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