Surgery Clerkship: Assignment #5

Splenic abscess

Cause of condition
Abscess of the spleen result from bacteremia particularly in the setting of abnormalities caused
by trauma and hemoglobinopathy. Immunocompromised stated that from human
immunodeficiency, virus infection may also a risk factor. Others risk factors neoplasm,
metastatic infection, splenic infarction, and diabetes.

Common sign and symptoms

The most common presenting symptoms are fever, abdominal pain and tender mass with
palpation of the left hypochondrium. The most common sign and symptoms of splenic abscess
include the triad fever, left upper quadrant tenderness and leukocytosis.

Pathophysiology
Most common seen as complication of infective which occur at 5% of patients, frequently
isolated pathogen include streptococcus, staphylococcus, mycobacterium, fungi and parasites.
Burkholderia pseudomallei is a cause of splenic abscesses. Mortality rates are high and fluctuate
with immune status.

Diagnosis
Blood work will reveal leukocytosis with a left shift and blood culture may be positive.
Radiographs of the chest can reveal many findings indicative of splenic abscesses such as
elevated left hemidiaphragm and left sided pleural effusion. A CT scan is the gold standard for
diagnosis.

Treatments
The gold standard for treating a splenic abscess is splenectomy. At admission is recommended
for all patient with splenic abscess a high dose parenteral broad-spectrum antibiotics and the
culture result guide the choice of antibiotics. Percutaneous aspiration is less invasive option in
patient of high risk for surgery or a temporary solution.
Prognosis
The prognosis of splenic abscess unlike the past, today is significant improved. The percutaneous
CT guided drainage is not the only safe and less invasive but it also avoid the morbidity of open
surgery. Alternative treatment is the laparoscopic splenectomy that is a open method with a
faster recovery and short hospital stays.

Reference:

1. Lotfollahzadeh, S. (2020, December 01). Splenic abscess. Retrieved May 09, 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK519546/

2. Chapman, J. (2020, August 16). Splenic infarcts. Retrieved May 09, 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK430902/