Splenic Abscess

• • 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)

Epidemiology

• • 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%

Symptoms and Signs

• • Abdominal pain

  • Fever

  • Left upper quadrant abdominal tenderness

  • Peritonitis with guarding and rebound tenderness

  • Palpable spleen

Laboratory Findings

• • Leukocytosis

Imaging Findings

• • 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

• • 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

Rule Out

• • Subphrenic abscess

  • Perinephric abscess

  • Splenic tumor or cyst

• • CT scan

  • CBC

  • Blood cultures

  • Culture of abscess fluid

When to Admit

• • Peritonitis

  • Sepsis

• • Broad-spectrum antibiotics

Surgery

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

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

Indications

• • All abscesses

Medications

• • Broad-spectrum antibiotics

Complications

• • Spontaneous rupture and peritonitis

Prognosis

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

  • 75% treated successfully with percutaneous drainage

References