Editing Splenic abscess


== '''Risk factors''' ==

* HIV AIDS
* Malignancy
* Septicaemia 
* Haemoglobinopathies
* IV drug use
* Prior splenic trauma
* Polycythaemia vera

== '''Aetiology''' ==

* '''Haematogenous''' (70%)
** Endocarditis
** Pneumonia
** Gastrointestinal perforation
** Arteriovenous malformation
** Osteomyelitis
* '''Local spread''' (30%)
** Infected peri-pancreatic collection
** Diverticulitis
** Pyelonephritis/renal abscess

== '''Microbiology''' ==

* Gram positive cocci and gram negative enteric organisms typically involved
* Consider fungi in immunocompromised patients

== '''Presentation''' ==

* Non-specific symptoms - vague abdominal pain, fever, peritonitis, pleuritic chest pain
* Splenomegaly is uncommon
* Unilocular in 70% of adults, and 30% of children

== '''Investigation''' ==

* CT is best, but can often also be seen on ultrasound

== '''Management''' ==

* Resuscitate and medically manage sepsis
* Find and treat underlying cause
* Treat with percutaneous drainage, local excision or splenectomy
** Unilocular - drainage and antibiotics
*** Drainage for unilocular abscesses has a pretty good success rate
** Multilocular - usually splenectomy, drainage of the left upper quadrant, and antibiotics. Can be done laparoscopically, but more commonly open.

== '''Prognosis''' ==

* Mortality 15-20% in previously healthy patients with single unilocular lesions, and up to 80% in immunocompromised patients with multifocal abscesses

[[Category:Spleen]]