Hadi Ivana Ariella Nita, Boleng Petrus Prasetio, Mengga Hendrik Benianto
Department of Surgery, Karitas Waitabula Hospital SouthWest Sumba, East Nusa Tenggara, Indonesia; Jl. Bulgur No 1, Waitabula, Sumba Barat Daya, Nusa Tenggara Timur 87255, Indonesia.
Department of Surgery, Karitas Waitabula Hospital SouthWest Sumba, East Nusa Tenggara, Indonesia; Jl. Bulgur No 1, Waitabula, Sumba Barat Daya, Nusa Tenggara Timur 87255, Indonesia.
Int J Surg Case Rep. 2021 Dec;89:106579. doi: 10.1016/j.ijscr.2021.106579. Epub 2021 Nov 4.
Splenic abscess is a potentially life-threatening disease. Antibiotics along with surgery are the gold standard therapy. We present a case of splenic-salvaged surgical management of a large splenic abscess in a rural setting, complying with the available resources.
A 35-year old female presented to the ER with a history of left hypochondrium pain and fever for seven days. Abdominal tenderness at the left hypochondrium with an enlarged spleen was found. Laboratory tests showed severe anemia, leukocytosis, and thrombocytosis. Chest X-ray suggested pulmonary tuberculosis with minimal left pleural effusion. Ultrasound revealed a large unifocal splenic abscess. Antibiotics were administered. Simplified percutaneous drainage was performed, followed by open surgery abscess drainage. The patient showed a smooth recovery.
Pulmonary tuberculosis finding in a patient with splenic abscess suggested the potential etiology which itself is a rare finding. Spleen preservation surgery along with antibiotics is preferable to retain immunologic functions. In the rural setting, like Indonesia, where a pig-tail catheter set is not available, a simplified abscess drainage procedure is feasible. In patients with poor conditions, laparotomy and splenectomy approaches would lead to higher mortality and morbidity rates. Chest tube insertion may not be necessary for minimal pleural effusion in a splenic abscess as it may resolve naturally along with the abscess recovery.
Large splenic abscess can be managed by abscess drainage if the lesion is unifocal, in a view of the spleen being salvageable in patients with poor general conditions.
脾脓肿是一种潜在的危及生命的疾病。抗生素联合手术是金标准治疗方法。我们报告一例在农村地区对巨大脾脓肿进行保留脾脏的手术治疗病例，该治疗符合现有资源情况。
一名35岁女性因左侧季肋部疼痛和发热7天就诊于急诊室。检查发现左侧季肋部有腹部压痛且脾脏肿大。实验室检查显示严重贫血、白细胞增多和血小板增多。胸部X线提示肺结核伴少量左侧胸腔积液。超声检查发现一个巨大的单灶性脾脓肿。给予抗生素治疗。先进行了简化的经皮引流，随后进行了开放性手术脓肿引流。患者恢复顺利。
脾脓肿患者出现肺结核表现提示了潜在病因，而这本身是一种罕见发现。保留脾脏的手术联合抗生素治疗更有利于保留免疫功能。在农村地区，如印度尼西亚，若没有猪尾导管套件，简化的脓肿引流程序是可行的。对于病情较差的患者，剖腹手术和脾切除方法会导致更高的死亡率和发病率。脾脓肿伴有少量胸腔积液时，可能无需插入胸管，因为积液可能会随着脓肿的恢复而自然消退。
鉴于一般状况较差的患者脾脏可保留，若病变为单灶性，巨大脾脓肿可通过脓肿引流进行治疗。
