Rajasekharan C, Jayapal T
Department of Internal Medicine, Medical College Hospital, Thiruvanthapuram, India.
Case Rep Gastroenterol. 2012 May;6(2):333-9. doi: 10.1159/000339463. Epub 2012 May 31.
The incidence of splenic abscesses is currently 0.14-0.7% with a reported mortality of 0-47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs) and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550) and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants), respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.
脾脓肿的发病率目前为0.14 - 0.7%，报告的死亡率为0 - 47%。脾脓肿破裂入腹腔的诊断常常被忽视，因为其罕见且临床表现具有误导性。经皮冠状动脉介入治疗（PCI）和冠状动脉支架置入手术分别从184,000例增加到885,000例（从每百万居民335例增加到1,550例）以及从3,000例增加到770,000例（从每百万居民5例增加到1,350例）。一名40岁的亚洲男性在经皮腔内冠状动脉成形术后5天因上腹部疼痛就诊于我们的急诊科。临床检查提示急性胰腺炎和腹腔内感染的可能性。腹部初次超声检查和血液检查均为阴性。腹部计算机断层扫描显示脾脓肿已破裂入腹腔。脓液培养显示一株对美罗培南敏感的耐多药肺炎克雷伯菌。患者在接受开放手术引流和抗生素治疗后迅速康复。由于这是第二例脾脓肿病例，也是首例PCI术后脾脓肿破裂的病例报告，因此对于接受经皮腔内冠状动脉介入治疗的高危免疫功能低下患者，给予短期抗生素预防性治疗是合理的。
