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脾脓肿由脾损伤的非手术治疗引起:病例报告。

Splenic abscess due to non-operative management of splenic injury: a case report.

机构信息

Department of Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

J Med Case Rep. 2023 Jul 16;17(1):305. doi: 10.1186/s13256-023-04026-5.

Abstract

BACKGROUND

Splenic abscess is a rare disease, with incidence of 0.2-0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery.

CASE PRESENTATION

A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization.

CONCLUSION

Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient's risk factors, vital signs, general conditions and presence or absence of sepsis.

摘要

背景

脾脓肿是一种罕见的疾病,既往研究报道发病率为 0.2-0.7%。它通常表现为左上腹疼痛、发热、寒战。脾脓肿常因感染的血行播散、心内膜炎、血管栓塞等一些罕见原因引起。治疗依赖于以下两种方法之一:经皮引流或手术。

病例介绍

一名 68 岁的糖尿病亚裔女性(亚裔女性)出现全腹疼痛、低血压、心动过速、发热、嗜睡和血糖升高。她因钝性腹部外伤和脾损伤在重症监护病房接受了保守治疗。超声和 CT 扫描显示她有一个巨大的脾脓肿,因此进行了脾切除术。我们的患者在未进行血管栓塞等干预的情况下发生了脾脓肿。

结论

脾损伤后选择非手术治疗的免疫功能低下患者需要密切随访,并至少在 2 周内评估脓肿形成情况。早期诊断和治疗包括经皮引流或脾切除术,具体取决于患者的危险因素、生命体征、一般情况以及是否存在脓毒症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/49dd/10350271/0d8fda2c519d/13256_2023_4026_Fig1_HTML.jpg

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