Septic shock due to splenic abscess, complicated by empyema, secondary to colosplenic fistula post-gastrojejunostomy procedure: a case report

Abstract

Background: Splenic abscess is a rare disease that can be due to many causes including infections or adnominal trauma and surgery. Complications of splenic abscess are fatal including septic shock which can be defined as sepsis leading to circulatory, cellular, and metabolic abnormalities, and the patient cannot maintain mean arterial pressure. Case Presentation: In this case, we report a 71-year-old male patient known to have diabetes mellitus, dyslipidemia, hypertension, and coronary artery disease. Past surgical history revealed that he underwent exploratory laparotomy and graham patch repair, followed by exploratory laparotomy with gastrojejunostomy. Patient has a history of deep venous thrombosis for 1 month on anticoagulant. He presented to the emergency department because of decreased level of consciousness. The patient appeared obtunded and pale, his blood pressure and oxygen saturation were low. Computed tomography (CT) pulmonary angiogram showed massive bilateral pleural effusion and abdominal CT showed splenic abscess and colosplenic fistula. Conclusion: Because splenic abscess secondary to previous abdominal surgeries is a rare condition, emergency physicians should have a high index of suspicion for such a rare phenomenon if they encounter severe sepsis or septic shock.