Sandbox:splenic abscess: Difference between revisions
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* Hematogenous spread of bacteria | * Hematogenous spread of bacteria | ||
* Contiguous spread of bacteria | * Contiguous spread of bacteria | ||
==Casuses== | |||
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. | |||
Common causes includes: | |||
* Esherichia coli | |||
* Staphylococcus aureus | |||
* Klebsiella pneumonia | |||
Most common causes | |||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref> | Common risk factors of splenic abscess include:<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref> | ||
* Diabetes mellitus | * Diabetes mellitus | ||
* Immunocompromised conditions such as AIDS<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref> | * Immunocompromised conditions such as AIDS<ref name="pmid7362937">{{cite journal| author=Simson JN| title=Solitary abscess of the spleen. | journal=Br J Surg | year= 1980 | volume= 67 | issue= 2 | pages= 106-10 | pmid=7362937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7362937 }} </ref> | ||
* | * Pulmonary tuberculosis | ||
* Concomitant liver disease such as cirrhosis | * Concomitant parenchymal liver disease such as cirrhosis | ||
* Malignancies | * Malignancies | ||
* Trauma | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Incidence=== | ===Incidence=== | ||
Indceidence of spelenic abscess varies between 0.1% to 0.7%.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> | Indceidence of spelenic abscess varies between 0.1% to 0.7%.<ref name="pmid6986009">{{cite journal| author=Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R et al.| title=Splenic abscess. | journal=Medicine (Baltimore) | year= 1980 | volume= 59 | issue= 1 | pages= 50-65 | pmid=6986009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6986009 }} </ref><ref name="pmid3892934">{{cite journal| author=Gadacz TR| title=Splenic abscess. | journal=World J Surg | year= 1985 | volume= 9 | issue= 3 | pages= 410-5 | pmid=3892934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3892934 }} </ref> | ||
===Prevalence=== | |||
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.<ref name="pmid15287600">{{cite journal| author=Farres H, Felsher J, Banbury M, Brody F| title=Management of splenic abscess in a critically ill patient. | journal=Surg Laparosc Endosc Percutan Tech | year= 2004 | volume= 14 | issue= 2 | pages= 49-52 | pmid=15287600 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287600 }} </ref> | |||
===Case Fatality Rate=== | ===Case Fatality Rate=== | ||
Splenic abscesses are associate with increased morbidity and mortality. | Splenic abscesses are associate with increased morbidity and mortality. | ||
==Natural History, Complications and Prognosis== | |||
===Complications=== | |||
Common complicaiton include: | |||
* Bacterial sepsis or septicemia | |||
* Respiratory complications such as post operative pneumonia<ref name="pmid23204694">{{cite journal| author=Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G| title=A retrospective study of 75 cases of splenic abscess. | journal=Indian J Surg | year= 2011 | volume= 73 | issue= 6 | pages= 398-402 | pmid=23204694 | doi=10.1007/s12262-011-0370-y | pmc=3236272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23204694 }} </ref> | |||
Other complications include: | |||
* Wound infection | |||
* Paralytic ileus | |||
* Deep vein thrombosis | |||
* Meningitis | |||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Common symptoms of splenic abscess include: | |||
* Fever | * Fever | ||
* Abdominal pain | * Abdominal pain | ||
| Line 35: | Line 55: | ||
====Abdominal Examination==== | ====Abdominal Examination==== | ||
* Tender splenomegaly | * Tender splenomegaly | ||
* Palpable spleen | |||
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as ultrasound, computerized tomography made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref> | As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as ultrasound, computerized tomography made the diagnosis early and more accurate that reduces morbidity and mortality.<ref name="pmid12185032">{{cite journal| author=Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA| title=Percutaneous CT-guided drainage of splenic abscess. | journal=AJR Am J Roentgenol | year= 2002 | volume= 179 | issue= 3 | pages= 629-32 | pmid=12185032 | doi=10.2214/ajr.179.3.1790629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12185032 }} </ref> | ||
===Laboratory Tests=== | ===Laboratory Tests=== | ||
| Line 40: | Line 61: | ||
* CBC with differential | * CBC with differential | ||
* Erythrocyte sedimentation ratio (ESR) | * Erythrocyte sedimentation ratio (ESR) | ||
* Blood culture | |||
==Treatment== | ==Treatment== | ||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
===Percutaneous Drainage=== | ===Percutaneous Drainage=== | ||
Percutaneous drainage is the primary mode of tretament for splenic abscess, even though splenectomy is the definitive treatment because of increased risk of infections in splenectomised patient.<ref name="pmid17143953">{{cite journal| author=Zerem E, Bergsland J| title=Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 45 | pages= 7341-5 | pmid=17143953 | doi= | pmc=4087495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143953 }} </ref><ref name="pmid16410091">{{cite journal| author=Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S| title=Management of splenic abscess in children by percutaneous drainage. | journal=J Pediatr Surg | year= 2006 | volume= 41 | issue= 1 | pages= e53-6 | pmid=16410091 | doi=10.1016/j.jpedsurg.2005.10.085 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410091 }} </ref> | |||
* First line of treatment for splenic abscess | * First line of treatment for splenic abscess | ||
* Safe and effective than surgery in both unilocular and bilocular abscesses. | * Safe and effective than surgery in both unilocular and bilocular abscesses. | ||
* Preserves spleen | * Preserves spleen | ||
===Open Drainage=== | ===Open Drainage=== | ||
=== | ===Splenectomy=== | ||
Spleen plays a pivotal role in the immunological function, hence splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as staphylococcus aureus. | |||
* Definitive treatment for splenic abscess | * Definitive treatment for splenic abscess | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:02, 30 January 2017
Overview
Splenic abscess is an uncommon and lifethreatening condition.
Classification
- Unilocular abscess
- Bilocular abscess
- Solitary abscess
- Multiple abscesses
Pathophysiology
Splenic abscess can result from various sources such as
- Splenic trauma or splenic laceration
- Hematogenous spread of bacteria
- Contiguous spread of bacteria
Casuses
Spleenic abscess is caused mostly by monomicrobial but some times it can be caused by polymicrobial agents. Common causes includes:
- Esherichia coli
- Staphylococcus aureus
- Klebsiella pneumonia
Most common causes
Risk Factors
Common risk factors of splenic abscess include:[1]
- Diabetes mellitus
- Immunocompromised conditions such as AIDS[2]
- Pulmonary tuberculosis
- Concomitant parenchymal liver disease such as cirrhosis
- Malignancies
- Trauma
Epidemiology and Demographics
Incidence
Indceidence of spelenic abscess varies between 0.1% to 0.7%.[3][4]
Prevalence
Prevalence of splenic abscess is increasing gradually due to increased risk factors and increased imaging modalities that can diagnose more accurately.[5]
Case Fatality Rate
Splenic abscesses are associate with increased morbidity and mortality.
Natural History, Complications and Prognosis
Complications
Common complicaiton include:
- Bacterial sepsis or septicemia
- Respiratory complications such as post operative pneumonia[1]
Other complications include:
- Wound infection
- Paralytic ileus
- Deep vein thrombosis
- Meningitis
Diagnosis
History and Symptoms
Common symptoms of splenic abscess include:
- Fever
- Abdominal pain
- Nausea and vomiting
Physical Examination Findings
Abdominal Examination
- Tender splenomegaly
- Palpable spleen
As the clinical features of splenic absecess are non specific and vague such as abdominal pain, fever and vomiting, that makes diagnosis is challenging and relied on imaging modalities. Imaging studies such as ultrasound, computerized tomography made the diagnosis early and more accurate that reduces morbidity and mortality.[6]
Laboratory Tests
Blood Tests
- CBC with differential
- Erythrocyte sedimentation ratio (ESR)
- Blood culture
Treatment
Antimicrobial Regimen
Percutaneous Drainage
Percutaneous drainage is the primary mode of tretament for splenic abscess, even though splenectomy is the definitive treatment because of increased risk of infections in splenectomised patient.[7][8]
- First line of treatment for splenic abscess
- Safe and effective than surgery in both unilocular and bilocular abscesses.
- Preserves spleen
Open Drainage
Splenectomy
Spleen plays a pivotal role in the immunological function, hence splenecetomisesd patients are more prone to infections especially catalase positive bacteria such as staphylococcus aureus.
- Definitive treatment for splenic abscess
References
- ↑ 1.0 1.1 Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G (2011). "A retrospective study of 75 cases of splenic abscess". Indian J Surg. 73 (6): 398–402. doi:10.1007/s12262-011-0370-y. PMC 3236272. PMID 23204694.
- ↑ Simson JN (1980). "Solitary abscess of the spleen". Br J Surg. 67 (2): 106–10. PMID 7362937.
- ↑ Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R; et al. (1980). "Splenic abscess". Medicine (Baltimore). 59 (1): 50–65. PMID 6986009.
- ↑ Gadacz TR (1985). "Splenic abscess". World J Surg. 9 (3): 410–5. PMID 3892934.
- ↑ Farres H, Felsher J, Banbury M, Brody F (2004). "Management of splenic abscess in a critically ill patient". Surg Laparosc Endosc Percutan Tech. 14 (2): 49–52. PMID 15287600.
- ↑ Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA (2002). "Percutaneous CT-guided drainage of splenic abscess". AJR Am J Roentgenol. 179 (3): 629–32. doi:10.2214/ajr.179.3.1790629. PMID 12185032.
- ↑ Zerem E, Bergsland J (2006). "Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients". World J Gastroenterol. 12 (45): 7341–5. PMC 4087495. PMID 17143953.
- ↑ Choudhury S R, Rajiv C, Pitamber S, Akshay S, Dharmendra S (2006). "Management of splenic abscess in children by percutaneous drainage". J Pediatr Surg. 41 (1): e53–6. doi:10.1016/j.jpedsurg.2005.10.085. PMID 16410091.