Bhandarkar Deepraj, Katara Avinash, Shankar Manu, Mittal Gaurav, Udwadia Tehemton E
Division of Minimal Access Surgery, P D Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai 400016, India.
J Minim Access Surg. 2010 Jul;6(3):83-5. doi: 10.4103/0972-9941.68582.
Abscess of the spleen is an uncommon clinical entity and a tuberculous abscess is particularly rare. Although image-guided aspiration has been reported, splenectomy is the preferred modality of treatment. We report a 32-year-old female diagnosed to have a large, multilocular splenic abscess during investigation of a pyrexial illness. Her haemoglobin was 9.8 gm%, ESR 100 mm/1(st) hour and she was HIV negative. She had been on anti-tubercular chemotherapy (started elsewhere) for 2 months but had shown poor response. A laparoscopic splenectomy undertaken using four-ports was challenging due to the presence of perisplenitis and adhesions in the splenic hilum. Also, fundus of stomach densely adherent to the upper pole of the spleen required stapled resection. Postoperatively, she developed a low-output pancreatic fistula that resolved with conservative treatment within a week. Histopathology of the spleen confirmed tuberculosis. She responded well to anti-tubercular chemotherapy and remains well 3 years later.
脾脓肿是一种不常见的临床病症，结核性脓肿尤为罕见。尽管已有影像引导下穿刺抽吸的报道，但脾切除术仍是首选的治疗方式。我们报告一例32岁女性，在对发热性疾病进行检查时被诊断为患有一个大的、多房性脾脓肿。她的血红蛋白为9.8克/％，血沉为100毫米/第1小时，且HIV检测呈阴性。她在其他地方开始接受抗结核化疗已有2个月，但反应不佳。由于存在脾周炎和脾门粘连，采用四孔法进行腹腔镜脾切除术具有挑战性。此外，胃底与脾上极紧密粘连，需要进行吻合器切除。术后，她出现了低流量胰瘘，经保守治疗在一周内得以解决。脾脏的组织病理学检查证实为结核病。她对抗结核化疗反应良好，3年后情况良好。
