Sawmiller C J, Dudrick S J, Hamzi M
Department of Surgery, St Mary's Hospital, Waterbury, Conn 06706, USA.
Arch Surg. 1998 Dec;133(12):1362-5. doi: 10.1001/archsurg.133.12.1362.
Patients with intra-abdominal processes that require prompt surgical intervention, including appendicitis, perforated viscus, ischemic bowel, volvulus, and bowel obstruction, often present with signs and symptoms of an acute abdomen. Several medical problems can mimic an acute abdomen. Overwhelming postsplenectomy infection is a life-threatening condition that can present with acute abdominal symptoms. The incidence of overwhelming postsplenectomy infection ranges from 1% to 25%, and is caused by Streptococcus pneumoniae in 50% of cases. Capnocytophaga canimorsus, a bacteria commonly found in dog saliva, accounts for less than 1% of cases. Overwhelming postsplenectomy infection has a rapidly deteriorating course that progresses to respiratory and renal failure, cardiovascular collapse, and death. The mortality associated with overwhelming postsplenectomy infection is 60% to 80%. Early diagnosis and institution of appropriate antibiotic therapy and supportive care is essential to improve patient outcome. A previously healthy woman who had undergone splenectomy secondary to trauma 11 years earlier presented with symptoms of an acute abdomen. A diagnosis of overwhelming postsplenectomy infection due to C canimorsus was made based on her peripheral blood smear and blood culture findings. Early aggressive care and antibiotic treatment resulted in a successful outcome for this patient with no long-term morbidity. This patient's clinical course demonstrates the importance of early diagnosis and treatment of overwhelming postsplenectomy infection.
患有需要及时进行手术干预的腹腔内疾病的患者，包括阑尾炎、脏器穿孔、缺血性肠病、肠扭转和肠梗阻，通常会出现急腹症的体征和症状。一些医学问题可能会模仿急腹症。脾切除术后暴发性感染是一种危及生命的疾病，可出现急性腹部症状。脾切除术后暴发性感染的发生率为1%至25%，50%的病例由肺炎链球菌引起。犬咬二氧化碳嗜纤维菌是一种常见于狗唾液中的细菌，病例占比不到1%。脾切除术后暴发性感染病程迅速恶化，会发展为呼吸和肾衰竭、心血管衰竭及死亡。与脾切除术后暴发性感染相关的死亡率为60%至80%。早期诊断并给予适当的抗生素治疗和支持性护理对于改善患者预后至关重要。一名11年前因外伤接受脾切除术的既往健康女性出现了急腹症症状。根据她的外周血涂片和血培养结果，诊断为犬咬二氧化碳嗜纤维菌引起的脾切除术后暴发性感染。早期积极的护理和抗生素治疗使该患者获得了成功的治疗结果，且无长期并发症。该患者的临床病程证明了早期诊断和治疗脾切除术后暴发性感染的重要性。
