eMedicine Specialties > General Surgery > Abdomen

Splenic Abscess: Follow-up

Author: Julian E Losanoff, MD, Associate Professor of Surgery, Wayne State University School of Medicine; Clinical Surgeon, Surgery Service, John D Dingell Veterans Affairs Medical Center
Coauthor(s): Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Contributor Information and Disclosures

Updated: Apr 14, 2009

Outcome and Prognosis

The natural history of untreated splenic abscess has not been studied prospectively. The lack of randomized studies does not provide a conclusive clinical algorithm for the condition. The published literature suggests that early diagnosis, individualized management, and increased experience with minimally invasive methods carry a potential for lower morbidity and mortality.

Future and Controversies

No prospective, randomized study is available to determine the most effective treatment for splenic abscess. The diversity of the patient population suggests the importance of patient selection to improve outcome.

CT scanning is currently considered the criterion standard for helping to establish the diagnosis of splenic abscess. Percutaneous, CT-guided drainage is a safe, minimally invasive, and successful treatment option that should be used as a spleen-conserving alternative to surgery in suitable patients.18

Available results from the use of laparoscopic splenectomy for splenic abscess have been appealing, suggesting that there is significant opportunity to further develop this method.25 Surgical splenectomy must currently be considered the most reliable treatment for this condition and must be considered if the other available, less invasive treatment methods fail.

 
Acknowledgments

This material is the result of work supported with resources and facility use at the JohnD. Dingell VeteransAffairsMedicalCenter, Detroit, Michigan.



More on Splenic Abscess

Overview: Splenic Abscess
Workup: Splenic Abscess
Treatment: Splenic Abscess
Follow-up: Splenic Abscess
Multimedia: Splenic Abscess
References
Further Reading
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References

  1. Reid SE, Lang SJ. Abscess of the spleen. American Journal of Surgery. 1954;88:912-917.

  2. Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol. Jan 21 2006;12(3):460-4. [Medline].

  3. Westh H, Reines E, Skibsted L. Splenic abscesses: a review of 20 cases. Scand J Infect Dis. 1990;22(5):569-73. [Medline].

  4. Al-Salem AH, Qaisaruddin S, Al Jam'a A, Al-Kalaf J, El-Bashier AM. Splenic abscess and sickle cell disease. Am J Hematol. Jun 1998;58(2):100-4. [Medline].

  5. Smyrniotis V, Kehagias D, Voros D, et al. Splenic abscess. An old disease with new interest. Dig Surg. 2000;17(4):354-7. [Medline].

  6. Schaberle W, Eisele R. [Percutaneous ultrasound controlled drainage of large splenic abscesses]. Chirurg. Jul 1997;68(7):744-8. [Medline].

  7. Fotiadis C, Lavranos G, Patapis P, et al. Abscesses of the spleen: report of three cases. World J Gastroenterol. May 21 2008;14(19):3088-91. [Medline].

  8. Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. Dec 22-29 1998;98(25):2936-48. [Medline]. [Full Text].

  9. Albanopoulos K, Archontovassilis F, Alexakis N, Pantelidaki A, Bramis C, Leandros E. Splenic abscess in a patient with Wegener's granulomatosis treated with laparoscopic splenectomy. Mt Sinai J Med. Nov 2006;73(7):1045-8. [Medline].

  10. Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. Feb 2004;37(1):39-44. [Medline]. [Full Text].

  11. Tung CC, Chen FC, Lo CJ. Splenic abscess: an easily overlooked disease?. Am Surg. Apr 2006;72(4):322-5. [Medline].

  12. Ulhaci N, Meteoglu I, Kacar F, Ozbas S. Abscess of the spleen. Pathol Oncol Res. 2004;10(4):234-6. [Medline].

  13. Villamil-Cajoto I, Lado FL, Van den Eynde-Collado A, Díaz-Peromingo JA. [Splenic abscess: presentation of nine cases.]. Rev Chilena Infectol. Jun 2006;23(2):150-4. [Medline].

  14. Iniguez A, Butte JM, Zuniga JM, et al. [Splenic abscesses. Report of seven cases]. Rev Med Chil. Jan 2008;136(1):38-43. [Medline].

  15. Liang JT, Lee PH, Wang SM, Chang KJ. Splenic abscess: a diagnostic pitfall in the ED. Am J Emerg Med. May/1995;13:337-43. [Medline].

  16. Alvi AR, Kulsoom S, Shamsi G. Splenic abscess: outcome and prognostic factors. J Coll Physicians Surg Pak. Dec 2008;18(12):740-3. [Medline].

  17. Klimpel V. [Does Kehr's sign derive from Hans Kehr? A critical commentary on its documentation?]. Chirurg. Jan 2004;75(1):80-3. [Medline].

  18. Moll R, Sailer M, Reith HB, Schindler G. CT-gesteuerte Drainagenbehandlung der Milz bei Abscessen und Hamatomen. Klinikarzt. June/2004;33:183-188.

  19. Volk M, Strotzer M. [Diagnostic imaging of splenic disease]. Radiologe. Mar 2006;46(3):229-43; quiz 244. [Medline].

  20. Legrand F, Lecuit M, Dupont B, et al. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis. Mar 1 2008;46(5):696-702. [Medline].

  21. Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients. World J Gastroenterol. Dec 7 2006;12(45):7341-5. [Medline].

  22. Ferraioli G, Brunetti E, Gulizia R, et al. Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis. Dec 11 2008;[Medline].

  23. Choudhury SR, Rajiv C, Pitamber S, et al. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg. Jan 2006;41(1):e53-6. [Medline].

  24. Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg. Jul 1997;174(1):87-93. [Medline].

  25. Carbonell AM, Kercher KW, Matthews BD, Joels CS, Sing RF, Heniford BT. Laparoscopic splenectomy for splenic abscess. Surg Laparosc Endosc Percutan Tech. Oct 2004;14(5):289-91. [Medline].

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Further Reading

Related eMedicine topics:
Candidiasis
Infective Endocarditis
Spleen, Trauma
Splenic Infarct
Splenic Rupture
Splenomegaly [Hematology]
Splenomegaly [Pediatrics: General Medicine]

Clinical guidelines:
Surgical treatment of disease and injuries of the spleen. Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society.  2004 Feb 21.  3 pages.  NGC:003836

Clinical trials:
Anticoagulation Post Laparoscopic Splenectomy
A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis (ATOM)

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Keywords

splenic abscess, spleen, abscess, splenectomy, spleen symptoms, spleen problems, spleen removal, endocarditis, spleen anatomy, spleens, spleen infection, splenic infarct, splenomegaly, abscess surgery, post splenectomy, removal of spleen, bacteremia, splenotomy

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Contributor Information and Disclosures

Author

Julian E Losanoff, MD, Associate Professor of Surgery, Wayne State University School of Medicine; Clinical Surgeon, Surgery Service, John D Dingell Veterans Affairs Medical Center
Julian E Losanoff, MD is a member of the following medical societies: American Society of Transplant Surgeons and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Medical Editor

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine
Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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