Splenic abscess--presentation, diagnosis, and treatment.

Splenic abscess is an unusual entity. In the last 30 years at the Johns Hopkins Hospital, only 11 patients have been treated for clinically overt splenic abscess. Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function. Prior to 1970, diagnosis was one of exclusion, and delay in treatment was frequent. Recently, diagnosis has been facilitated by splenic scintiscans, ultrasonography, and computerized axial tomography. These techniques now afford earlier, objective evidence of splenic involvement. Although splenectomy controls local splenic suppuration, the ultimate prognosis rests on the underlying process predisposing the patient to development of splenic infection.