You can also split and merge files back together using out free online merge tool. Splenic abscess is a rare but possibly lifethreatening condition that can be caused by various grampositive and gramnegative bacterial pathogens. May 21, 2008 abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Ctguided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen. Infective endocarditis is associated with systemic embolization in 22% to 50% of cases. We report our experience of percutaneous drainage of splenic abscess under ultrasound us guidance. Oct 14, 2016 splenic abscess, post splenectomy drainage of abscess. On imaging the possibility of splenic abscesses was kept. Splenic abscesses are potentially fatal complication of typhoid fever. Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot. Historically, splenectomy has been the treatment of choice for abscesses. We are reporting a rare case study of splenic abscess as a progression of splenic infarction after a routine sleeve gastrectomy. Splenic abscess caused by salmonella typhi and coinfection.
Sep 03, 2017 splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Multiple splenic abscesses are very rarely encountered in surgical practice with a reported high mortality rate in neglected and untreated cases. Splenicabscess anotherlook at an olddisease grace s. Spleen was the source of emotion aristotle challenged this idea and argued that the spleen was unnecessary gaius pliny secundus natural history remove the spleen to improve the speed of athletes. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The severity of the injury, suggested by grade ct grade, neurologic status, age 55 and or the presence of associated injuries are not contraindications to a trial of nop management. Case report a 50yearold male patient from lower socio. There are no specific clinical findings for a splenic abscess. Splenic abscess is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. First, the abscesses discovered at postmortem usually are. Pdf documents are often used because they help preserve the original content of the document, but this can make splitting the file up a little more difficult than other document formats. Assistant professor of surgery, jefferson medical college clinical assistant in surgery, jefferson medical college philadelphia, pennsylvania splenic abscess occurs with consider able frequency as is demonstrated by numerous references to the condition found in the literature. Ct is a reasonable first line test in determining splenic pathology, with mri or biopsy being used to problemsolve. Isolated splenic cold abscesses with perisplenic extension.
Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction tissue death due to oxygen shortage in the organ. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. We report a case of splenic abscess from which only shigella flexneri serotype 1a and bacteroides fragilis were isolated.
Splenic abscess in cancer chemotherapy bmc research. Right axial cect in a patient with a recent history of traumatic injury to the spleen and a new fever demonstrates a rimenhancing fluid collection with an airfluid level, consistent with a splenic abscess. Split pdf pdf split into multiple files online free. Splenic abscesses are extremely rare complications of ibd. Splenic tuberculosis tb in the form of multiple splenic cold abscesses with perisplenic extensions is a rare disease, especially in an immunocompetent host. Splenic abscess detection and monitoring using sonography. Trauma center practice management guideline iowa methodist medical center des moines blunt splenic injury management suspected or. Help your pdf meet the size limit by breaking down large documents into smaller pieces to facilitate electronic distribution. Splenic abscess and multiple brain abscesses caused by. We report a case of splenic abscess, caused by salmonella typhi, and coinfection with leptospira in a previously healthy young male. Assistant professor of surgery, jefferson medical college clinical assistant in surgery, jefferson medical college philadelphia, pennsylvania splenic abscess occurs with consider able frequency as is demonstrated by numerous references to the condition found in the. The medical files of 16 consecutive patients 12 male and four female. Traditional treatment for splenic abscess has been splenectomy and antibiotic therapy but imageguided percutaneous aspiration and drainage can also be considered. Etiology, clinical spectrum and therapy 39 the only laboratory abnormality that is frequently present is leukocytosis, which is seen in 60% to 80% of cases 2.
However, if the diagnosis is missed, splenic abscess does carry very high mortality. Usguided fine needle aspiration was the first line treatment in patients with. Spleen abscess often coexists with several risk factors, but the major one is the patients immunodeficiency. The mortality rate is as high as 50% when antimicrobial therapy is the only treatment used for a pyogenic splenic abscess.
They uncommonly affect the spleen due to its efficient reticuloendothelial system phagocytic activity and, consequently, are more likely seen in immunosuppressed patients. Combined hepatic and splenic abscesses in a patient with. In africa, splenic abscess is common due to prevalence of hemoglobinopathies such as sickle cell disease, which is a common risk factor for this disease. Burkholderia pseudomallei is a soil saprophyte, endemic in south east asian countries vietnam, thailand and also in australia. Streptococcus intermedius, a member of the streptococcus anginosus group, is a common commensal organism of the oral cavity and gastrointestinal tract, and it is a known. May 25, 2007 it has been shown that splenic abscesses respond poorly to antibiotics alone. Splenic abscesses, like abscesses elsewhere, are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. Abscess of the spleen is a rare discovery, with about 600 cases reported in the international literature so far. Splenic abcess is an uncommon complication for cancer treatment. The latter four patients had developed splenic microabscesses with a. The classic triad fever, pain of the left hypochondrium, and sensitive mass left is only present in onethird of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss. Splenic abscess is rare with potentially lifethreatening evolution. Splenic abscess is an uncommon entity that can be treated percutaneously. During a recent 5year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound us examination.
This report describes a patient with crohns disease of the colon who presented with a rare extraintestinal complication. Splenic abscess complicating gastroenteritis due to. We report a patient with a rare presentation of this king of diseases. In the first mentioned case, a search to find common risk factors was. Additional features of this case were the association of multiple extraintestinal manifestations of crohns disease, including iritis, ankylosing spondylitis, and pericholangitis, and polymicrobial bacteremia. Splenic abscess with drainage and recovery sciencedirect. It occurs more frequently in immunocompromised patients. We report our experience of percutaneous drainage of splenic abscess under. Patient presented with fever and blood investigations revealed leukocytosis,there was no history of trauma or pancreatitis. Splenic abscess is an unusual disease and may be present either as a localized area of infection in the spleen or as a part of generalized sepsis. Jun 23, 2018 once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated.
Most splenic abscesses are due to aerobial microorganisms. It is a rare condition, with fewer than 600 cases reported in the literature. The finding of a splenic abscess is rare, with only 500 to 600 cases ever. Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. The patient was a 59yearold diabetic female who displayed minimal gastrointestinal symptoms. Splenic abscess after a sleeve gastrectomy is an extremely rare occurrence, with only one case reported internationally and none were yet documented in united states. Septic peritonitis secondary to jejunal rupture from a perforating ulcer arrow. The spleen is delivered to the midline by means of blunt and sharp dissection of the areolar plane between the kidney and the pancreas. Etiology, clinical spectrum and therapy 38 patients, recent series have showed greater numbers of fungal isolates, including candida albicans, aspergillusspp, and agents of mucromycosis. An instructional note at k65 says to use an additional code b95b97 to identify the infectious organism.
It may arise either from the spread of infection from a neighboring organ that is, a diverticular abscess or a ruptured gastric ulcer or from hematogenous spread in patients with infective endocarditis. Jul 23, 2009 splenic abscess is an unusual and potentially lifethreatening disease with a diagnostic challenge due to the nonspecific clinical picture and diagnosis confirmed based mostly on imaging studies. Splenic abscess after sleeve gastrectomy sages abstract. It demonstrates diagnostic complexity, which makes identification of the disease difficult. Splenic abscess complicating gastroenteritis due to salmonella virchow in an immunocompetent host splenic abscesses should be suspected in patients with unexplained fevers and left upper quadrant pain lessons from practice clinical record a 20yearold man was admitted to a regional hospital with. Splenic abscess is an uncommon disease, and it has been noted to occur at a rate of 0. The splenic abscess was aseptic and treated with steroids and cyfig. A spleen abscess or splenic abscess occurs when bacteria or fungi from elsewhere in the body travel via the blood stream into the spleen tissue where they multiply. The gold standard for treatment of splenic abscess is splenectomy.
We report a case of splenic abscess with multiple brain abscesses caused by streptococcus intermedius in a healthy young man without any identifiable risk factors, which resolved with percutaneous drainage and antibiotics. Multiple splenic abscesses with pleural effusion and free fluid in peritoneum with incidentally detected mild fatty infiltration of liver, cholelithiasis and vesical calculus. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. Multiple splenic abscesses in a rather healthy woman. The finding of a splenic abscess is rare, with only 500 to 600 cases ever having been reported internationally. Splenic abscess definition of splenic abscess by medical. Treatment depends on the patients overall condition, comorbidities, and primary disorder if any, as well as the size and topography of the abscess. Once the diagnosis of a splenic abscess has been made, the patient must be admitted to the hospital and treated. He postulated that 1 of 3 courses was followed by a patient with a splenic abscess. A study of ct cases through our regional radiology centre. We report a case of an immunocompetent adult male who presented with fever, pain in the left lower chest, decreased appetite, and significant. Though inoculation is believed to be the major mode of infection, ingestion and person to person transmission have also been suggested in certain cases. In most of these patients, hemoglobinopathies or some other underlying immunocompromised state is usually present. A spleen abscess can cause a fever and left upper abdominal pain.
Splenomegaly with fever typhoid,malaria,kala azar,military tuberculosis, infective endocarditis,leukemia,lymphoma 3. Splenic abscess or splenitis, splenic torsion mesenteric lymph node abscess umbilical abscess iatrogenic surgical peritoneal contamination peritoneal dialysis figure 1. Fungal splenic abscesses respond much more favorably to antifungal therapy. Abscesses of the spleen have been reported periodically since the time of hippocrates. Our handy tool even allows you to automatically split individual pages of your document into separate files.
Highly tender spleen rupture with sub capsular hematoma splenic abscess splenic infarct sickling of rbc in splenic artery, embolismmural,endocardial,left atrial myxoma. Underlying immunosuppression or the presence of comorbidities such as diabetes mellitus significantly increase mortality. To study the aerobic and anaerobic microbiology of liver and spleen abscesses and correlate the results with predisposing factors, potential causes and routes of infection, clinical and laboratory. Jul 20, 2018 abscesses of the spleen have been reported periodically since the time of hippocrates. With the spleen retracted medially, the phrenicocolic ligament is. During angioembolization, trauma surgeon and interventional radiologist are to be aware that. Splenic abscess is an unusual and potentially lifethreatening disease with a diagnostic challenge due to the nonspecific clinical picture and diagnosis confirmed based mostly on imaging studies. December 7 95 case of the month splenic abscess caused by salmonella typhi and coinfection with leptospira monalisa sahu1, arvind kumar1, neeraj nischal2, bg bharath1, smita manchanda3, naveet wig 4 1department of medicine, 2assistant professor, department of medicine, 3department of radiodiagnosis, 4professor, department of medicine, all india institute of medical. Since this is not included in documentation a code is not used. We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patients clinical condition and inflammatory parameters. Diseases and injuries, look for abscessspleen and you are referred to d73. The gold standard for treatment of a splenic abscess is splenectomy. Multiple aseptic splenic abscesses in a 15 year old. The patient was treated with percutaneous drainage and antibiotics.
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