[Splenic abscesses: From diagnosis to therapy]

Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses

Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8-34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.

Case report: a case of multiple splenic abscesses in a child and literature review

Splenic abscesses in children are very rare, and multiple splenic abscesses are rarer. These lesions are difficult to diagnose quickly because of their low incidence and the low specificity of the associated clinical and imaging findings. The treatment of splenic abscesses includes conservative treatment, percutaneous drainage, and splenectomy, but the selection criteria for treatment are still unclear. We present a case of a 13-year-old girl with multiple splenic abscesses. Her blood culture report was negative. We eventually confirmed the diagnosis by enhanced magnetic resonance imaging (MRI). The patient underwent a successful laparoscopic total splenectomy, and her symptoms were resolved thereafter.

Splenic Abscess in Qatar: A Single-Center Experience

BACKGROUND & OBJECTIVES

Splenic abscess (SA) is a rare clinical entity. There is a lack of information on SA in most Arab and Gulf countries, including Qatar. This study describes the demographics, clinical features, microbiologic etiologies, treatments, and outcomes of patients with SA at the largest tertiary medical center in Qatar over the previous six years.

METHODS

This retrospective observational study was conducted at Hamad general hospital. It involved all patients of 18 years old or above who were admitted with the diagnosis of SA for the period between January 1, 2015, and December 31, 2020.

RESULTS

We recruited 25 patients, of which 14 (56%) were males, and 11 (44%) were females. The mean age ( ±  SD) of them was 48.64 ± 19.08 years. The mean illness duration was 22.88 ± 11.88 days. Fever was the most common presenting symptom and was found in 21 (84%) cases, whereas bacteremia was the most predisposing factor found in 15 (60%) patients. The etiology of SA was bacterial in 16 cases (64%), mixed (fungal and bacterial) in one (4%), and tuberculous in one (4%), whereas the etiological agent was unidentified in seven (28%) cases. Intravenous antimicrobial therapy was administered empirically in all patients. However, seven patients (28%) received intravenous antibiotics as the only treatment modality for SA, 15 patients (60%) underwent percutaneous drainage with a pigtail catheter, and two patients underwent splenectomy. The inhospital mortality was three (12%).

CONCLUSIONS

This study showed that SA could be caused by various organisms that should be isolated to guide the choice of antimicrobial agents. An abdominal computed tomography is a good diagnostic modality, whereas computed tomography- and ultrasonography-guided percutaneous drainage were efficient therapeutic options that reduce the need for surgery.

Splenic abscess caused by Toxocara spp. in a lung transplant recipient, Marseille, France

Infections represent one of the leading causes of morbidity and mortality in solid organ transplantation (SOT) recipients. Although Toxocara species are prevalent worldwide, toxocariasis is an important neglected human disease that can manifest as visceral or ocular larva migrans, or covert toxocariasis. Herein, we report and discuss the first documented case of a splenic abscess associated with toxocariasis in a 69-year-old lung transplant recipient, in France. This case emphasizes the need to include prevention of toxocariasis in the management of lung transplant patients.

Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature

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Splenic abscess (SA) is an uncommon and life-threatening disease.

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Spontaneous rupture of a SA with peritonitis is a rare occurrence.

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Preoperative diagnosis of ruptured SA is a challenge due to non-specific clinical presentation.

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Nowadays there are no guidelines for the management of SA.

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Splenectomy represents the treatment of choice along with antibiotics in ruptured SA.

Introduction and importance

Splenic abscess (SA) is an uncommon, life-threatening disease with about 600 reported cases in the literature. It is caused by various infective pathogens and generally occurs in immunocompromised patients. SA is a rare complication of non-typhoid Salmonella (NTS) infection. Diagnosis of ruptured SA is a challenge because the absence of specific symptoms and signs. Abdominal computed tomography (CT) scan represents the gold standard in diagnosing of SA. Splenectomy is the treatment of choice of ruptured SA with peritonitis.

Case presentation

A 26-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain and fever. Physical examination revealed severe and generalized abdominal pain on superficial and deep palpation with obvious muscle guarding and rebound tenderness. Abdominal CT scan showed ruptured SA. Laboratory tests reported anemia (hemoglobin 10.4 g/dl). The patient was taken emergently to the operating room for splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of NTS SA was made by pus cultures.

Clinical discussion

SA is a rare complication of NTS infection associated with high morbidity and mortality rates. Although different types of treatment of SA are reported in the literature, splenectomy represents the treatment of choice of ruptured SA.

Conclusion

NTS SA is difficult to diagnose because of its rarity and non-specific clinical presentation, often fatal if left untreated. Although there is no gold standard for treating SA, splenectomy with peritoneal lavage is mandatory in case of ruptured SA with peritonitis.

Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review

Organ abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.

Splenic abscess after arterial embolization: a rare cause of acute abdomen

Splenic abscess is a rare disease and a diagnostic challenge for the medical team. Attributable to its high mortality, prompt diagnosis and treatment are essential. A high degree of clinical awareness is required in conjunction with aggressive treatment, as misleading symptoms may delay treatment and worsen the patient's prognosis. The management of splenic abscess is based on medical therapy, antibiotics and splenectomy or percutaneous drainage. We present the case of a 58-year-old patient presented with a splenic abscess after arterial embolization. He underwent surgery and completely recovered.

Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy

BACKGROUND

Delayed intra splenic abscess after laparoscopic sleeve gastrectomy (LSG) is a very rare complication with poor manifestations.

METHODS

We present three cases of delayed intrasplenic abscess which were managed in our departmentof minimal invasive surgery.

DISCUSSION

Splenic abscess may occur in the early post-operative period following LSG; it is usually an extra splenic event after the gastric leak or an infected hematoma. In our cases, two patients had an asymptomatic ischemic demarcation in the upper part of the spleen. This underlines the possible role of ischemia as a factor in abscess formation of late intrasplenic abscesses that enhanced by a state of transient immune suppression.

CONCLUSION

Intrasplenic abscess complicating laparoscopic sleeve gastrectomy is different from early extra splenic abscesses. The exact causes are still unclear; the role of partial splenic ischemia has to be rolled out.