Peña-Ros Emilio, Méndez-Martínez Marcelino, Vicente-Ruiz María, Sánchez-Cifuentes Ángela, Martínez-Sanz Nuria, Albarracín Marín-Blázquez Antonio
Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
Cir Cir. 2015 Sep-Oct;83(5):433-7. doi: 10.1016/j.circir.2015.05.044. Epub 2015 Jul 9.
Splenic abscess is a rare clinic entity, its incidence has increased due to the rising number of clinical conditions involving immunosuppression. Endocarditis is the most frequent cause, and gram-positive aerobes are the main causal agents. Its clinical presentation is non-specific and delays diagnosis. Computed tomography scan is the method of choice, and the treatment is based on antibiotics and drainage, radiological or surgical, involving splenectomy in special cases that require it.
A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day.
Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
脾脓肿是一种罕见的临床病症，由于涉及免疫抑制的临床病症数量增加，其发病率有所上升。心内膜炎是最常见的病因，革兰氏阳性需氧菌是主要病原体。其临床表现不具特异性，会延迟诊断。计算机断层扫描是首选方法，治疗基于抗生素和引流，包括放射引流或手术引流，在特殊情况下需要进行脾切除术。
一名55岁男性，有腹痛和发热症状。检查发现白细胞增多至14,000/mm³，凝血酶原活性为53%，并伴有代谢性酸中毒。计算机断层扫描显示肝周气腹、液性液体、脾周气泡，十二指肠球部周围脂肪有轻微条索状改变且该区域存在气腹。患者接受了正中剖腹手术，发现因脾脓肿破裂导致化脓性腹膜炎，遂进行了脾切除术。液体培养显示有多形核白细胞，但未发现微生物。患者病情好转，术后第5天出院。
脾脓肿是一种罕见病症，诊断往往延迟，未经治疗的患者死亡率很高。其与气腹的关联可能会使诊断偏向于内脏穿孔。因此，在通过辅助检查发现不明原因气腹时必须怀疑脾脓肿。首选治疗方法是脾切除术，因为所有病例中包膜破裂是常见情况。
