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  • • Abdominal pain, tenderness, peritonitis, and sepsis may be present

    • CT scan demonstrates fluid-filled lesion, possibly containing gas

    • May be caused by:

    • -Hematogenous seeding of the spleen with bacteria from remote septic focus (endocarditis, intra-abdominal infection)

      -Direct spread of infection from adjacent structures (pancreatic or perinephric abscess, diverticulitis, colon or gastric perforation)

      -Splenic trauma or infarction with secondarily infected hematoma or necrotic parenchyma

    • Complication of injection drug abuse and immunosuppression (AIDS, chemotherapy, transplant, corticosteroid use)

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Epidemiology

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  • • 65% of cases are solitary and unilocular; 8% are solitary and multiloculated

    • Multiple abscesses are present in 27% of cases

    Staphylococcus species, 20%; Salmonella, 15%; anaerobic bacteria, 15%; E coli, 10-15%; Streptococcus species, 10%; Enterococcus species, 5-10%

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Symptoms and Signs

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  • • Abdominal pain

    • Fever

    • Left upper quadrant abdominal tenderness

    • Peritonitis with guarding and rebound tenderness

    • Palpable spleen

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Laboratory Findings

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  • • Leukocytosis

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Imaging Findings

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  • Abdominal x-ray: Soft-tissue mass in left upper quadrant, displaced gastric bubble, extraluminal gas, elevated left hemidiaphragm

    Chest film: Basilar atelectasis, left pleural effusion

    CT scan: Nonenhancing, low-density lesion containing gas and fluid levels

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  • • A left pleural effusion combined with unexplained leukocytosis in a septic patient suggests a splenic abscess

    • In some patients, unexplained sepsis, progressive splenic enlargement, and abdominal pain are the presenting manifestations

    • Gas in the spleen on radiographic imaging is pathognomonic of splenic abscess

    • Most splenic abscesses remain localized, but spontaneous rupture and peritonitis may occur

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Rule Out

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  • • Subphrenic abscess

    • Perinephric abscess

    • Splenic tumor or cyst

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  • • CT scan

    • CBC

    • Blood cultures

    • Culture of abscess fluid

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When to Admit

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  • • Peritonitis

    • Sepsis

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  • • Broad-spectrum antibiotics

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Surgery

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  • • Splenectomy essential for cure if sepsis is localized to the spleen

    • Percutaneous drainage of large, solitary juxtacapsular abscesses may be feasible

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Indications

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  • • All abscesses

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Medications

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  • • Broad-spectrum antibiotics

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Complications

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  • • Spontaneous rupture and peritonitis

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Prognosis

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  • • 85-95% of cases treated successfully with splenectomy

    • 75% treated successfully with percutaneous drainage

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References

Tung CC et al: Splenic abscess: an easily overlooked disease? Am Surg 2006;72:322.  [PubMed: 16676856]

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