TAILIEUCHUNG - Chapter 121. Intraabdominal Infections and Abscesses (Part 8)

Splenic Abscesses Splenic abscesses are much less common than liver abscesses. The incidence of splenic abscesses has ranged from to in various autopsy series. The clinical setting and the organisms isolated usually differ from those for liver abscesses. The degree of clinical suspicion for splenic abscess needs to be high, as this condition is frequently fatal if left untreated. Even in the most recently published series, diagnosis was made only at autopsy in 37% of cases. While splenic abscesses may arise occasionally from contiguous spread of infection or from direct trauma to the spleen, hematogenous spread of infection. | Chapter 121. Intraabdominal Infections and Abscesses Part 8 Splenic Abscesses Splenic abscesses are much less common than liver abscesses. The incidence of splenic abscesses has ranged from to in various autopsy series. The clinical setting and the organisms isolated usually differ from those for liver abscesses. The degree of clinical suspicion for splenic abscess needs to be high as this condition is frequently fatal if left untreated. Even in the most recently published series diagnosis was made only at autopsy in 37 of cases. While splenic abscesses may arise occasionally from contiguous spread of infection or from direct trauma to the spleen hematogenous spread of infection is more common. Bacterial endocarditis is the most common associated infection Chap. 118 . Splenic abscesses can develop in patients who have received extensive immunosuppressive therapy particularly those with malignancy involving the spleen and in patients with hemoglobinopathies or other hematologic disorders especially sickle cell anemia . While 50 of patients with splenic abscesses have abdominal pain the pain is localized to the left upper quadrant in only half of these cases. Splenomegaly is found in 50 of cases. Fever and leukocytosis are generally present the development of fever preceded diagnosis by an average of 20 days in one series. Left-sided chest findings may include abnormalities to auscultation and chest radiographic findings may include an infiltrate or a left-sided pleural effusion. CT scan of the abdomen has been the most sensitive diagnostic tool. Ultrasonography can yield the diagnosis but is less sensitive. Liver-spleen scan or gallium scan may also be useful. Streptococcal species are the most common bacterial isolates from splenic abscesses followed by S. aureus presumably reflecting the associated endocarditis. An increase in the prevalence of gramnegative aerobic isolates from splenic abscesses has been reported these organisms often derive from a .

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