Liang J T, Lee P H, Wang S M, Chang K J
Department of Surgery, National Taiwan University Hospital, Taipei, R.O.C.
Am J Emerg Med. 1995 May;13(3):337-43. doi: 10.1016/0735-6757(95)90215-5.
Splenic abscess, with its rare incidence and various misleading clinical manifestations, usually is a diagnostic pitfall in the modern emergency department. The most frequently seen symptoms and signs are fever, abdominal pain and tenderness over left upper quadrant, splenomegaly, leucocytosis, and left lower chest abnormalities. Four cases were collected during the past five years. On admission, one patient manifested symptoms mimicking a perforated peptic ulcer and the other three patients presented clinical and roentgenographic signs suggestive, but non-specific, for splenic abscess. In two cases, the diagnosis was based on sonography followed by computed tomography (CT). In one case, the splenic abscess was only visualized by CT. They all survived after splenectomy and appropriate antibiotic therapy. Culturing disclosed the offending organisms to be Escherichia coli, Pseudomonas aeruginosa, a Salmonella species, and Streptococcus viridans. These nonspecific clinical pictures should be thoroughly investigated, and CT, the most sensitive diagnostic tool, should be used whenever splenic abscess is suspected. Early diagnosis and timely treatment reduce the morbidity and mortality associated with splenic abscess.
脾脓肿发病率低且临床表现多样易误导诊断，在现代急诊科常成为诊断陷阱。最常见的症状和体征有发热、腹痛、左上腹压痛、脾肿大、白细胞增多及左下胸异常。过去五年收集到4例病例。入院时，1例患者表现出类似消化性溃疡穿孔的症状，另外3例患者的临床和影像学表现提示为脾脓肿，但不具有特异性。2例通过超声检查后行计算机断层扫描（CT）确诊。1例仅通过CT发现脾脓肿。经脾切除及适当抗生素治疗后，所有患者均存活。培养结果显示病原菌为大肠杆菌、铜绿假单胞菌、一种沙门氏菌和草绿色链球菌。对于这些非特异性临床表现应进行全面检查，怀疑脾脓肿时应使用最敏感的诊断工具CT。早期诊断和及时治疗可降低脾脓肿相关的发病率和死亡率。
