Splenic abscess: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Splenic abscess can result from various sources such as:<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> | |||
* Splenic trauma or splenic laceration | |||
* Hematogenous spread of bacteria | |||
* Contiguous spread of bacteria | |||
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse; | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Pathogenic Mechanism'''}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Discription'''}} | |||
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!Hematogenous Dissemination | |||
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* Hematogenous Dissemination or arterial dissemination is the most common mode of infection that results in splenic abscess.<ref name="pmid4550054">{{cite journal| author=Gadacz T, Way LW, Dunphy JE| title=Changing clinical spectrum of splenic abscess. | journal=Am J Surg | year= 1974 | volume= 128 | issue= 2 | pages= 182-7 | pmid=4550054 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4550054 }} </ref> | |||
* It is a metastatic infection through hematologic seeding from distant infections such as infective endocarditis, purulent teeth-related infections and urinary tract infections | |||
* Most common organism involved is Staphylococcs aureus | |||
* Often results in multiple abscesses | |||
'''Sources of pathogen'''<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref> | |||
* Intra-abdominal sepsis especially after bowel surgery | |||
* Chest infection | |||
* Osteomyelitis | |||
* Infected vascular access sites | |||
* Infected ventriculo peritoneal shunts | |||
* Skin lesions | |||
* Tooth extraction | |||
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!Secondary infection of splenic infarction | |||
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* Embolic or thrombotic non-infectious events due to red cell abnormalities such as hemolytic and sickle cell anemia causes ischemia followed by superinfection of emboli which tend to obstruct free blood flow and oxygen delivery to the spleen on the microscopic level. | |||
'''Sources of emboli:'''<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref> | |||
* Cardiac arrhythmia | |||
* Bacterial endocarditis | |||
* Lipid embolization with Weber-Christian disease | |||
* Iatrogenic splenic artery embolization for the treatment of autoimmune hemolytic anemia | |||
'''Source of thrombus formation in splenic artery''' | |||
* Sickle cell disease | |||
* Hemoglobinopathies such as thalassemia | |||
* Unexplained thrombocytosis | |||
* After pancreatitis | |||
|- | |||
!Contiguous spread of bacteria | |||
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* It is a mode of infection spread to the spleen from anatomically neighboring structures such as stomach or large bowel perforation, infected pancreatic cyst, perisplenic or subpleuric abscess. | |||
* Can cause either solitory or multiple abscesses<ref name="pmid3300398">{{cite journal| author=Nelken N, Ignatius J, Skinner M, Christensen N| title=Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. | journal=Am J Surg | year= 1987 | volume= 154 | issue= 1 | pages= 27-34 | pmid=3300398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3300398 }} </ref> | |||
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! Trauma | |||
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* secondary infections may developed due to splenic trauma during any intra-abdominal procedures.<ref name="pmid9240961">{{cite journal| author=Ooi LL, Leong SS| title=Splenic abscesses from 1987 to 1995. | journal=Am J Surg | year= 1997 | volume= 174 | issue= 1 | pages= 87-93 | pmid=9240961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9240961 }} </ref> | |||
'''Iatrogenic causes of splenic truma''' | |||
* Gastric surgery | |||
* Distal pancreatectomy | |||
* Endoscopic retrograde cholangio pancreatography | |||
* Percutaneous nephrostomy | |||
* Therapeutic splenic arterial embolization for autoimmune hemolytic anemia and hypersplenism | |||
* During splenic conservative techniques such as exploration only, mesh splenorraphy | |||
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! Immunodeficiency | |||
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* It is major factor involved in the course of splenic abscess especially if the causative organism is fungi or any other atypical organism. | |||
'''Common immunodeficient states associate with splenic absecess''' | |||
* Systemic lupus erythematosus | |||
* Felty’s syndrome | |||
* End-stage renal disease | |||
* Infectious mononucleosis | |||
* Cancers like multiple myeloma and leukemia | |||
* chemotherapy-induced abscesses developed particularily in leukemias | |||
* Immunosuppressive therapy with renal transplantation | |||
|} | |||
==Causes== | ==Causes== |
Revision as of 13:44, 6 February 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]
Synonyms and keywords:Abscess of spleen
Overview
Splenic abscess is an uncommon and lifethreatening condition. Clinical presentation, etiological factors, natural history, treatment and prognosis depends on whether the abscess was solitary or multiple.[1] It is always fatal if left untreated. Most commonly associate with immunodeficient patients especially, hematological disorders such as leukemia, sickle cell disease etc.
Definition
Splenic abscess is defined as any infectious suppurative process involving identifiable macroscopic filling defects either in the parenchyma of the spleen or the subcapsular space.[2]
Historical Perspective
- Since the times of Hippocrates, splenic abscess has been reported several times and he described the natural history and prognosis of splenic abscess.[3]
- In the early days of 20th century, splenic abscess most commonly caused by typhoid and then followed by malaria.[4]
- Ooi et al. described significant etiological differences such increase in the percentage of abscess cases due to aenarobics as compared to aerobics (7 vs 18-28%), fungi (1 vs 18-41%) as well as Mycobacterium tuberculosis (0.8 vs. 14%) in the second half of 20th century.[5]
Classification
Classification by Pathogenesis
Splenic abscess is classified traditionally based on the pathogenesis as follows:[1][6]
- Hematogenous or Metastatic infection: Seen in endocarditis
- Embolic phenomenon: splenic abscess developed as consequence of cellular embolism in hemoglobinopathies such as sickle cell anemia or disease
- Contagious infection: Splenic abscesses can develop through continuity of infection from primary sources which are anatomically close eg. subphrenical abscesses
- Splenic trauma: secondary infections may developed due to splenic trauma
- Depressed immune defenses: chemotherapy-induced abscesses developed particularily in leucemias
Classification by Etiology
Classification of splenic abscesses based on the etiological factors is as follows:[5]
- Mono-microbial abscess
- Poly-microbial abscess
- Sterile abscess
Pathophysiology
Splenic abscess can result from various sources such as:[7]
- Splenic trauma or splenic laceration
- Hematogenous spread of bacteria
- Contiguous spread of bacteria
Pathogenic Mechanism | Discription |
---|---|
Hematogenous Dissemination |
Sources of pathogen[5]
|
Secondary infection of splenic infarction |
Sources of emboli:[5]
Source of thrombus formation in splenic artery
|
Contiguous spread of bacteria |
|
Trauma |
Iatrogenic causes of splenic truma
|
Immunodeficiency |
Common immunodeficient states associate with splenic absecess
|
Causes
Differentiating Splenic abscess from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 1.0 1.1 1.2 Gadacz T, Way LW, Dunphy JE (1974). "Changing clinical spectrum of splenic abscess". Am J Surg. 128 (2): 182–7. PMID 4550054.
- ↑ 2.0 2.1 Nelken N, Ignatius J, Skinner M, Christensen N (1987). "Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature". Am J Surg. 154 (1): 27–34. PMID 3300398.
- ↑ Billings AE (1928). "ABSCESS OF THE SPLEEN". Ann Surg. 88 (3): 416–28. PMC 1398901. PMID 17865957.
- ↑ Elting AW (1915). "ABSCESS OF THE SPLEEN". Ann Surg. 62 (2): 182–92. PMC 1406707. PMID 17863403.
- ↑ 5.0 5.1 5.2 5.3 5.4 Ooi LL, Leong SS (1997). "Splenic abscesses from 1987 to 1995". Am J Surg. 174 (1): 87–93. PMID 9240961.
- ↑ Phillips GS, Radosevich MD, Lipsett PA (1997). "Splenic abscess: another look at an old disease". Arch Surg. 132 (12): 1331–5, discussion 1335-6. PMID 9403539.
- ↑ 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.