Kawahara Naoki, Kojima Mitsuaki, Morishita Koji
Trauma and Acute Critical Care Centre, Institute of Science Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0098. Epub 2025 Apr 25.
Splenic abscess is a rare but potentially life-threatening condition that can rupture, leading to pneumoperitoneum and symptoms that mimic gastrointestinal perforation in rare cases. This can significantly complicate accurate diagnosis and prompt treatment. A splenic abscess can become life-threatening by rupturing, which may cause diffuse peritonitis or sepsis.
A 68-year-old man with uncontrolled diabetes presented with fever, chills, and abdominal pain. Initial evaluation at a previous hospital, including computed tomography (CT), suggested a lower gastrointestinal perforation, leading to his transfer to our facility. CT revealed a non-enhancing lesion with gas in the spleen and free intraperitoneal air; however, there was no clear evidence of gastrointestinal perforation. An emergency exploratory laparotomy was performed, which revealed purulent ascites and a ruptured splenic abscess without any gastrointestinal perforation. After thorough lavage to eliminate contamination, open abdominal management was initiated owing to a need for catecholamine support and an inability to completely rule out the possibility of gastrointestinal perforation. A second-look laparotomy confirmed that there was no further contamination or gastrointestinal tract perforation. Blood and abscess cultures revealed , leading us to initiate targeted antibiotic therapy. The patient recovered successfully and was discharged on postoperative day 40 without any recurrence. Ruptured splenic abscess with pneumoperitoneum is rare and poses significant diagnostic challenges, particularly in patients with diabetes, owing to its clinical similarity to gastrointestinal perforation. This study highlights the utility of exploratory laparotomy and staged open abdominal management when gastrointestinal perforation cannot be ruled out.
Physicians should consider ruptured splenic abscesses in patients with pneumoperitoneum, particularly those with diabetes. Exploratory laparotomy with staged open abdominal management may represent an effective approach that facilitates safe monitoring and targeted treatment, thereby reducing the risk of fatal complications.
脾脓肿是一种罕见但可能危及生命的疾病，可发生破裂，导致气腹，在极少数情况下会出现类似胃肠道穿孔的症状。这会使准确诊断和及时治疗显著复杂化。脾脓肿破裂可危及生命，可能导致弥漫性腹膜炎或败血症。
一名68岁的糖尿病控制不佳的男性患者出现发热、寒战和腹痛。之前一家医院的初步评估，包括计算机断层扫描（CT），提示为下消化道穿孔，随后他被转至我院。CT显示脾脏有一个无强化的含气病变及腹腔内游离气体；然而，没有明确的胃肠道穿孔证据。进行了急诊剖腹探查术，发现脓性腹水和一个破裂的脾脓肿，未发现任何胃肠道穿孔。在彻底冲洗以清除污染后，由于需要儿茶酚胺支持且无法完全排除胃肠道穿孔的可能性，开始进行开放腹腔处理。二次剖腹探查术证实没有进一步的污染或胃肠道穿孔。血液和脓肿培养结果显示……，因此我们开始进行针对性抗生素治疗。患者成功康复，术后第40天出院，无任何复发。伴有气腹的破裂脾脓肿很罕见，并且带来重大的诊断挑战，尤其是对于糖尿病患者，因为其临床表现与胃肠道穿孔相似。本研究强调了在无法排除胃肠道穿孔时，剖腹探查术和分期开放腹腔处理的实用性。
医生应考虑气腹患者，尤其是糖尿病患者存在破裂脾脓肿的可能性。采用分期开放腹腔处理的剖腹探查术可能是一种有效的方法，有助于安全监测和针对性治疗，从而降低致命并发症的风险。
