collapse
|
5
|
Saijo F, Funatsu T, Yokoyama J, Ryomoto M, Hayashi K. Percutaneous drainage and staged valve replacement followed by laparoscopic splenectomy in infective endocarditis with splenic abscess. Gen Thorac Cardiovasc Surg 2021; 70:285-288. [PMID: 34791600 DOI: 10.1007/s11748-021-01741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Splenic abscess is a severe complication of infective endocarditis. The need for splenectomy to control prosthetic valve infection remains controversial. Here, we present the case of a 49-year-old man who complained of fever and general fatigue. Blood cultures grew Group G Streptococcus, and intravenous antibiotics were started. Abdominal computed tomography showed splenic abscess; thus, percutaneous drainage was performed. Two-dimensional transthoracic echocardiogram revealed a mobile vegetation on the right coronary cusp of the aortic valve with mild aortic regurgitation. The patient underwent aortic valve replacement using a 23-mm SJM Regent mechanic valve, followed by laparoscopic splenectomy 3 days later. The patient was asymptomatic without recurrence of infection 13 months postoperatively. Current guidelines recommend that splenectomy should be performed first, followed by valve replacement. However, we performed valve surgery first because of the risk of embolism. Depending on the patient's condition, performing splenic drainage and valve replacement first may be considered.
Collapse
Affiliation(s)
- Fumiyoshi Saijo
- Department of Cardiovascular Surgery, Rinku General Medical Center, Rinku Oraikita 2-23 izumisano, Osaka, 072-469-3111, Japan.
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Rinku General Medical Center, Rinku Oraikita 2-23 izumisano, Osaka, 072-469-3111, Japan
| | - Junya Yokoyama
- Department of Cardiovascular Surgery, Rinku General Medical Center, Rinku Oraikita 2-23 izumisano, Osaka, 072-469-3111, Japan
| | - Masaaki Ryomoto
- Department of Cardiovascular Surgery, Rinku General Medical Center, Rinku Oraikita 2-23 izumisano, Osaka, 072-469-3111, Japan
| | - Kosuke Hayashi
- Department of Diabetology, Nagayama Hospital, Okubo Higashi 1-1-10 Kumatori Sennnann, Osaka, 072-453-1122, Japan
| |
Collapse
|
6
|
Sakran N, Zakeri R, Madhok B, Graham Y, Parmar C, Mahawar K, Arhi C, Shah K, Pouwels S. Splenic Abscess Following Sleeve Gastrectomy: A Systematic Review of Clinical Presentation and Management Methods. Obes Surg 2021; 31:2753-2761. [PMID: 33791929 DOI: 10.1007/s11695-021-05396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic abscess is a rare complication following sleeve gastrectomy. METHODS We performed a systematic review to clarify its clinical significance, presentation, and management. PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were searched up to the 19th of July 2020. A total of 18 patients were included, of which 11 were female and 7 were male. The mean age was 34.1 ± 12.3 years, and the mean body mass index was 45.8 ± 7.6 kg/m2. Type 2 diabetes mellitus was reported in 11.1% of patients and hypertension in 22.2%. Fever was the most common presenting symptom seen in 17 (94.4%) patients, followed by abdominal pain in 10 (55.6%). The mean duration from surgery to presentation was 98.6 ± 132.7 days (range 10-547 days). Computed tomography was used for investigations in 17/18 (94.4%) patients. Seven patients had reported leak, three reported bleeding, and 2 reported pleural effusion. Thirteen patients had unilocular abscess. All patients were treated with antibiotics. Four patients needed total parenteral nutrition, and three were given proton pump inhibitor. In total, 11 patients needed percutaneous drainage as a part of treatment and 11 patients needed total splenectomy and 1 needed partial splenectomy. CONCLUSION Splenic abscess following sleeve gastrectomy is a rare identity. The etiology of formation of splenic abscess needs further studies. A computed tomography of the abdomen with contrast is the preferred diagnostic tool. There is no gold standard treatment for splenic abscess.
Collapse
Affiliation(s)
- Nasser Sakran
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.
- Technion - Israel Institute of Technology, Haifa, Israel.
| | - Roxanna Zakeri
- Department of Surgery, Whittington Health NHS Trust, London, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Chanpreet Arhi
- Department of Surgery, University Hospital Lewisham, London, UK
| | - Kamran Shah
- Bariatric and Upper GI Department, GB Obesitas Skaane, Malmö, Sweden
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| |
Collapse
|
7
|
Hwang H, Baeg MK, Kim P, Kim YJ, Kang SH. Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 72:209-212. [PMID: 30419646 DOI: 10.4166/kjg.2018.72.4.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Splenic abscess is a rare disease that generally occurs in immunocompromised patients. It is difficult to distinguish between splenic abscesses and cysts using imaging studies, especially if they are asymptomatic. A 50-year-old asymptomatic man who had received steroid therapy for underlying rheumatoid arthritis was referred to a university hospital due to presence of several splenic cysts, with the largest being 3.5 cm in diameter. Percutaneous aspiration was performed, and fluid analysis showed cysts infected by extended-spectrum, beta-lactamase-producing Escherichia coli. The patient was treated with ertapenem for four weeks, and the lesion disappeared on follow-up imaging studies. Splenic abscess should be included as a differential diagnosis of splenic cystic lesions in immunocompromised patients.
Collapse
Affiliation(s)
- Hyunjung Hwang
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Myong Ki Baeg
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Pumsoo Kim
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Yu Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Seok Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| |
Collapse
|
8
|
Samadi K, Arellano RS. Drainage of Intra-abdominal Abscesses. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Blasi S, De Martino A, Levantino M, Pratali S, Anastasio G, Bortolotti U. Splenectomy and Valve Replacement in Patients With Infective Endocarditis and Splenic Abscesses. Ann Thorac Surg 2017; 102:e253-e255. [PMID: 27549557 DOI: 10.1016/j.athoracsur.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 01/30/2016] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
Abstract
In patients with infective endocarditis (IE), splenic involvement is a rare but well-known adverse event. The treatment of patients with IE and splenic abscesses is still challenging and controversial. We report 3 patients with IE and splenic abscesses who underwent successful valve replacement and splenectomy. Our experience confirms that in such a patient, a valve operation combined with splenectomy can be performed with excellent results during the same hospitalization. The timing of splenectomy and the type of surgical approach should be based mainly on the stability of a patient's hemodynamic condition.
Collapse
Affiliation(s)
- Stefania Blasi
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Andrea De Martino
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Maurizio Levantino
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Stefano Pratali
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Gerardo Anastasio
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Uberto Bortolotti
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy.
| |
Collapse
|
10
|
Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne 2017; 38:614-618. [PMID: 28196700 DOI: 10.1016/j.revmed.2016.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/23/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.
Collapse
Affiliation(s)
- B Davido
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - A Dinh
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Rouveix
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - P Crenn
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Service de gastro-entérologie, nutrition transversale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - J Salomon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| |
Collapse
|
11
|
Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E. Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis. Int J Surg Case Rep 2016; 25:48-50. [PMID: 27318859 PMCID: PMC4915948 DOI: 10.1016/j.ijscr.2016.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/01/2016] [Accepted: 04/13/2016] [Indexed: 12/01/2022] Open
Abstract
Difficult diagnosis due to the paucity of symptoms and atypical radiological findings. Primary site of infection was not detected. Splenectomy is the best therapeutic choice in case of splenic abscess.
Introduction Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy. Case presentation We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli. Conclusion In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.
Collapse
Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Simona Macina
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy.
| | - Rosario Fornaro
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Marco Frascio
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Cesare Stabilini
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Ezio Gianetta
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| |
Collapse
|
12
|
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3169] [Impact Index Per Article: 352.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
Collapse
|
13
|
Peña-Ros E, Méndez-Martínez M, Vicente-Ruiz M, Sánchez-Cifuentes Á, Martínez-Sanz N, Albarracín Marín-Blázquez A. [Pneumoperitoneum due to splenic abscess: a diagnostic challenge. Case Report]. CIR CIR 2015; 83:433-7. [PMID: 26164134 DOI: 10.1016/j.circir.2015.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/05/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Splenic abscess is a rare clinic entity, its incidence has increased due to the rising number of clinical conditions involving immunosuppression. Endocarditis is the most frequent cause, and gram-positive aerobes are the main causal agents. Its clinical presentation is non-specific and delays diagnosis. Computed tomography scan is the method of choice, and the treatment is based on antibiotics and drainage, radiological or surgical, involving splenectomy in special cases that require it. CLINICAL CASE A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day. CONCLUSIONS Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
Collapse
Affiliation(s)
- Emilio Peña-Ros
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
| | - Marcelino Méndez-Martínez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | - María Vicente-Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | - Ángela Sánchez-Cifuentes
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | - Nuria Martínez-Sanz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | | |
Collapse
|
14
|
Bhatia M, Lohar H, Nirhale DS, Tomar V. Splenic abscess: a rare presentation. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2015. [DOI: 10.4103/1110-7782.159477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Abdellatif A, Günther C, Peppler C, Kramer M. A rare case of splenic abscess with septic peritonitis in a German shepherd dog. BMC Vet Res 2014; 10:201. [PMID: 25319320 PMCID: PMC4159529 DOI: 10.1186/s12917-014-0201-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/15/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Splenic abscess is a rare disease with only few reports in small-animal practice as well as in human medicine. It has been mostly reported in immunocompromised patients or following penetrating foreign bodies. This report aims to add to the current veterinary literature on recommended diagnostic tools for splenic abscess, as well as to provide follow-up findings after successful surgical treatment. CASE PRESENTATION An 8-year-old male German shepherd dog was admitted to the clinic for evaluation of fever, anorexia, and lethargy for the previous 3 days. During the physical examination, a mass was palpated in the left cranioventral abdomen. Diagnostic imaging including radiography and ultrasonography revealed the presence of a large mass in the spleen and signs of peritonitis. Laboratory tests reflected highly septic pyogranulomatous inflammation and, together with imaging findings, raised a high suspicion of splenic abscess and septic peritonitis. Therapy included complete splenectomy and placement of peritoneal drainage. Bacteriological examination revealed severe infection with Staphylococcus epidermidis and S. pseudintermedius. Histopathological evaluation of the mass confirmed the diagnosis of splenic abscess. CONCLUSION Early diagnosis of splenic abscess in small animals requires a high level of suspicion based on clinical and ultrasonographic findings. Immediate surgical intervention is preferable and confirms the diagnosis. Total splenectomy remains the most effective therapy. Although there are many predisposing factors for splenic abscess, the true etiology remains obscure.
Collapse
Affiliation(s)
- Ahmed Abdellatif
- />Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University, Frankfurter Street 108, Giessen, 35392 Germany
- />Animal Surgery Department, Assiut University, Assiut, 71515 Egypt
| | - Charlotte Günther
- />Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University, Frankfurter Street 108, Giessen, 35392 Germany
| | - Christine Peppler
- />Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University, Frankfurter Street 108, Giessen, 35392 Germany
| | - Martin Kramer
- />Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University, Frankfurter Street 108, Giessen, 35392 Germany
| |
Collapse
|
16
|
|
17
|
Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G. A retrospective study of 75 cases of splenic abscess. Indian J Surg 2011. [PMID: 23204694 DOI: 10.1007/s12262-011-0370-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Splenic abscess is an uncommon and life-threatening condition. Due to its nonspecific clinical picture, it remains a diagnostic challenge. Multiple radiological modalities are used for the diagnosis. In this retrospective study we analyzed 75 patients treated between 1999 and 2009. The patients were divided into three groups depending on the treatment received. Group I (n = 14) consisted of patients treated with only antibiotics, Group II (n = 19) patients were treated with percutaneous drainage and Group III (n = 42) with splenectomy. We tried to establish epidemiologic and clinical features and therapeutic options in splenic abscess. Our study suggests that percutaneous drainage is a safe and effective alternative to surgery especially in unilocular or bilocular abscesses thus allowing preservation of the spleen. It should be considered as the first line of treatment although splenectomy remains the final definitive procedure if percutaneous drainage fails.
Collapse
Affiliation(s)
- H Sreekar
- Department of Plastic Surgery, Christian Medical College, Vellore, 632004 India
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Percutaneous abscess drainage is one of the most common and rewarding procedures performed by interventional radiologists. Technical success is immediately apparent by aspiration of purulent contents and is nearly always achieved, with rates exceeding 90% in most literature studies. Clinical success is typical even for many abscesses colonized with multidrug-resistant organisms. In patients presenting with sepsis, this procedure offers an immediate and minimally invasive solution to a life-threatening condition, often resulting in defervescence and restoration of hemodynamic stability within 1 to 2 days. Although complications of abscess drainage are uncommon, radiologists should be able to recognize and treat all adverse sequelae discussed in this article.
Collapse
Affiliation(s)
- Jonathan Lorenz
- Section of Interventional Radiology, University of Chicago Hospitals, Chicago, Illinois
| | | |
Collapse
|
19
|
|
20
|
Abstract
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.
Collapse
Affiliation(s)
- Won-Suk Lee
- Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Sang Tae Choi
- Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Keon Kuk Kim
- Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| |
Collapse
|
21
|
Splenic abscess as the first manifestation of Crohn's disease. J Crohns Colitis 2010; 4:703-4. [PMID: 21122585 DOI: 10.1016/j.crohns.2010.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 09/07/2010] [Indexed: 02/08/2023]
|
22
|
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1230] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Ferraioli G, Brunetti E, Gulizia R, Mariani G, Marone P, Filice C. Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis 2008; 13:524-30. [PMID: 19070526 DOI: 10.1016/j.ijid.2008.08.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/25/2008] [Accepted: 08/16/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Splenic abscess is an uncommon disease, with a reported incidence of 0.14-0.7% in autoptic series. The best treatment option remains unclear. We report our experience of percutaneous drainage of splenic abscess under ultrasound (US) guidance. METHODS From 1979 to 2005, 16 consecutive patients (12 male and four female; mean age 39.9 years, range 16-72 years) were diagnosed with splenic abscess by means of US, and were treated with medical therapy alone or combined with US-guided percutaneous aspiration or catheter drainage. RESULTS Ten of 16 patients had bacterial abscesses (including one case of tubercular abscess), two had an amebic abscess, and four had fungal abscesses. Seven of ten patients with bacterial abscesses were successfully treated with fine needle aspiration alone, one patient was successfully treated with fine needle aspiration for one abscess and catheter drainage for another, and one patient, who subsequently required a splenectomy for an abdominal trauma, successfully underwent percutaneous catheter drainage alone. Four patients with fungal lesions were treated with medical therapy alone, and two patients later required a splenectomy. One patient with a bacterial abscess due to endocarditis was treated with medical therapy alone, and his recovery was uneventful. CONCLUSIONS US-guided percutaneous aspiration of splenic abscesses is a safe and effective procedure. It can be used as a bridge to surgery in patients who are critically ill or have several comorbidities. Percutaneous aspiration may allow complete non-operative healing of splenic abscesses or temporize patients at risk for surgery.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- Infectious and Tropical Diseases Division, IRCCS S. Matteo Foundation, University of Pavia, Via Taramelli 5, 27100 Pavia, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
Chou YH, Chiou HJ, Tiu CM, Chiou SY, Wang HK. Ultrasonography-guided Percutaneous Interventional Procedures of the Spleen. J Med Ultrasound 2008. [DOI: 10.1016/s0929-6441(09)60002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
27
|
Matsubayashi T, Matsubayashi R, Saito I, Tobayama S, Machida H. Splenic abscess in an infant caused by Streptococcus intermedius. J Infect Chemother 2007; 13:423-5. [PMID: 18095094 DOI: 10.1007/s10156-007-0561-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 09/03/2007] [Indexed: 10/25/2022]
Abstract
We report a 20-month-old girl with splenic abscess. The patient was admitted to our hospital because of persistent high fever and abdominal pain. Laboratory data showed leucocytosis and elevated C-reactive protein levels. Abdominal computed tomography showed multiple low-density lesions in the spleen. These findings were consistent with a diagnosis of splenic abscess. She was successfully treated with ultrasonographically guided percutaneous drainage for 11 days and intravenous antibiotic for 17 days. On culture, aspirated fluid from the abscess grew Streptococcus intermedius. This case illustrates that the differential diagnosis of unknown-focus infection in infants should include splenic abscess. We recommend conservative therapy (antibiotics and drainage) as first-line therapy for splenic abscess in pediatric patients, based on the importance of the immunological functions of the spleen.
Collapse
Affiliation(s)
- Tadashi Matsubayashi
- Department of Pediatrics, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan.
| | | | | | | | | |
Collapse
|
28
|
Kogo H, Yoshida H, Mamada Y, Taniai N, Bando K, Mizuguchi Y, Ishikawa Y, Yokomuro S, Akimaru K, Tajiri T. Successful percutaneous ultrasound-guided drainage for treatment of a splenic abscess. J NIPPON MED SCH 2007; 74:257-60. [PMID: 17625377 DOI: 10.1272/jnms.74.257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of splenic abscess that was successfully treated with percutaneous ultrasound-guided drainage and without splenectomy. A 40-year-old woman was admitted to Nippon Medical School Hospital because of pyrexia and left upper quadrant pain, which had persisted despite antibiotic treatment. On admission, computed tomography demonstrated a low-density area in the spleen, which had been been seen on computed tomography 3 months earlier. Ultrasonography demonstrated a hypoechoic area in the spleen. Initial laboratory tests revealed a serum C-reactive protein concentration of 19.7 mg/dl and a white blood cell count of 15,800 /microl. The serum glucose concentration was 267 mg/dl, and the glycolated hemoglobin value was 7.7%. A splenic abscess was diagnosed and was treated with percutaneous drainage. Milky yellow fluid was obtained, and the patients left upper quadrant abdominal pain and pyrexia resolved. A culture of the drainage fluid yielded Escherichia coli. The drainage catheter was removed 12 days after insertion. The patient was discharged 6 days later. The splenic abscess has not recurred during 3 months of follow-up. Our results suggest that ultrasound-guided percutaneous drainage is a safe and effective alternative to surgery for the treatment of splenic abscess and allows preservation of the spleen.
Collapse
Affiliation(s)
- Hideki Kogo
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kang M, Kalra N, Gulati M, Lal A, Kochhar R, Rajwanshi A. Image guided percutaneous splenic interventions. Eur J Radiol 2007; 64:140-6. [PMID: 17374470 DOI: 10.1016/j.ejrad.2007.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 02/11/2007] [Accepted: 02/13/2007] [Indexed: 11/29/2022]
Abstract
AIM The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. MATERIALS AND METHODS We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n=93) or CT (n=2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n=78) and aspiration (n=10) or percutaneous catheter drainage of a splenic abscess (n=7). RESULTS Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. CONCLUSIONS Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.
Collapse
Affiliation(s)
- Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | | | | | | | | | | |
Collapse
|
30
|
Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients. World J Gastroenterol 2006; 12:7341-5. [PMID: 17143953 PMCID: PMC4087495 DOI: 10.3748/wjg.v12.i45.7341] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the results of ultrasound guided percu-taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess.
METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed.
RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure.
CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.
Collapse
Affiliation(s)
- Enver Zerem
- Interventional Ultrasonography Department, The University Clinical Centar Tuzla, Trnovac BB, Tuzla 75000, Bosnia and Herzegovina.
| | | |
Collapse
|
31
|
Taşar M, Uğurel MS, Kocaoğlu M, Sağlam M, Somuncu I. Computed tomography-guided percutaneous drainage of splenic abscesses. Clin Imaging 2006; 28:44-8. [PMID: 14996448 DOI: 10.1016/s0899-7071(03)00033-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2002] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the role of computed tomography (CT)-guided percutaneous drainage in the management of solitary splenic abscesses. MATERIALS AND METHODS Sonography and CT were used in the initial diagnosis of splenic abscess in patients with vague left upper quadrant pain and/or fever. Solitary splenic abscesses of nine male patients whose ages varied between 21 and 27 years (mean age: 24.7 years) were percutaneously drained under CT guidance. Puncture with 18-gauge Chiba needles and coaxial guidewire technique was used for insertion of six or eight French pigtail catheters. Antibiotics in accordance with the microbiological results were also given adjuvant to drainage. Follow-up examinations were performed by sonography, daily for the first week and weekly for the next 7 weeks, and by CT at the end of first, fourth and eighth weeks. RESULTS All patients tolerated the intervention well, except for one complicating with splenic rupture and hemorrhage, who underwent emergency splenectomy. The remaining eight patients recovered within 4 weeks without any splenic sequela. A mean of 3.9 days was needed before removing the drainage catheter based on regression criteria. DISCUSSION AND CONCLUSION CT-guided percutaneous drainage of splenic abscesses may be proven effective and is superior to splenectomy in selected cases, as it preserves host immunity.
Collapse
Affiliation(s)
- Mustafa Taşar
- Department of Diagnostic Radiology, Gülhane Military Medical School, 06018 Etlik, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
32
|
Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2006; 111:e394-434. [PMID: 15956145 DOI: 10.1161/circulationaha.105.165564] [Citation(s) in RCA: 912] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. METHODS AND RESULTS This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. CONCLUSIONS The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
Collapse
|
33
|
Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg 2006; 41:e53-6. [PMID: 16410091 DOI: 10.1016/j.jpedsurg.2005.10.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics. MATERIALS AND METHODS Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. Ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. Ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew Escherichia coli in 1 case, Salmonella paratyphi A in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks. RESULTS All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy. CONCLUSION Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.
Collapse
Affiliation(s)
- Roy Choudhury S
- Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India.
| | | | | | | | | |
Collapse
|
34
|
Abstract
Splenic abscess is a rare disease but with increasing frequency. The authors present 9 patients with splenic abscess treated at the Institute of Digestive System Diseases, Clinical Centre of Serbia, in a period from January 1, 1986 to May 15, 2004. Splenic abscess was the complication of septic endocarditis in 4, trauma in 2, dental infection in 1, while in 2 cases it was the complication of chemotherapy in myeloproliferative disorders. All 9 patients had fever, 7 - abdominal pain, 4 - left shoulder pain, and 1 patient had nausea and vomiting. Higher white blood count was found in 6 patients, pleural effusion in 4, elevated left hemidiaphragm in 1 and basal pneumonia in 1 patient as well. Ultrasonography and CT were the most reliable diagnostic procedures. CT was superior in diagnosis of multiple small abscesses. Culture of the pus recovered the Enterococcus in 3 cases, Streptococcus a hemolyticus in 1, Staphylococcus epidermidis and Candida albicans in 1, Staphylococcus aureus, E. Coli and Candida albicans in 1, Staphylococcus aureus and Salmonella enteritidis in 1 case. Eight patients underwent splenectomy and 1 was cured by combined antibiotics in high doses. One patient died postoperatively due to septic endocarditis that had been present before surgery. The authors believe that splenectomy and antibiotics administered according to drug susceptibility test as well as management of underlying disease are the method of choice for splenic abscess treatment. Conservative antibiotic treatment is indicated in selected cases only.
Collapse
Affiliation(s)
- Nikica Grubor
- Institute of Digestive System Diseases, Clinical Centre of Serbia, Belgrade
| | | | | | | |
Collapse
|
35
|
Peddu P, Shah M, Sidhu PS. Splenic abnormalities: a comparative review of ultrasound, microbubble-enhanced ultrasound and computed tomography. Clin Radiol 2004; 59:777-92. [PMID: 15351243 DOI: 10.1016/j.crad.2004.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Revised: 01/14/2004] [Accepted: 01/20/2004] [Indexed: 01/08/2023]
Abstract
The ultrasound appearances of abnormalities of the spleen are reviewed and images compared with computed tomography. Focal lesions, both benign and malignant, trauma, infarction and congenital abnormalities are presented. The use of microbubble ultrasound contrast media as an aid to identifying and characterizing abnormalities is discussed.
Collapse
Affiliation(s)
- P Peddu
- Department of Radiology, King's College Hospital, London, UK
| | | | | |
Collapse
|
36
|
Abstract
Splenic abscess is an unusual and potentially life-threatening disease. Due to the nonspecific clinical picture, it remains a diagnostic challenge. Splenic abscess should be suspected in febrile patients with left upper quadrant tenderness and leukocytosis, and diagnosis confirmed based mostly on imaging studies, microbiologic and / or pathologic evidence, or by response to antibiotic or antifungal treatment. We present 29 cases of splenic abscess treated in our hospital from 1990 to 2001. There were 18 male patients (62%) and 11 female patients (38%). Ages ranged from 4 to 85 years, with a median of 44 years. There were five pediatric patients (17%) and 24 adults (83%). The most common associated condition was leukemia. Most patients were immunocompromised (72%). The more common signs and symptoms were fever (90%), chills (41%), abdominal pain (31%), and leukocytosis (38%). Ultrasonography of the abdominal cavity was positive in 27 cases (93%); computerized tomography or magnetic resonance imaging was used in 26 patients (90%) and was positive in all patients. The abscess was solitary in 21 cases (72%) and multiple in eight cases (28%). Positive blood cultures were found in only seven patients (24%). According to the literature, the treatment of choice is still splenectomy, but in our study, the success rate of 75% with antibiotics alone indicates that antibiotic therapy should be considered an important alternative treatment modality in patients not suitable for percutaneous drainage and splenectomy.
Collapse
Affiliation(s)
- I-Shun Chiang
- Department of Emergency Medicine, Jiann Ren Hospital, Nanzih District, Kaohsiung, Taiwan.
| | | | | | | |
Collapse
|
37
|
Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA. Percutaneous CT-guided drainage of splenic abscess. AJR Am J Roentgenol 2002; 179:629-32. [PMID: 12185032 DOI: 10.2214/ajr.179.3.1790629] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of our study was to determine the current role of percutaneous CT-guided drainage as an alternative to surgical treatment of splenic abscesses. CONCLUSION Splenic abscess is an uncommon entity that can be treated percutaneously. CT-guided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen.
Collapse
Affiliation(s)
- Loucas Thanos
- Second Department of Radiology, Athens University Medical School, Papadiamantopoulou 20, 115 28 Athens, Greece
| | | | | | | | | | | |
Collapse
|
38
|
Green BT. Splenic Abscess: Report of Six Cases and Review of the Literature. Am Surg 2001. [DOI: 10.1177/000313480106700118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Splenic abscesses are rare but appear to be increasing in frequency. Recent advances in radiologic techniques have affected the diagnosis and management. The purpose of this study was to evaluate these effects. The medical records of one institution were retrospectively reviewed and six cases of splenic abscesses seen between 1989 and 1999 were identified. All patients had predisposing conditions with metastatic hematogenous infection in three and one each with trauma, immunodeficiency, and a contiguous site of infection. Fever was present in all patients with chills and vomiting in five and three patients, respectively. Left upper quadrant tenderness appeared in four patients and leukocytosis was found in every patient except one with the acquired immunodeficiency syndrome. Chest roentgenograms were abnormal in five patients with a left pleural effusion most common. Ultrasound revealed the defect in both patients it was utilized in and computed tomography was diagnostic in all cases. The causative organisms were anaerobes in two cases and Candida albicans, Streptococcus viridans, Escherichia coli, and Citro-bacter freundii each present in one case. Radiology guided percutaneous drainage was attempted in four patients but was only successful in one. Splenectomy with antibiotics was curative in the remainder with a 100 per cent survival. These data suggest that percutaneous drainage may be appropriate for certain patients initially, but the high failure rate demonstrates that splenectomy remains the standard treatment.
Collapse
Affiliation(s)
- Bryan T. Green
- From the Division of Infectious Diseases, University of South Alabama, Mobile, Alabama
| |
Collapse
|
39
|
Pinto Júnior FEL, Oliveira AJFD, Medeiros ADC. Abscesso esplênico. Rev Col Bras Cir 2000. [DOI: 10.1590/s0100-69912000000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
40
|
Trouillet JL, Hoen B, Battik R, Michel PL, Canavy I, Brochet E, Wolff M, Selton-Suty C. [Splenic involvement in infectious endocarditis. Association for the Study and Prevention of Infectious Endocarditis]. Rev Med Interne 1999; 20:258-63. [PMID: 10216883 DOI: 10.1016/s0248-8663(99)83054-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Splenic involvement in the course of endocarditis consists in either splenic infarct or abscess. Pathophysiological examinations suggest the existence of a continuum between the two types of lesion. Signs and symptoms are usually poor or aspecific. Current incidence and diagnostic methods are rarely reported in recent medical literature. EXEGESIS We report a retrospective study conducted from a questionnaire that was circulated to nine French medical units. Two hundred and twenty five patients with infectious endocarditis according to Duke university criteria were included in the study. The existence of splenic lesions was investigated in 153 patients (68%). Splenic involvement was documented in 35 patients. Diagnostic methods were: abdominal echography (n = 77), abdominal CT scan (n = 40), and both techniques (n = 36). The incidence of splenic lesions was 9%, 35% and 36%, respectively. Among patients investigated using both diagnostic techniques, splenic abnormalities were detected by CT scan in 13 cases and by echography in six cases. Splenic abscess was suspected in nine patients by combining suggestive clinical course and radiological abnormalities, but was definitively evidenced in only four patients (surgery, n = 2, post-mortem examination, n = 2) presenting with large lesions (> or = 8 cm) associated with aortic endocarditis. All other 26 cases were categorized as splenic infarcts; however, diagnosis was confirmed in only two cases (surgery n = 1, autopsy n = 1). CONCLUSION These data suggest that: 1) the incidence of splenic involvement during endocarditis is approximately 35%, 2) CT scan is probably superior to echography for spleen screening, and 3) incidence of abscess requiring specific surgery is very low, inferior to 2%.
Collapse
Affiliation(s)
- J L Trouillet
- Service de réanimation médicale, hôpital Bichat-Claude-Bernard, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, Levison M, Chambers HF, Dajani AS, Gewitz MH, Newburger JW, Gerber MA, Shulman ST, Pallasch TJ, Gage TW, Ferrieri P. Diagnosis and management of infective endocarditis and its complications. Circulation 1998; 98:2936-48. [PMID: 9860802 DOI: 10.1161/01.cir.98.25.2936] [Citation(s) in RCA: 369] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Alterman P, Vigder C, Shabun A, Feldman J, Spiegel D, Yaretzky A. Splenic abscess in geriatric care. J Am Geriatr Soc 1998; 46:1481-3. [PMID: 9809778 DOI: 10.1111/j.1532-5415.1998.tb06025.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Civardi G, Di Candio G, Giorgio A, Goletti O, Ceragioli T, Filice C, Caremani M, Buscarini L. Ultrasound guided percutaneous drainage of abdominal abscesses in the hands of the clinician: a multicenter Italian study. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1998; 8:91-9. [PMID: 9845785 DOI: 10.1016/s0929-8266(98)00059-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Image guided percutaneous drainage is a well established therapeutic technique. The results of these procedures, when performed directly by the clinician and under sonographic guidance,in respect to other imaging techniques are not yet clarified. METHODS The 886 cases of ultrasound guided drainage were collected from eight italian clinical institutions and the results were analyzed according to location of the abscess, drainage technique, underlying diseases, microbiological findings, immunological patient status and previous surgical intervention. RESULTS We observed an overall cure rate of 90.4%. The best results were obtained in hepatic abscesses, both amoebic and pyogenic (cure rate 98.7 and 94.3%). Slightly lower cure rates were obtained in abdominal and splenic abscesses, postoperative collections and severely immunocompromised patients. The frequency of complications was low (6.6%) and mostly related to catheter drainage. No drainage-related deaths occurred. CONCLUSIONS The study confirms the high clinical efficiency and safety of ultrasound guided percutaneous drainage, even when performed directly by the clinician. The sonographic guidance showed similar efficacy, more manageability and lower costs than other imaging techniques and it should be preferred whenever possible. For hepatic abscesses, ultrasound guided needle aspiration showed good results and less complications than catheter drainage.
Collapse
Affiliation(s)
- G Civardi
- 1a Divisione di Medicina, Ospedale Civile, V. Taverna 49, 29100 Piacenza, Italy
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Chou YH, Tiu CM, Chiou HJ, Hsu CC, Chiang JH, Yu C. Ultrasound-guided interventional procedures in splenic abscesses. Eur J Radiol 1998; 28:167-70. [PMID: 9788024 DOI: 10.1016/s0720-048x(97)00127-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The results of ultrasound (US)-guided interventional procedures over a period of 12 years in 21 consecutive patients with splenic abscess were reviewed. The interventional procedures were done with 21- or 18-gauge needles for aspiration of relatively small abscesses (< 3.5 cm) in eight patients and with an 8.3-9.0 French pigtail catheter for continuous drainage in 13 patients with larger abscesses (> or = 3.5 cm). In some patients, multiple abscesses were treated separately according to their various sizes. More than one catheterization were done in three patients because of detached catheter or recurrent abscesses. The interventional procedures were followed by at least eight weeks of appropriate antibiotic therapy. Only one patient had the complication of minimal subcapsular hematoma which needed no further treatment. All the patients had uneventful clinical courses. US-guided interventional procedure proved to be a treatment-of-choice for splenic abscess, and may avoid splenectomy by conserving the spleen.
Collapse
Affiliation(s)
- Y H Chou
- Department of Radiology, Veterans General Hospital-Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Abscess formation in chronic pancreatitis is rare and the pancreas and liver are the most frequent localizations. We present a novel case of splenic abscess in chronic pancreatitis that led to diabetic ketoacidosis in an alcoholic patient. Percutaneous drainage and antibiotic treatment sufficed to resolve completely the abscess.
Collapse
Affiliation(s)
- P G Lankisch
- Department of Internal Medicine, Municipal Hospital of Lüneburg, Germany
| | | | | | | |
Collapse
|
46
|
Civardi G, Filice C, Caremani M, Giorgio A, Vallisa D, Berté R, Cavanna L. Clinical efficacy of ultrasound guided percutaneous drainage of abscesses in patients with leukaemia and lymphoma. Eur J Cancer 1998; 34:580-3. [PMID: 9713313 DOI: 10.1016/s0959-8049(97)10032-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ultrasound guided percutaneous drainage (US-PD), a minimally invasive technique, has been reported as highly effective for the treatment of deeply located abscesses, particularly in immunocompromised patients. Therefore, we retrospectively studied its therapeutic efficacy and safety in a series of 14 patients with leukaemia and lymphoma. We collected the clinical and sonographic data of 14 patients with various types of leukaemia and lymphoma. These patients were consecutively observed in four clinical centres with long-term experience with ultrasound guided therapeutic techniques. The cases were analysed according to underlying disease, clinical features, location of the abscess, drainage technique, microbiological data and both short- and long-term outcome. In our series, 11 patients were treated with repeated ultrasound guided needle aspirations (US-NA) and 3 underwent catheter drainage (US-PCD). In 12/14 cases the procedure was successful (86%): the mortality rate was 14%. 5 patients died during the follow-up period because of the underlying disease, without abscess recurrence. No complications were reported. Our data suggest that ultrasound guided percutaneous drainage should be considered the first choice, minimally invasive procedure for the treatment of deeply located abscesses in patients with leukaemia and lymphoma.
Collapse
Affiliation(s)
- G Civardi
- 1st Medical Division, City Hospital, Piacenza, Italy
| | | | | | | | | | | | | |
Collapse
|
47
|
Rørbakken G, Schulz T. Splenic abscess caused by Salmonella braenderup, treated with percutaneous drainage and antibiotics. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1997; 29:423-4. [PMID: 9360262 DOI: 10.3109/00365549709011843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Splenic abscess is a rare condition and its optimal treatment is still debated. We report on a 17-year-old immunocompetent female patient, hospitalized with Salmonella braenderup gastroenteritis and splenic abscess, who was treated with ciprofloxacin, percutaneous catheter drainage and despite remaining drainage of 50 ml/24 h, the catheter was removed and the antibiotic treatment was stopped when the fluid was clear. Following removal a transient increase in the size of the splenic cavity was observed, but without any clinical symptoms or deterioration of laboratory parameters. At the 1-year follow-up, ultrasound examination of the spleen disclosed only a 8 mm scar.
Collapse
Affiliation(s)
- G Rørbakken
- Department of Medicine, Aust Agder Central Hospital, Arendal, Norway
| | | |
Collapse
|
48
|
Abstract
BACKGROUND Isolated splenic abscesses is an uncommon clinical entity that is being increasingly recognized as a cause of intraabdominal sepsis in a wide variety of clinical situations, and involving a wide range of organisms. The increasing incidence of immunosuppressed states in this decade due to the use of chemotherapy for oncology, immunosuppression therapy for transplantation, and acquired immune deficiency syndrome, has changed the disease pattern of splenic abscesses. METHOD Data from 287 cases reported in the English literature between 1987 and 1995 were collected, analyzed, and compared with two previous reviews of cases reported before 1987. RESULTS Staphylococcus, Salmonella, and Escherichia coli are the most common organisms cultured. Immunosuppressed states were present in 33.5% of cases, with intravenous drug abuse and acquired immune deficiency syndrome accounting for half these cases. Computerized tomography and ultrasonography are diagnostic, with a sensitivity of 92.2% and 87.2%, respectively. Nonoperative management has a success rate of less than 65%, but salvage splenectomy does not increase mortality compared with splenectomy as initial therapy. CONCLUSIONS Splenic abscesses are increasingly recognized with immunosuppressed states. Percutaneous radiologically guided drainage may be suitable in some cases, but splenectomy with appropriate antibiotics is the definitive treatment.
Collapse
Affiliation(s)
- L L Ooi
- Department of Surgery, Singapore General Hospital, Singapore
| | | |
Collapse
|
49
|
Abstract
Splenic abscess, with its rare incidence and various misleading clinical manifestations, usually is a diagnostic pitfall in the modern emergency department. The most frequently seen symptoms and signs are fever, abdominal pain and tenderness over left upper quadrant, splenomegaly, leucocytosis, and left lower chest abnormalities. Four cases were collected during the past five years. On admission, one patient manifested symptoms mimicking a perforated peptic ulcer and the other three patients presented clinical and roentgenographic signs suggestive, but non-specific, for splenic abscess. In two cases, the diagnosis was based on sonography followed by computed tomography (CT). In one case, the splenic abscess was only visualized by CT. They all survived after splenectomy and appropriate antibiotic therapy. Culturing disclosed the offending organisms to be Escherichia coli, Pseudomonas aeruginosa, a Salmonella species, and Streptococcus viridans. These nonspecific clinical pictures should be thoroughly investigated, and CT, the most sensitive diagnostic tool, should be used whenever splenic abscess is suspected. Early diagnosis and timely treatment reduce the morbidity and mortality associated with splenic abscess.
Collapse
Affiliation(s)
- J T Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, R.O.C
| | | | | | | |
Collapse
|