Percutaneous drainage of splenic abscess in typhoid fever--a case report

Computed tomography-guided percutaneous drainage of splenic abscesses

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.

Problem pathogens: extra-intestinal complications of Salmonella enterica serotype Typhi infection

Typhoid fever, caused by Salmonella enterica seroptype Typhi (S typhi), has an estimated worldwide prevalence of 12-33 million cases. The pathogenesis of this disease depends on the ingested inoculum size of S typhi, the virulence of the strain, the host's immune response and previous exposure, and local protective factors. Numerous extra-intestinal complications can occur with S typhi infection, including the involvement of the central nervous system (3-35%), cardiovascular system (1-5%), pulmonary system (1-86%), bone and joints (< or =1%), hepatobiliary system (1-26%), genitourinary system (<1%), and others. Due to an increase in multidrug-resistant S typhi, fluoroquinolones and third-generation cephalosporins have been increasingly used for typhoid fever and its complications. We describe the epidemiology, clinical manifestations, pathogenesis, and treatment of extra-intestinal S typhi infections.

Typhoidal focal suppurative lymphatic abscess

We describe a submandibular suppurative lymphatic abscess caused by Salmonella typhi in an 8-year-old child. The diagnosis was confirmed by repeated isolation of S. typhi from the abscess. A literature search found no previous report of a similar nature and this therefore seems to be the first case report of focal suppurative typhoidal lymphatic abscess. The child responded to cephalexin and surgical drainage.