1
|
Nunez-Ordonez N, Luna JS, Mackenzie JC, Jiménez AF, González A, Pico AJ, Román CF, Rivera PAC, Hincapié CAV. Management of embolic splenic abscess secondary to aortic valve endocarditis - case report and review of literature. J Cardiothorac Surg 2024; 19:220. [PMID: 38627803 PMCID: PMC11020989 DOI: 10.1186/s13019-024-02727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.
Collapse
Affiliation(s)
- Nicolas Nunez-Ordonez
- Cardiovascular Surgery Department, Fundación Cardioinfantil-LaCardio, Bogota, Colombia.
- Cardiovascular Surgery Resident, Universidad del Rosario, Bogota, Colombia.
| | | | - Jaime Camacho Mackenzie
- Chair, Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogota, Colombia
| | - Andrés Felipe Jiménez
- Cardiovascular Surgery Department, Fundación Cardioinfantil-LaCardio, Bogota, Colombia
- Cardiovascular Surgery Fellow, Universidad del Rosario, Bogotá, Colombia
| | - Alejandro González
- General Surgeon, General surgery department, Fundacion Cardioinfantil-LaCardio, Bogota, Colombia
| | - Andrea J Pico
- General surgery resident, Universidad de la Sabana, Bogotá, Colombia
| | - Carlos F Román
- General Surgeon, General surgery department, Fundacion Cardioinfantil-LaCardio, Bogota, Colombia
| | - Paulo A Cabrera Rivera
- General Surgeon, General surgery department, Fundacion Cardioinfantil-LaCardio, Bogota, Colombia
| | - Carlos A Villa Hincapié
- Cardiovascular surgeon, Cardiovascular Surgery Department, Fundacion Cardioinfantil-LaCardio, Bogota, Colombia
| |
Collapse
|
2
|
Nagata K, Nakamura K, Iida T, Iwasaki J, Ito R, Asai S, Ishihara M, Hata T, Itami A, Kyogoku T. A case of progressive xanthogranulomatous pancreatitis with splenic abscess. Clin J Gastroenterol 2024:10.1007/s12328-024-01930-1. [PMID: 38457070 DOI: 10.1007/s12328-024-01930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings.
Collapse
Affiliation(s)
- Keiji Nagata
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Kojiro Nakamura
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan.
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Taku Iida
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Junji Iwasaki
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Ryo Ito
- Department of Gastroenterology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Satsuki Asai
- Department of Diagnostic Pathology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Misa Ishihara
- Department of Diagnostic Pathology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Toshiyuki Hata
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Atsushi Itami
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| | - Takahisa Kyogoku
- Department of Surgery, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, Kobe, Hyogo, 651-2273, Japan
| |
Collapse
|
3
|
Zarei E, Pour Mohammad A, Vafadar M, Gholizadeh Mesgarha M. Ruptured splenic abscess as an extremely rare cause of pneumoperitoneum: A comprehensive review with a case report. Radiol Case Rep 2023; 18:4380-4383. [PMID: 37929045 PMCID: PMC10624761 DOI: 10.1016/j.radcr.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023] Open
Abstract
Splenic abscess leading to rupture and pneumoperitoneum is a very rare condition that is limited to a few case reports. In this study, we first introduced a case of an adolescent girl with a medical history of diabetes mellitus who presented with left upper quadrant abdominal pain and fever. Ultrasound revealed an abscess in the spleen and a computed tomography (CT) scan of the abdomen revealed evidence of pneumoperitoneum secondary to the rupture of this abscess. The patient underwent splenectomy without postoperative complications. Secondly, we reviewed and discussed the current literature on this topic which predominantly denotes that the pneumoperitoneum following splenic abscess rupture mostly occurs in the immunocompromised status, without a specific predominant infectious agent but the culprit is a gas-forming organism, acute abdomen ensues if the diagnosis is delayed, diagnosis is via abdominal CT when there is hemodynamic stability otherwise exploratory laparotomy uncovers the diagnosis, and splenectomy with broad-spectrum antibiotic therapy is the mainstay of treatment.
Collapse
Affiliation(s)
- Elham Zarei
- Department of Radiology, Ali Asghar Children Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Vafadar
- Department of Pediatric Endocrinology, Ali Asghar Children Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | |
Collapse
|
4
|
Ma Y, Yang K, Liu Y, Zhou X. An Unusual Case of splenic abscess misdiagnosed as a splenic littoral cell angioma. Asian J Surg 2023; 46:5486-5488. [PMID: 37591760 DOI: 10.1016/j.asjsur.2023.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Yiqun Ma
- Department of Radiology, 3201 Hospital, Hanzhong, Shaanxi, 723000, PR China
| | - Kang Yang
- Department of Radiology, 3201 Hospital, Hanzhong, Shaanxi, 723000, PR China
| | - Yonghao Liu
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, PR China
| | - Xinjun Zhou
- Department of Radiology, 3201 Hospital, Hanzhong, Shaanxi, 723000, PR China.
| |
Collapse
|
5
|
Moghimi Z, Sadeghian E, Notash AY, Sobhanian E. Splenic abscess due to non-operative management of splenic injury: a case report. J Med Case Rep 2023; 17:305. [PMID: 37454091 DOI: 10.1186/s13256-023-04026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Splenic abscess is a rare disease, with incidence of 0.2-0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery. CASE PRESENTATION A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization. CONCLUSION Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient's risk factors, vital signs, general conditions and presence or absence of sepsis.
Collapse
Affiliation(s)
- Zahra Moghimi
- Department of Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Sadeghian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Sobhanian
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Fukuda H, Hayakawa A, Takahashi Y, Komatsu Y, Kawamura M, Kubo R, Tokue H, Kominato Y, Sano R. Acute subdural hematoma caused by rupture of a mycotic aneurysm due to meningitis associated with infectious endocarditis: comparison of autopsy findings with postmortem computed tomography. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00640-3. [PMID: 37222902 DOI: 10.1007/s12024-023-00640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
Forensic pathologists often encounter cases of acute subdural hematoma (SDH) due to trauma, whereas those attributable to endogenous causes are rare. Here, we report a case of the latter type in a 42-year-old man who was found dead at home after several months of fever and malaise. Postmortem computed tomography (PMCT) and autopsy were undertaken to clarify the cause of death. PMCT images revealed a fatal SDH and a localized hyper-density area in the right parietal lobe; macroscopic and microscopic examinations revealed SDH due to rupture of a mycotic aneurysm (MA) associated with meningitis. The PMCT images also indicated thickening and calcification of the mitral valve, while autopsy demonstrated infective endocarditis (IE). In addition, PMCT demonstrated a low-density area in the spleen, which was shown to be a splenic abscess at autopsy. PMCT also demonstrated tooth cavities. Based on the findings of autopsy, the cause of death was considered to be SDH due to rupture of the MA resulting from meningitis with IE and splenic abscess. Although PMCT was unable to clarify the significance of any individual feature, a retrospective review of the PMCT images might have suggested IE, bacteremia, or ruptured MA leading to SDH. This case suggests that, instead of interpreting individual features demonstrated on PMCT images, integrated interpretation of overall PMCT findings might provide clues for identifying causes of death, despite the fact that PMCT lacks diagnostic accuracy for infectious diseases such as IE and meningitis.
Collapse
Affiliation(s)
- Haruki Fukuda
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan.
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Yuka Komatsu
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| |
Collapse
|
7
|
Alzahrani A, Islami MM, Batayyah E. Post-laparoscopic sleeve gastrectomy with splenic abscess: Case report. Int J Surg Case Rep 2023; 105:108024. [PMID: 37028181 PMCID: PMC10112174 DOI: 10.1016/j.ijscr.2023.108024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE One of the complications of laparoscopic sleeve gastrectomy (LSG) is a splenic abscess, considered a rare complication. As it is rare, it is a challenge to diagnose. CASE PRESENTATION In this case, a 62-year-old male patient who underwent LSG returned after three weeks with abdominal pain and fever. CLINICAL DISCUSSION: leak, Infection, spleen infarction These seemed like common complications, such as leaking from the stapler line, but the CT findings indicated a splenic abscess. The primary explanation for such an abscess is unclear in our case as the other reported cases were with the hypothesis of the late leak. A different treatment approach, laparoscopic exploration with incision and drainage, is the preferred option for this patient. CONCLUSION rare complications can be a challenge and how to manage them can be different from the standard to help the patient.
Collapse
Affiliation(s)
- Ahmed Alzahrani
- Department of General Surgery, King Fahd General Hospital, Jeddah 23325, Saudi Arabia.
| | - Maha M Islami
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
| | - Esam Batayyah
- Department of General Surgery, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia.
| |
Collapse
|
8
|
Zheng L, Wu L, Zhang B, Qiu W, Zhang X, Liu S. Sigmoid colon perforation with splenic abscess due to ulcerative colitis: A case report and review of the literature. Int J Surg Case Rep 2023; 104:107938. [PMID: 36827852 PMCID: PMC9978463 DOI: 10.1016/j.ijscr.2023.107938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The occurrence of abscesses in the spleen, a substantial abdominal organ with hematopoietic function, is relatively rare in clinical cases and mostly occurs in immunodeficient populations. The early symptoms of splenic abscess are not obvious, and the diagnosis is usually confirmed by a combination of patient symptoms, imaging manifestations and blood culture results. CASE PRESENTATION A 36-year-old male patient was treated in the emergency room for severe lower abdominal pain and discomfort. An abdominal CT(Computed Tomography) examination initially suggested an acute bowel perforation and an enlarged and abnormally thick spleen. The patient first underwent a repair of the bowel perforation, which was followed by fever and no reduction in abdominal symptoms, while the patient's splenic abscess was then treated with a repeat splenectomy. CLINICAL DISCUSSION Splenic abscesses mostly occur in immunocompromised patients. The treatment of splenic abscesses includes simple antibacterial medication, percutaneous puncture placement for drainage, and splenectomy for drainage. In our case, the treatment of this patient's splenic abscess was divided into several stages, and we finally used splenectomy for drainage because the patient's symptoms were not significantly better than before and combined with coagulation abnormalities. CONCLUSION In patients with severe abdominal infection and relevant ancillary tests suggesting abnormal spleen size and density, it is also important to consider whether a splenic abscess has formed and to provide early diagnosis and treatment of splenic abscess while fighting abdominal infection.
Collapse
Affiliation(s)
- Longkun Zheng
- School of Clinical Medicine of Jining Medical University, Jining, China
| | - Lin Wu
- Department of Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, China
| | - Baogui Zhang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Weilong Qiu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiaobei Zhang
- Department of Central Laboratory, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shiqi Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jining Medical University, Jining, China.
| |
Collapse
|
9
|
Oyamada T, Nabeta R, Azakami D. A canine case of splenic hemangiosarcoma complicated with infectious splenic abscess. Vet Res Forum 2022; 13:451-454. [PMID: 36320301 PMCID: PMC9548233 DOI: 10.30466/vrf.2021.526184.3148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
A 12-year-old spayed female Yorkshire Terrier presented with anorexia, and an intra-abdominal mass was examined at the Animal Medical Center, Tokyo University of Agriculture and Technology, Tokyo, Japan. Abdominal ultrasonography revealed that the mass originated from the spleen. Total splenectomy was performed the following day, where evidence of past rupture of the splenic mass and a small amount of purulent ascites were found. No gastrointestinal perforation or abscess formation in other tissues was noted during the surgery. Intra-operative cytological examination of the ascites revealed a large number of degenerated neutrophils and macrophages phagocytosing cocci. The splenic mass was histopathologically diagnosed as a splenic abscess, concurrent with a splenic hemangiosarcoma. Bacterial culture examination of the ascites identified Staphylococcus schleiferi. Although surgical management had been successful, the dog eventually developed clinical signs suggestive of intra-abdominal hemorrhage attributable to hemangiosarcoma approximately five months after surgery. This clinical report describes that splenic hemangiosarcoma might have created a milieu favorable for the development of splenic abscess.
Collapse
Affiliation(s)
- Tomohiro Oyamada
- Animal Medical Center, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Rina Nabeta
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan; ,Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Daigo Azakami
- Laboratory of Veterinary Clinical Oncology, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan.,Correspondence Daigo Azakami. DVM, PhD Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan . E-mail:
| |
Collapse
|
10
|
Mousavimaleki A, Amr B, Taherzadeh M, Rokhgireh S, Setaredan SA, Kermansaravi M. Post-Bariatric Splenic Complications; Diagnosis and Treatment. A Systematic Review. Obes Surg 2022; 32:3125-3137. [PMID: 35778627 DOI: 10.1007/s11695-022-06190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis and management protocols. A systematic literature search was performed in electronic database until March 2022. A total of 41 articles were included on the subject of splenic complications following bariatric/metabolic surgery (BMS). Splenic abscess was the most common splenic complications (44.2%) after BMS and leak was the most common reported etiology of the splenic abscess. Fever and abdominal pain were the most common presenting symptom in all splenic complications and CT scan was the most common diagnostic modality. Splenic complications after BMS are relatively rare but may lead to dangerous consequences. Prompt diagnosis and treatment can prevent potentially life-threatening outcomes.
Collapse
Affiliation(s)
- Ali Mousavimaleki
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bassem Amr
- Taunton and Somerset Foundation Trust, Taunton, UK
| | - Mahsa Taherzadeh
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amin Setaredan
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Tehran, Iran. .,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran.
| |
Collapse
|
11
|
Qu J, Zong Z. Giant splenic cyst complicated by infection due to Salmonella enterica serovar Livingstone in a previously healthy adolescent male: a case report. BMC Infect Dis 2022; 22:557. [PMID: 35717143 PMCID: PMC9206239 DOI: 10.1186/s12879-022-07529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background Splenic cyst complicated by non-typhoid Salmonella infection is rare in healthy individuals in the era of antibiotics. Salmonella enterica subsp. enterica serovar Livingstone causing infection of giant splenic cyst has not been previously reported. Case presentation We report a case of giant splenic cyst (maximum diameter, 21 cm) complicated with Salmonella Livingstone infection, which resulted in splenic abscess, in a 16-year-old previously healthy adolescent male. The splenic abscess was successfully treated with ultrasonography-guided percutaneous drainage and antimicrobial therapy. Conclusion Infection of splenic cyst may be caused by S. Livingstone in immunocompetent individuals. This case may help clinicians to raise awareness towards splenic abscess and highlights the importance of drainage and antimicrobial agents to avoid splenectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07529-6.
Collapse
Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital (Huaxi), Sichuan University, Guoxuexiang 37, Chengdu, 610041, China
| | - Zhiyong Zong
- Center of Infectious Disease, West China Hospital (Huaxi), Sichuan University, Guoxuexiang 37, Chengdu, 610041, China. .,Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
12
|
Hellinckx H, Mertes H, Vanreusel I, Demedts I, Dutré J. Clostridium perfringens splenic abscess treated with percutaneous drainage and antibiotic therapy: a case report. Acta Clin Belg 2022; 77:688-692. [PMID: 34151751 DOI: 10.1080/17843286.2021.1940606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Splenic abscesses are a rare medical entity with high mortality, with Clostridium perfringens 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 C. perfringens. RESULT After antibiotic treatment and percutaneous drainage, the patient recovered both clinically and radiographically. DISCUSSION We reviewed literature about C. perfringens splenic abscesses. In all cases identified, a splenectomy was performed. This is the first case description of splenic abscess caused by C. perfringens 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 C. perfringens splenic abscesses.
Collapse
Affiliation(s)
- Hanne Hellinckx
- Department of internal medicine, Catholic University of Leuven, Leuven, Belgium
| | - Helena Mertes
- Department of Infectiology, Jan Palfijn Merksem, Merksem, Belgium
| | - Inne Vanreusel
- Department of cardiology, University of Antwerp, Antwerp, Belgium
| | - Ingrid Demedts
- Department of Gastro-enterology, UZ Leuven, Leuven, Belgium
| | - Joris Dutré
- Department of Gastro-enterology, Jan Palfijn Merksem, Merksem, Belgium
| |
Collapse
|
13
|
Imam M, Hammond GW. Splenic infarction secondary to COVID-19 complicated by Clostridium Paraputrificum infection. IDCases 2021; 27:e01357. [PMID: 34900587 PMCID: PMC8647475 DOI: 10.1016/j.idcr.2021.e01357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old woman with COVID-19 presented with an acute abdomen. Her spleen was found to be infarcted with a large fluid and gas collection. Treatment included broad-spectrum antibiotics and CT-guided drainage. Definitive treatment was splenectomy. We postulate that COVID-19 related splenic infarction created ideal conditions for Clostridium paraputrificum to cause a splenic abscess.
Collapse
Affiliation(s)
- Malaz Imam
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory William Hammond
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
14
|
Hadi IAN, Boleng PP, Mengga HB. Surgical management of splenic abscess complicated by pleural effusion in rural setting: A case report from rural Indonesia. Int J Surg Case Rep 2021; 89:106579. [PMID: 34801780 PMCID: PMC8605439 DOI: 10.1016/j.ijscr.2021.106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Splenic abscess is a potentially life-threatening disease. Antibiotics along with surgery are the gold standard therapy. We present a case of splenic-salvaged surgical management of a large splenic abscess in a rural setting, complying with the available resources. Case presentation A 35-year old female presented to the ER with a history of left hypochondrium pain and fever for seven days. Abdominal tenderness at the left hypochondrium with an enlarged spleen was found. Laboratory tests showed severe anemia, leukocytosis, and thrombocytosis. Chest X-ray suggested pulmonary tuberculosis with minimal left pleural effusion. Ultrasound revealed a large unifocal splenic abscess. Antibiotics were administered. Simplified percutaneous drainage was performed, followed by open surgery abscess drainage. The patient showed a smooth recovery. Clinical discussion Pulmonary tuberculosis finding in a patient with splenic abscess suggested the potential etiology which itself is a rare finding. Spleen preservation surgery along with antibiotics is preferable to retain immunologic functions. In the rural setting, like Indonesia, where a pig-tail catheter set is not available, a simplified abscess drainage procedure is feasible. In patients with poor conditions, laparotomy and splenectomy approaches would lead to higher mortality and morbidity rates. Chest tube insertion may not be necessary for minimal pleural effusion in a splenic abscess as it may resolve naturally along with the abscess recovery. Conclusion Large splenic abscess can be managed by abscess drainage if the lesion is unifocal, in a view of the spleen being salvageable in patients with poor general conditions. Splenic abscess is a potentially life-threatening disease Mycobacterium tuberculosis is a rare etiology of splenic abscess, yet should be considered in the high TB burden countries A drainage procedure instead of splenectomy may be done for a large splenic abscess in patients with poor general conditions. A simplified drainage procedure in a rural setting with limited instrumentations is feasible and post a good outcome. Pleural effusion as splenic abscess complication may recede spontaneously along with the abscess recovery.
Collapse
Affiliation(s)
- Ivana Ariella Nita Hadi
- Department of Surgery, Karitas Waitabula Hospital SouthWest Sumba, East Nusa Tenggara, Indonesia; Jl. Bulgur No 1, Waitabula, Sumba Barat Daya, Nusa Tenggara Timur 87255, Indonesia.
| | - Petrus Prasetio Boleng
- Department of Surgery, Karitas Waitabula Hospital SouthWest Sumba, East Nusa Tenggara, Indonesia; Jl. Bulgur No 1, Waitabula, Sumba Barat Daya, Nusa Tenggara Timur 87255, Indonesia
| | - Hendrik Benianto Mengga
- Department of Surgery, Karitas Waitabula Hospital SouthWest Sumba, East Nusa Tenggara, Indonesia; Jl. Bulgur No 1, Waitabula, Sumba Barat Daya, Nusa Tenggara Timur 87255, Indonesia
| |
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
16
|
Perez AR, Aburayyan N, Sto Domingo MR, Onglao M. Disseminated Melioidosis presenting as pneumonia, femoral and sacral osteomyelitis, splenic abscess and high rectal fistula: A case report and review of literature. Int J Surg Case Rep 2021; 89:106588. [PMID: 34775325 PMCID: PMC8593263 DOI: 10.1016/j.ijscr.2021.106588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Melioidosis is a rare infectious tropical disease caused by Burkholderia pseudomallei (B. pseudomallei), an environmental saprophyte usually habitating on soils of Southeast Asian fields. Most of the reported cases present with pneumonia and intra-abdominal abscess. Diagnosis is established by culture studies from the blood, sputum or abscess drainage. Management relies on culture-guided antibiotic treatment, with good prognosis. Surgical intervention is required in cases not responsive to medical management. PRESENTATION OF CASE We are presenting a case of Melioidosis in a 72 year old Filipino who presented with Pneumonia, Femoral and Sacral Osteomyelitis, Splenic Abscess and High Rectal Fistula. He was successfully managed with systemic antibiotic treatment and surgery. The splenic abscess was managed by splenectomy and a transverse loop colostomy was used for fecal diversion to address the rectal fistula. DISCUSSION Melioidosis varies in its presentation and thus management should be individualized, depending on the organs involved. Our patient presented with multiple foci of infection which rendered the treatment more complicated as compared to those reported previously in published literature. The pneumonia and the osteomyelitis were managed with aggressive systemic antibiotics but the other sites of infection required drainage and surgery. CONCLUSION Melioidosis is a rare infection caused by an environmental saprophyte Burkholderia pseudomallei. An accurate diagnosis using culture studies is essential to institute appropriate treatment. Antibiotic treatment complemented by surgery for specific organ involvement is essential for cure.
Collapse
Affiliation(s)
- Anthony R Perez
- University of the Philippines, Manila College of Medicine, Philippines; Makati Medical Center, Department of Surgery, Philippines.
| | - Nour Aburayyan
- Makati Medical Center, Department of Surgery, Philippines
| | | | - Mark Onglao
- University of the Philippines, Manila College of Medicine, Philippines; Makati Medical Center, Department of Surgery, Philippines
| |
Collapse
|
17
|
Demma J, Weiss D, Kedar A, Shussman N, Zamir G, Pikarsky A, Bala M. Splenic infarction complicated with abscess after pelvic trauma as the first presentation of patent foramen ovale - A case report. Trauma Case Rep 2021; 33:100479. [PMID: 34027002 PMCID: PMC8121688 DOI: 10.1016/j.tcr.2021.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/29/2022] Open
Abstract
Hypercoagulability after trauma is a known entity. Following significant trauma, most guidelines advise anticoagulation treatment for venous thromboembolism (VTE) prophylaxis. VTE following minor trauma convoyed with arterial or systemic embolization dictate the need to search for uncommon source of thromboembolic complications. This is a report of an unusual case of pulmonary and systemic emboli complicated by splenic abscess following minor trauma in a patient with Diabetes Mellitus as the first presentation of patent foramen ovale (PFO).
Collapse
Affiliation(s)
- J Demma
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - D Weiss
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Kedar
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - N Shussman
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - G Zamir
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Pikarsky
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - M Bala
- General Surgery and Traumatology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
18
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
19
|
Schneider M, Kobayashi K, Uldry E, Demartines N, Golshayan D, Halkic N. Rhizomucor hepato splenic abscesses in a patient with renal and pancreatic transplantation. Ann R Coll Surg Engl 2021; 103:e131-e135. [PMID: 33682478 DOI: 10.1308/rcsann.2020.7125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.
Collapse
Affiliation(s)
- M Schneider
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - K Kobayashi
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - E Uldry
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - N Demartines
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - D Golshayan
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - N Halkic
- Lausanne University Hospital and University of Lausanne, Switzerland
| |
Collapse
|
20
|
Eckbo EJ, Mijovic H, Tam J, Goldfarb DM, Kollmann TR. An unusual case of abdominal pain and splenomegaly in a paediatric patient. SAGE Open Med Case Rep 2021; 9:2050313X21991059. [PMID: 33796309 PMCID: PMC7970672 DOI: 10.1177/2050313x21991059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/08/2021] [Indexed: 11/16/2022] Open
Abstract
Fusobacterium species are members of the oral microbiota and have been found to cause a wide spectrum of opportunistic infections. We describe the case of a previously healthy teenager with a large splenic abscess secondary to Fusobacterium nucleatum, successfully managed with percutaneous drainage and intravenous antibiotics. Identification of the organism was achieved using anaerobic culture of the aspirated fluid and matrix-assisted laser desorption/ionization time of flight, later confirmed by 16S ribosomal RNA metagenomic sequencing of the fluid. Fusobacteria are typically associated with oropharyngeal infections but are very rarely implicated in splenic abscesses. Aerobic and anaerobic blood cultures should be drawn when an intra-abdominal infection is suspected in a paediatric patient, and empiric antimicrobial therapy should be administered with coverage for gram-positive, gram-negative, and anaerobic bacteria.
Collapse
Affiliation(s)
- Eric J Eckbo
- Division of Medical Microbiology & Infection Control, Department of Pathology & Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hana Mijovic
- Division of Pediatric Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Jennifer Tam
- Division of Pediatric Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - David M Goldfarb
- Division of Pediatric Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada.,Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Tobias R Kollmann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
21
|
Evola G, Piazzese E, Cantella R, Iudica M, Veroux G, Sarvà S. Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature. Int J Surg Case Rep 2021; 79:160-163. [PMID: 33477075 PMCID: PMC7815976 DOI: 10.1016/j.ijscr.2020.12.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Splenic abscess (SA) is an uncommon and life-threatening disease. Spontaneous rupture of a SA with peritonitis is a rare occurrence. Preoperative diagnosis of ruptured SA is a challenge due to non-specific clinical presentation. Nowadays there are no guidelines for the management of SA. 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.
Collapse
Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.
| | - Enrico Piazzese
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Roberto Cantella
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Marianna Iudica
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Gastone Veroux
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| | - Salvatore Sarvà
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy
| |
Collapse
|
22
|
Baral S, Chhetri RK, Gyawali M, Thapa N. Splenic abscess complicated by pleural empyema: A rare case report from rural Nepal. Int J Surg Case Rep 2020; 75:492-496. [PMID: 33076203 PMCID: PMC7530217 DOI: 10.1016/j.ijscr.2020.09.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/19/2020] [Indexed: 12/03/2022] Open
Abstract
Splenic abscess is one of the rarer findings which is commonly seen in immunocompromised individuals. Splenic abscess may present with features of pleural effusion along with empyema if gets infected. Pleural empyema needs tube drainage. Splenic entity if unilocular, can be managed with broad spectrum antibiotics along with percutaneous aspiration or drainage. Open drainage or splenectomy is mandatory in case percutaneous techniques fail.
Introduction Splenic abscess generally occurs through hematogenous spread and typically follows endocarditis or seeding from contiguous sites of infection. This can be complicated by empyema thoracis. We present a rarer case of chronic alcoholic with splenic abscess along with empyema thoracis. Presentation of a case A 39-year old alcoholic male presented with history of pain at left hypochondrium and difficulty breathing for 7 days. Abdominal examination revealed tenderness at left hypochondrium along with enlarged spleen and liver associated with decreased air entry of left chest. Chest X-ray showed complete white out lung field on left side. Contrast enhanced tomography abdomen and pelvis revealed splenic abscess involving lower pole of spleen along with peri splenic extension. Tube thoracostomy drainage on left chest was done followed by ultrasonography guided repeated aspiration of splenic entity. Pus culture sensitivity showed growth of Streptococcus pyogenes while splenic aspirate remained sterile. Patient got discharged on 8th day of admission with full recovery. Discussion Splenic abscess is the rare entity which is commonly seen in immunocompromised individuals that might get complicated as empyema thoracis and management includes broad spectrum antibiotics along with tube thoracostomy and percutaneous drainage of splenic abscess if possible, in view of spleen being salvageable. Pleural collection revealed growth of Streptococcus pyogenes in our case which itself is the rare finding. Conclusion Splenic abscess can be managed with percutaneous aspiration/drainage if lesion is unilocular in the view of salvaging spleen. Complicated empyema can be managed with tube thoracostomy along with broad spectrum antibiotics.
Collapse
Affiliation(s)
- Suman Baral
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Raj Kumar Chhetri
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Milan Gyawali
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Neeraj Thapa
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| |
Collapse
|
23
|
Hung SK, Kou HW, Hsu KH, Wu CT, Lee CW, Leonard Goh ZN, Seak CK, Chen-Yeen Seak J, Liu YT, Seak CJ. Sarcopenia is a useful risk stratification tool to prognosticate splenic abscess patients in the emergency department. J Formos Med Assoc 2020; 120:997-1004. [PMID: 32917483 DOI: 10.1016/j.jfma.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Splenic abscess is a life-threatening surgical emergency which requires early diagnosis and intervention to maximize patient outcomes. This can be achieved through accurate risk stratification in the emergency department (ED). Sarcopenia refers to an age-related loss of skeletal muscle mass and strength that is accompanied by major physiologic and clinical ramifications, and often signifies decreased physiologic reserves. It is associated with poor clinical outcomes in sepsis, acute respiratory failure, oncological surgery, and liver transplantation. This study evaluates the utility of sarcopenia as a radiological stratification tool to predict in-hospital mortality of splenic abscess patients in the ED. This will assist emergency physicians, internists and surgeons in rapid risk stratification, assessing treatment options, and communicating with family members. METHODS 99 adult patients at four training and research hospitals who had undergone an abdominal contrast computed tomography scan in the ED with the final diagnosis of splenic abscess from January 2004 to November 2017 were recruited. Evaluation for sarcopenia was performed via calculating the psoas cross-sectional area at the level of the third lumbar vertebra and normalising for height, before checking it against pre-defined values. Univariate analyses were used to evaluate the differences between survivors and non-survivors. Sensitivity, specificity, and predictive values of the presence of sarcopenia in predicting in-hospital mortality were calculated. Kaplan-Meier methods, log-rank test, and Cox proportional hazards model were also performed to examine survival between groups with sarcopenia versus non-sarcopenia. RESULTS Splenic abscess patients with sarcopenia were 7.56 times more at risk of in-hospital mortality than those without sarcopenia (multivariate-adjusted HR: 7.56; 95% CI: 1.55-36.93). Presence of sarcopenia was found to have 84.62% sensitivity and 96.49% negative predictive value in predicting mortality. CONCLUSION Sarcopenia is associated with poor prognoses of in-hospital mortality in patients with splenic abscess presenting to the ED. We recommend its use in the ED to rapidly risk stratify and predict outcome to guide treatment strategies.
Collapse
Affiliation(s)
- Shang-Kai Hung
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao-Wei Kou
- Department of Surgery, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Department of Surgery, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | | | - Ya-Tung Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.
| | | |
Collapse
|
24
|
Dapri G. Laparoscopic wedge resection of the proximal sleeve and handsewn esophago-sleeve anastomosis for repair of complicated staple line leak. Surg Obes Relat Dis 2020; 16:1621-2. [PMID: 32753303 DOI: 10.1016/j.soard.2020.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
|
25
|
Hasan LZ, Shrestha NK, Dang V, Unai S, Pettersson G, El-Hayek K, Coppa C, Gordon SM. Surgical infective endocarditis and concurrent splenic abscess requiring splenectomy: a case series and review of the literature. Diagn Microbiol Infect Dis 2020; 97:115082. [PMID: 32535414 DOI: 10.1016/j.diagmicrobio.2020.115082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
Splenic abscess is an uncommon but serious complication of infective endocarditis (IE). The timing of surgical management of splenic abscess can be challenging when valve surgery is required. The American Heart Association (AHA) and the European Society of Cardiology (ESC) currently recommends splenectomy before valve replacement due to fear of reinfection of the heart valve; however, published data to support this recommendation are limited. In this series, we report outcomes for 5 patients with IE and splenic abscess who underwent valve replacement first, followed by splenectomy at a median of 19 days (range: 10-77 days) after valve surgery, with no recurrent infection of the new valve. Our experience and review of the available literature provide reassurance for splenectomy after valve surgery for IE.
Collapse
Affiliation(s)
- Leen Z Hasan
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Vinh Dang
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Kevin El-Hayek
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA; Division of General Surgery, Division of Surgical Oncology, MetroHealth System, Cleveland, OH, USA.
| | - Christopher Coppa
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
26
|
Lu V, Kanhere H. A case report of septic shock and splenic abscess formation secondary to gastric band erosion: A rare complication of laparoscopic adjustable gastric banding. Int J Surg Case Rep 2020; 69:55-57. [PMID: 32276217 PMCID: PMC7139125 DOI: 10.1016/j.ijscr.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION With the rising burden of obesity, bariatric surgery is becoming more common as a treatment option. Laparoscopic adjustable gastric banding (LAGB) is considered safe and effective and is a popular procedure in Australia. However there are recognised complications to be aware of such as band erosion which can lead to infection and abscess formation. PRESENTATION OF CASE A 59-year-old caucasian female presented with fevers, rigors and feeling generally unwell. She was previously fit and well with her only past medical history being LAGB 14 years prior. Clinically the patient was in septic shock and required intensive care admission for inotropic support. On investigations the CRP was 227 and abdominal computed tomography (CT) revealed a splenic abscess. Follow up upper gastrointestinal endoscopy diagnosed an eroded gastric band in the stomach. The patient proceeded to laparoscopy, a gastrotomy was performed and the band was removed. The splenic abscess was concurrently drained and the patient treated with an extended course of intravenous and oral antibiotics. DISCUSSION Band erosion is a rare but serious complications of LAGB surgery along with band slippage, pouch dilatation and abscess formation. Patients are often asymptomatic making early diagnosis difficult. Upper gastrointestinal endoscopy is used to locate the band and recommended treatment is band removal via laparoscopy or laparotomy. CONCLUSION Band erosion should be suspected in patients with a history of LAGB presenting with nonspecific symptoms such as abdominal pain or fevers. This case also highlights the importance of appropriate patient follow up post operatively and counselling of operative risks and long-term complications.
Collapse
Affiliation(s)
- Victoria Lu
- Upper Gastro-intestinal Surgical Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Harsh Kanhere
- Upper Gastro-intestinal Surgical Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
27
|
Abstract
Background Splenic abscess usually arises from hematogenous spread. Causative pathogens are various and anaerobic pathogens are rarely reported. Case presentation We report the case of a 50-year-old male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia. Causative pathogens were Clostridium perfringens and Streptococcus gallolyticus. The patient was successfully treated by splenectomy and targeted intravenous antibiotics. No underlying or predisposing disease was found. Conclusion Gangrenous necrosis of the spleen is a rare entity that can be successfully treated by splenectomy and antibiotics.
Collapse
Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland.
| | - Arnaud Dupuis
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Benedikt D Huttner
- Division of Infectious Diseases, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Matthieu Tihy
- Division of Pathology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Léo Bühler
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| |
Collapse
|
28
|
Hwang H, Baeg MK, Kim P, Kim YJ, Kang SH. Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated. Korean J Gastroenterol 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
29
|
Bain K, Lelchuk A, Parizh D, Meytes V, Kumar S. Splenic abscess following laparoscopic cholecystectomy: a case report of a rare disease and a review of its management. AME Case Rep 2018; 2:15. [PMID: 30264011 DOI: 10.21037/acr.2018.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 11/06/2022]
Abstract
Splenic abscess is a rare disease that has several predisposing factors. Case reports have documented post-surgical development of splenic abscesses, most commonly after laparoscopic sleeve gastrectomy. We present the case of a 69-year-old female with gallstone pancreatitis who underwent an uncomplicated laparoscopic cholecystectomy. The hospital course was complicated by persistent postoperative leukocytosis with a CT scan demonstrating a moderate sized splenic abscess. Interventional radiology was consulted for percutaneous drainage, and the patient was subsequently discharged home in stable condition. Splenic abscess is an important entity to remember as it is associated with significant mortality. Prompt treatment is vital for improving patient survival. Image guided percutaneous interventions have been increasing used and carry numerous benefits compared to surgical approaches. However, there is a paucity of data comparing the efficacy of percutaneous and surgical therapies. Percutaneous interventions can be successfully performed when the abscess is unilocular/bilocular, has a discrete wall, has no internal septations, or has thin liquid content. Further investigation through multicenter, prospective, randomized clinical trials are needed to analyze treatment options.
Collapse
Affiliation(s)
- Kevin Bain
- Department of Surgery, NYU Langone Hospital - Brooklyn, Brooklyn, NY, USA
| | - Andrew Lelchuk
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - David Parizh
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Vadim Meytes
- Department of Surgery, NYU Langone Hospital - Brooklyn, Brooklyn, NY, USA
| | - Sampath Kumar
- Department of Surgery, NYU Langone Hospital - Brooklyn, Brooklyn, NY, USA
| |
Collapse
|
30
|
Dissanayake HA, Weeratunga PN, Karunanayake P, Lanerolle RD, Chandu de Silva MV, Jayasinghe S. Embolizing pulmonary aspergillosis, mycobacterial & aspergillous splenic abscess and cytomegalovirus co-infection following steroid induced immunosuppression: a case report. BMC Infect Dis 2018; 18:367. [PMID: 30081818 PMCID: PMC6080400 DOI: 10.1186/s12879-018-3293-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aspergillosis is a serious infection particularly affecting the immunodeficient host. Its co-infection with tuberculosis and cytomegalovirus has not been reported before. Embolic events are well recognized with aspergillous endocarditis and aortitis. Splenic abscess is a rare serious complication of disseminated aspergillosis and is difficult to treat. We report the first case of multiple embolic events and splenic abscess in a patient with pulmonary aspergillosis and cytomegaloviral and tuberculous co-infection, without endocarditis or aortitis. CASE PRESENTATION Thirty-year-old male presented with fever and non-productive cough while on glucocorticoids for glomerulonephritis. He was found to have pulmonary aspergillosis and subsequently developed bilateral lower limb and cerebral fungal emboli and fungal abscess in the spleen. He had IgM and B cell deficiency and cytomegalovirus (CMV) and tuberculous co-infections. He recovered after prolonged course of antimicrobials, splenectomy and cessation of glucocorticoid therapy which also lead to the resolution of immune deficiencies. CONCLUSION This report illustrates rare combination of B and T cell suppressive effects of glucocorticoids leading to co-infections with CMV, Mycobacterium tuberculosis and Aspergillus and systemic fungal embolization from pulmonary aspergillosis.
Collapse
Affiliation(s)
| | | | - Panduka Karunanayake
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rushika D Lanerolle
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
31
|
Khalphallah A, Elmeligy E, Elsayed HK, Abedellaah BEA, Salman D, Al-lethie ALA, Bayoumi SA. Ultrasonography as a diagnostic tool in Egyptian buffaloes ( Bubalus bubalis) with traumatic pericarditis. Int J Vet Sci Med 2017; 5:159-167. [PMID: 30255066 PMCID: PMC6137839 DOI: 10.1016/j.ijvsm.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 12/01/2022] Open
Abstract
Traumatic pericarditis (TP) remains a serious problem facing bovine producers; particularly in the developing countries; causing severe economic losses. This study was carried out on 47 buffaloes including; control buffaloes (n = 20) and buffaloes with TP (n = 27) at Assiut governorate, Egypt. All animals were subjected to thorough clinical examination, whole blood profiling, blood serum biochemical assays, and radiographic and ultrasonographic examinations. The recorded ultrasonographic findings included; the contractility, contour and shape of the reticulum, shape and size of the heart and spleen involvement. All data were statistically analysed. Buffaloes with TP showed lymphocytic leucocytosis, increase in serum activities of AST, hyperproteinaemia, hypoalbuminaemia and hyperglobulinaemia. Radio-opaque metal foreign bodies, cardiomegaly and loss of the normal cardiac shape and contour were the most common radiographic findings in the diseased buffaloes. Ultrasonographically, the diseased buffaloes showed either acute pericarditis (n = 10) or chronic suppurative pericarditis (n = 17). Complete cessation of reticular contractions (0/3 min) and displacement of the reticulum from the diaphragm by a distance about 2.6-4.5 cm were the most common ultrasonographic findings of both types of pericarditis. In addition, the reticulum had uneven contour and the heart showed characteristic changes in its size, shape and contractility that was either accelerated or reduced. Reticular abscesses and peritoneal effusions were also imaged in all diseased buffaloes. In acute TP; the affected heart was enlarged with strong and clear cardiac contractions. Accumulation of hypoechoic fluids interspersed with echogenic deposits of fibrin within heart tissue and pericardium was observed. In chronic suppurative pericarditis, cardiomegaly, thickening of the cardiac wall and loss of the characteristic recognisable heart shape were the common ultrasonographic findings. Accumulation of hypoechoic fluids (usually pus) interspersing with echogenic deposits of fibrin within the pericardium, ventricles, atria and valves was also observed. In conclusion, ultrasonography with the aids of other diagnostic tools such as clinical findings, laboratory analysis and radiography has a high efficacy in evaluation of diseased buffaloes with TP.
Collapse
Affiliation(s)
- Arafat Khalphallah
- Division of Internal Medicine, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt
| | - Enas Elmeligy
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt
| | - Hanan K. Elsayed
- Division of Internal Medicine, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt
| | - Bahaa Eldeen A. Abedellaah
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt
| | - Doaa Salman
- Division of Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt
| | - Al-lethie A. Al-lethie
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Aswan University, Aswan 81528, Egypt
| | - Sara A. Bayoumi
- Division of Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt
| |
Collapse
|
32
|
Abstract
Colon cancer is among the common malignancies. Common cancer-related complications are regional tumor extension, obstruction, and tumor perforation. Abscess formation is among the rare complications. We report a case of a 60-year-old female who presented with shortness of breath and left upper quadrant pain and was diagnosed with splenic abscess associated with colon cancer. This type of presentation necessitates an early surgical intervention.
Collapse
Affiliation(s)
- Rishitha Yelisetti
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Madiha Khurshid
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Areig Awad
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Anand Kaji
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| |
Collapse
|
33
|
Ahmed S, Oh HB, Kheng DLLS, Krishnan P. Case report of successful partial splenectomy for a splenic abscess in a paediatric patient. Int J Surg Case Rep 2017; 38:176-179. [PMID: 28768231 PMCID: PMC5536388 DOI: 10.1016/j.ijscr.2017.07.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Splenic abscess (SA) is a rare potentially fatal condition in the paediatric population. It is difficult to diagnose given its non-specific presentation. There are no current guidelines for management of SA in this population but splenic preservation is advantageous given the vital role the spleen plays in immunity. PRESENTATION OF CASE We present a case of a 15-year-old boy with a large splenic abscess. He underwent successful partial splenectomy with resolution of his symptoms thereafter. DISCUSSION Standard surgical treatment for splenic abscess is antibiotics and drainage. Spleen-preserving options include percutaneous drainage, partial splenectomy, subtotal splenectomy and splenic auto-transplantation. Spleen-preserving techniques should be used where possible to achieve best outcome in clearing infection and to ensure the immunologic role of the spleen is not compromised. CONCLUSION Splenic abscess is rare conditions seen in paediatric practice with high mortality and partial splenectomy can be a useful spleen-preserving technique in treating this condition.
Collapse
Affiliation(s)
- Saleem Ahmed
- Department of Paediatric Surgery, Khoo Teck Puat - National University Children's Medical Institute, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore.
| | - Han Boon Oh
- Department of Paediatric Surgery, Khoo Teck Puat - National University Children's Medical Institute, Singapore; University Surgical Cluster, National University Health System, Singapore
| | - Dale Lincoln Loh Ser Kheng
- Department of Paediatric Surgery, Khoo Teck Puat - National University Children's Medical Institute, Singapore
| | - Prabhakaran Krishnan
- Department of Paediatric Surgery, Khoo Teck Puat - National University Children's Medical Institute, Singapore
| |
Collapse
|
34
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
35
|
Barrón-Reyes JE, Chávez-Galván JC, Martínez-Peralta JA, López-Valdés JC. [Splenic rupture secondary to abscess: Rare cause of pneumoperitoneum. Case report]. CIR CIR 2017; 85 Suppl 1:62-7. [PMID: 28027808 DOI: 10.1016/j.circir.2016.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 09/10/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Splenic abscesses are rare entities; reports are commonly described in immunocompromised patients (72%) as: hematologic diseases, diabetes, endocarditis, acquired immunodeficiency syndrome, transplant patients and subjects who had abdominal trauma or splenic infarction. The main and most serious complication is the abscess rupture into the peritoneal cavity or adjacent organs (stomach or colon), which determines hemodynamic instability or septic state. CLINICAL CASE Fifty-year-old man, who was admitted at Emergency Room due eight days' progressive, oppressive, and current pain; intensity 4/10, irradiated at hemi-back, which was higher intensity during the standing and decreased at supine position. It was accompanied by nausea and vomiting in two occasions. LABORATORY RESULTS Hemoglobin 15.1g/dl, hematocrit 45.2%, platelets 176×103, 23.1×103 leukocytosis, neutrophils 92%. Simple abdominal radiographic studies revealed in 'ground glass' and radiopaque imagines. CONCLUSIONS At presence of free air inside the abdominal cavity, is usually to think of a complicated diverticular disease, intestinal perforation or perforated peptic ulcer. The actual medical literature described very few cases of splenic abscess with pneumoperitoneum as cardinal manifestation. In our case, the splenic abscess was detected during exploratory laparotomy and only in retrospective the imaging studies were interpreted.
Collapse
|
36
|
Abstract
Cat scratch disease (CSD) can present as a systemic disease in 5-10% of cases and lead to various disease entities. A previously healthy 16-month-old boy presented with fever for 7 days without other obvious symptoms. Abdominal computed tomography scan demonstrated enlarged right inguinal lymph nodes and multiple small round hypodensities in the spleen. Despite antibiotic treatment for 1 week, the fever persisted and the intrasplenic lesions progressed. Inguinal lymph node biopsy confirmed CSD by immunohistochemistry staining. The diagnosis of CSD was also supported by a history of contact, imaging and serological findings. The patient recovered after treatment with azithromycin for a total of 5 weeks and, in serial follow-up, the hepatosplenic micro-abscesses resolved after 4th months.
Collapse
Affiliation(s)
- Chih-Chen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Chia-Jie Lee
- b Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Liang-Shiou Ou
- c Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Chao-Jan Wang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Yhu-Chering Huang
- b Department of Pediatrics , Chang Gung Memorial Hospital , Linkou , Taiwan.,d Chang Gung University College of Medicine , Kweishan, Taoyuan , Taiwan
| |
Collapse
|
37
|
Chong VH, Abdullah MS, Sangkarakumar S, Mathew VV, Telisinghe PU. Chronic Splenic Abscess as the First Manifestation of Pancreatic Tail Tumor. Indian J Surg 2016; 77:1504-5. [PMID: 27011620 DOI: 10.1007/s12262-014-1137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022] Open
Abstract
Pancreatic carcinoma is still associated with a poor survival due to the late presentation. Excluding head of pancreas tumor, manifestations are often vague resulting in delayed diagnosis. Manifestations as infective complications are rare, and in topic countries where infection remains common, diagnosis will be further delayed. We report a rare case of pancreatic tail carcinoma that manifested as chronic splenic abscess.
Collapse
Affiliation(s)
- Vui Heng Chong
- Division of Gastroenterology and Hepatology, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam
| | - Muhd Syafiq Abdullah
- Division of Palliative Care, RIPAS Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam
| | - S Sangkarakumar
- Department of Radiology, RIPAS Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam
| | | | | |
Collapse
|
38
|
Abstract
Imaging plays a major role in the evaluation of patients who present to the emergency department with acute left upper quadrant (LUQ) pain. Multidetector computed tomography is currently the primary modality used for imaging these patients. The peritoneal reflections, subperitoneal compartment, and peritoneal spaces of the LUQ are key anatomic features in understanding the imaging appearance of acute diseases in this area. Diseases of the stomach, spleen, pancreas, and splenic flexure are encountered in patients with acute LUQ pain. Optimization of the imaging protocol is vital for accurate diagnosis and characterization of these diseases in the acute setting.
Collapse
Affiliation(s)
- Jacob S Ecanow
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA
| | - Richard M Gore
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA.
| |
Collapse
|
39
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
40
|
Elasfar A, AlBaradai A, AlHarfi Z, Alassal M, Ghoneim A, AlGhofaili F. Splenic abscess associated with infective endocarditis; Case series. J Saudi Heart Assoc 2015; 27:210-5. [PMID: 26136636 DOI: 10.1016/j.jsha.2015.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/07/2015] [Accepted: 02/08/2015] [Indexed: 11/23/2022] Open
Abstract
Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can be fatal. We present three case reports that describe the management of splenic abscesses in patients initially diagnosed with infective endocarditis. In all cases, the diagnosis was based on the findings of abdominal computed tomography (CT) scan or magnetic resonance imaging (MRI). In two of the cases, splenectomy was performed before valve surgery; while in the third case, the spleen was removed after cardiac surgery. All three patients recovered fully, with satisfactory follow-up as outpatients. Immediate splenectomy, combined with appropriate antibiotics and valve replacement surgery alongside multi-disciplinary team work could be the treatment of choice in this clinical scenario.
Collapse
|
41
|
Seng P, Quenard F, Menard A, Heyries L, Stein A. Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing. Int J Infect Dis 2014; 29:238-40. [PMID: 25447730 DOI: 10.1016/j.ijid.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/28/2022] Open
Abstract
Splenic abscess is a rare disease that primarily occurs in patients with splenic trauma, endocarditis, sickle cell anemia, or other diseases that compromise the immune system. This report describes a culture-negative splenic abscess in an immunocompetent patient caused by Campylobacter jejuni, as determined by 16S rRNA gene sequencing.
Collapse
Affiliation(s)
- Piseth Seng
- Service de Maladies Infectieuses, Centre Interrégional de Référence des Infections Ostéo-articulaires Méditerranée Sud, CHU de la Conception, Assistance Publique - Hôpitaux de Marseille, 147, boulevard Baille, Marseille, France; Aix Marseille Université, Marseille, France.
| | - Fanny Quenard
- Service de Maladies Infectieuses, Centre Interrégional de Référence des Infections Ostéo-articulaires Méditerranée Sud, CHU de la Conception, Assistance Publique - Hôpitaux de Marseille, 147, boulevard Baille, Marseille, France
| | - Amélie Menard
- Service de Maladies Infectieuses, Centre Interrégional de Référence des Infections Ostéo-articulaires Méditerranée Sud, CHU de la Conception, Assistance Publique - Hôpitaux de Marseille, 147, boulevard Baille, Marseille, France
| | - Laurent Heyries
- Service d'Hépato-Gastro-Entérologie, CHU de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Andreas Stein
- Service de Maladies Infectieuses, Centre Interrégional de Référence des Infections Ostéo-articulaires Méditerranée Sud, CHU de la Conception, Assistance Publique - Hôpitaux de Marseille, 147, boulevard Baille, Marseille, France; Aix Marseille Université, Marseille, France
| |
Collapse
|
42
|
McPhillips S, Friese R, Vercruysse G. Case report of rare chronic myelogenous leukemia related multibacterial splenic abscess presenting with scrotal swelling. Int J Surg Case Rep 2014; 5:951-3. [PMID: 25460444 PMCID: PMC4275781 DOI: 10.1016/j.ijscr.2014.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/17/2014] [Accepted: 10/17/2014] [Indexed: 11/29/2022] Open
Abstract
Splenic abscesses associated with chronic myelogenous leukemia (CML) are rare. When they occur they are mostly fungal and associated with the immunosuppressive effects of the chemotherapy. Splenomegaly and scrotal swelling can have multiple etiologies and although rare, they can be presenting symptoms of CML. Epididymitis can cause scrotal swelling which may be exacerbated by the effects of splenomegaly upon the systemic circulation promoting venous congestion.
INTRODUCTION Splenic abscesses associated with leukemia are rare. Most reported cases of splenic abscesses occur after chemotherapy and are related to the immunosuppressive effects of the chemotherapy. Their etiology is most frequently fungal. PRESENTATION OF CASE A 58-year-old male presented with splenomegaly and scrotal swelling secondary to a multibacterial splenic abscess which required a splenectomy. Upon investigation he was found to suffer from chronic myeloid leukemia (CML) and epididymitis. DISCUSSION Splenic abscesses are rarely found in leukemic patients. Reported cases are fungal and commonly occur after chemotherapy due to immunosuppression. Scrotal swelling with concurrent splenomegaly can be found in other pathologies including brucellosis, Lyme disease and even non-Hodgkin primary testicular lymphoma. Scrotal swelling in our case was likely secondary to epididymitis and exacerbated by the effects of splenomegaly upon the systemic circulation promoting venous congestion. CONCLUSION This case illustrated an unusual presentation of CML because the patient presented with splenomegaly, a multibacterial splenic abscess, and scrotal swelling.
Collapse
Affiliation(s)
- Sean McPhillips
- Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85721, USA.
| | - Randall Friese
- Department of Surgery and Trauma, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85721, USA.
| | - Gary Vercruysse
- Department of Surgery and Trauma, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85721, USA.
| |
Collapse
|
43
|
Jaiswal SS, Talreja M, Chawla B, Chitkara G, Beedkar S. Organ preservation in splenic abscess. Med J Armed Forces India 2014; 70:195-7. [PMID: 24843212 DOI: 10.1016/j.mjafi.2012.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 06/18/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- S S Jaiswal
- Senior Advisor (Surgery), Base Hospital Delhi Cantt, Delhi 110010, India
| | - M Talreja
- Classified Specialist (Surgery), Base Hospital Delhi Cantt, Delhi 110010, India
| | - B Chawla
- Resident (Surgery), Base Hospital Delhi Cantt, Delhi 110010, India
| | - Garvit Chitkara
- Resident (Surgery), Base Hospital Delhi Cantt, Delhi 110010, India
| | - Saurabh Beedkar
- Resident (Surgery), Base Hospital Delhi Cantt, Delhi 110010, India
| |
Collapse
|
44
|
Kiritani S, Kaneko J, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, Kokudo N. Multiple splenic nodules with fever: a case of splenic abscess due to Propionibacterium acnes. Clin J Gastroenterol 2013; 6:434-7. [PMID: 26182133 DOI: 10.1007/s12328-013-0427-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/11/2013] [Indexed: 12/13/2022]
Abstract
A 64-year-old man with a history of chronic lymphocytic leukemia (CLL) presented in the hematology department due to remarkable leukocytosis and progressing anemia. Ultrasound confirmed splenomegaly and plain computed tomography revealed multiple hypoattenuating areas in the large spleen. Following a clinical diagnosis of relapse of CLL, he underwent treatment with fludarabine, cyclophosphamide, and rituximab (FC-R). After five cycles of FC-R treatment, his leukocyte count and hemoglobin level were normalized, and the size of the spleen also decreased. He began to have intermittent high fever (38 °C), however, approximately 6 months after the initiation of FC-R treatment. The results of an interferon-gamma release assay were positive. (18)F-fluoro-2-deoxy-D-glucose positron emission tomography showed multiple areas of high-uptake in the spleen, which was unclear in other radiologic modalities. We performed a splenectomy for the high fever and to confirm the diagnosis. Tissue cultures of the infarcted area of spleen were positive for Propionibacterium acnes. After splenectomy, the patient's condition improved and there were no further episodes of fever. Until recently, three cases of splenic abscess caused by Propionibacterium acnes were reported. Here we present a fourth case of splenic abscess due to Propionibacterium acnes and review the literature.
Collapse
Affiliation(s)
- Sho Kiritani
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taku Aoki
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiko Sugawara
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
45
|
Bhongle NN, Nagdeo NV, Thombare VR. A Splenic Abscess which was Caused by Salmonella Typhi in a Non Sickler Patient: A Rare Case Finding. J Clin Diagn Res 2013; 7:537-8. [PMID: 23634415 DOI: 10.7860/jcdr/2013/4563.2816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/10/2012] [Indexed: 11/24/2022]
Abstract
A splenic abscess which is caused by Salmonella typhi is a very rare complication of typhoid fever. We are reporting a case of a 14 year old female who presented with fever and pain in the abdomen. She was treated for fever of unknown origin in a rural hospital and was then admitted to our hospital after 15 days . She complained of fever and pain in the abdomen. On ultrasound, multiple splenic abscesses were seen. A USG guided aspiration was done and the aspirated material was received for culture, which was found to be positive for Salmonella typhi. A blood and stool culture which were done were negative and the Widal test showed a positive result with titres of TO 1:320 and TH 1:320. No predisposing factor was found in our case. Sickling was negative and HIV and HBsAg screening showed negative results. She responded favourably to the antibiotics which were given as per our antibiotic sensitivity report.
Collapse
|
46
|
Kunnathuparambil SG, Sathar SA, Tank DC, Sreesh S, Mukunda M, Narayanan P, Vinayakumar KR. Splenic abscess due to chronic melioidosis in a patient previously misdiagnosed as tuberculosis. Ann Gastroenterol 2013; 26:77-79. [PMID: 24714690 PMCID: PMC3959514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
Melioidosis is endemic in Southeast Asia and Northern Australia. Sporadic cases have been reported from many parts of the world where it has an epidemic potential with high-rate fatality cases. In non-endemic areas, melioidosis may be misdiagnosed with common diseases and this may prove fatal. Sporadic cases of melioidosis are mistaken for tuberculosis in India. We report a case of splenic abscess due to chronic melioidosis who was earlier misdiagnosed as tuberculosis and underwent anti-tuberculosis therapy. Following treatment of melioidosis his symptoms subsided. This case is reported because of the rarity of the disease and to highlight the importance of looking for melioidosis in patients with splenic abscess even in non-endemic areas.
Collapse
Affiliation(s)
- Sojan George Kunnathuparambil
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India,
Correspondence to: Dr Sojan George Kunnathuparambil, Senior Resident, Department of Medical Gastroenterology, SSB-3, super specialty block 3rd floor, Government Medical College, Thiruvananthapuram 695 011, India, Tel.: + 91 94 000 73067, e-mail:
| | - Shanid Abdul Sathar
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Devang Chandrakanth Tank
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Srijaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Madhav Mukunda
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | | |
Collapse
|
47
|
Abstract
The incidence of splenic abscesses is currently 0.14–0.7% with a reported mortality of 0–47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs) and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550) and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants), respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.
Collapse
Affiliation(s)
- C Rajasekharan
- Department of Internal Medicine, Medical College Hospital, Thiruvanthapuram, India
| | | |
Collapse
|
48
|
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
|
49
|
Piplani S, Nandi B, Ganjoo RK, Madan R, Chander BN. Two Cases of Salmonella Splenic Abscess. Med J Armed Forces India 2011; 62:77-8. [PMID: 27407854 DOI: 10.1016/s0377-1237(06)80167-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 07/26/2005] [Indexed: 11/17/2022] Open
Affiliation(s)
- S Piplani
- Classified Specialist (Med) and Oncologist, Command Hospital, Air Force, Bangalore
| | - B Nandi
- Classified Specialist (Med) and Gastroenterologist, Command Hospital, Air Force, Bangalore
| | - R K Ganjoo
- Air Officer Commanding, AFCME, New Delhi
| | - R Madan
- Graded Specialist (Pathology) and Oncopathologist, Command Hospital, Air Force, Bangalore
| | - B N Chander
- Senior Advisor (Radiodiagnosis), Command Hospital, Air Force, Bangalore
| |
Collapse
|
50
|
Naito R, Mitani H, Ishiwata S, Yamaguchi T, Tanaka K, Naruse Y, Araoka H, Hashimoto M, Ohno M. Infective endocarditis complicated with splenic abscess successfully treated with splenectomy followed by double valve replacement. J Cardiol Cases 2010; 2:e20-e22. [PMID: 30524586 DOI: 10.1016/j.jccase.2010.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/09/2010] [Accepted: 01/14/2010] [Indexed: 11/26/2022] Open
Abstract
Splenic abscess (SA) is a rare complication of infective endocarditis (IE). A successful outcome lies with a choice between medical and surgical treatments. However, there is still insufficient evidence in the decision-making process. Our patient was a 73-year-old male who complained mainly of fever and general fatigue. An echocardiography showed vegetation of 10 mm in diameter and severe mitral and aortic regurgitation and a diagnosis was made of IE. Because of a recent brain embolism, we decided to treat him initially with medical therapy. Antibiotics were effective, but on the 28th day after starting treatment, he complained of left upper abdominal pain. An abdominal computed tomography scan showed SA. The administration of vancomycin did not improve the condition. We decided that he should undergo surgical treatment. A splenectomy was performed and 9 days after the splenectomy, the mitral and aortic valves were successfully replaced. There is still no clear-cut evidence to support the order of surgical interventions. Indeed, the current guidelines, which recommend that splenectomy is to be performed first, are not supported by strong evidence. The present case report showed that splenectomy before valve surgery successfully treated the patient.
Collapse
Affiliation(s)
- Ryo Naito
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Haruo Mitani
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Sugao Ishiwata
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Tetsu Yamaguchi
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Keita Tanaka
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Yoshihiro Naruse
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Hideki Araoka
- Department of Infectious Disease, Toranomon Hospital, Tokyo, Japan
| | - Masaji Hashimoto
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Minoru Ohno
- Cardiovascular Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| |
Collapse
|