Ebels J, Van Elst F, Vanderveken M, Van Cauwelaert R, Brands C, Declercq S, Willemsen P
Department of General Surgery, ZNA Middelheim, Antwerp, Belgium.
Acta Chir Belg. 2007 Nov-Dec;107(6):720-3. doi: 10.1080/00015458.2007.11680158.
We present three case-reports of splenic abscess in patients who were initially diagnosed with bacterial endocarditis. In all cases the diagnosis of splenic abscess was based on the findings of abdominal CT scan or MRI. All patients were treated by laparotomy and splenectomy. Two patients fully recovered and one patient, who suffered from splenic rupture and massive blood loss before surgery, died. Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can prove fatal. Abdominal CT scan or MRI should be performed if there is clinical suspicion of splenic abscedation. Immediate splenectomy combined with appropriate antibiotics and valve replacement surgery is the treatment of choice. Splenic tissue is very fragile--especially if the abscess is located subcapsular--and a splenic rupture can result from minimal trauma. If the patient's general state allows it, it is best to perform splenectomy prior to valve replacement surgery to prevent re-infection of the valve prosthesis. A combined one-stage procedure is also an option.
我们报告了3例最初被诊断为细菌性心内膜炎患者并发脾脓肿的病例。所有病例中，脾脓肿的诊断均基于腹部CT扫描或MRI的检查结果。所有患者均接受了剖腹手术和脾切除术。2例患者完全康复，1例患者在手术前发生脾破裂并大量失血，最终死亡。脾脓肿是感染性心内膜炎一种虽已被充分描述但较为罕见的并发症。由于其病情发展可能致命，快速诊断和治疗至关重要。如果临床上怀疑有脾脓肿形成，应进行腹部CT扫描或MRI检查。立即行脾切除术并联合使用适当的抗生素及瓣膜置换手术是首选的治疗方法。脾组织非常脆弱——尤其是当脓肿位于包膜下时——轻微的创伤就可能导致脾破裂。如果患者的一般状况允许，最好在瓣膜置换手术前进行脾切除术，以防止人工瓣膜再次感染。一期联合手术也是一种选择。
