Large Splenic Abscess Research Articles

S3084 Metastatic Pancreatic Tail Adenocarcinoma Presenting With Multiple Hepatosplenic Abscesses: A Case Report

Introduction: Pancreatic cancer is the third leading cause of cancer-related deaths in the United States. It is often detected in advanced stages and may present in unusual ways such as pyogenic liver abscesses (PLA) or splenic abscesses which may be a diagnostic and therapeutic challenge. Case Description/Methods: A 78-year-old dialysis-dependent man with a history of end stage renal disease, hypertension and cerebrovascular accident was evaluated for diffuse abdominal pain and altered mental status for one day. The examination was pertinent for generalized weakness and altered sensorium. Laboratory tests revealed transaminitis and leukocytosis. Computed tomography (CT) of the abdomen and pelvis showed multiple hypoattenuating hepatic foci with hepatosplenomegaly. A set of blood cultures grew Clostridium inoculum. A pyogenic liver abscess was diagnosed, drained percutaneously and the culture grew pansensitive Escherichia coli. A follow up CT of the abdomen and pelvis revealed a large splenic abscess. Exploratory laparotomy, splenectomy, liver biopsy and peritoneal lavage were performed. Immunostaining of the sample was positive for CK7, CK20 and CDX2. Pancreaticobiliary adenocarcinoma metastatic to the spleen and liver was confirmed by pathology. CA 19-9 and CA 125 were elevated. A repeat CT of the abdomen with pancreatic protocol showed a pancreatic tail mass. Vancomycin resistant Enterococcus faecium grew on peritoneal fluid culture. Daptomycin and ceftriaxone were started. The patient improved clinically but he was deemed unsuitable for further invasive procedures or chemotherapy. (Figure) Discussion: Uncommon presentations of pancreatic adenocarcinoma include gastrointestinal (GI) bleeding from metastasis and acute abdomen from splenic infarct. PLA is associated with GI malignancies including pancreatic cancer. Some experts recommend cancer evaluation for GI malignancies in patients with PLA. Mucosal barrier breach by cancer cells, translocation of bacteria into the circulation and inoculation at metastatic sites are possible explanations for developing liver and splenic abscesses. Dialysis is also a risk factor for hepatosplenic abscess. In an elderly patient with hepatosplenic abscess and elevated tumor markers, a thorough evaluation for GI malignancies including pancreatic cancer should be done.Figure 1.: Image 1 shows cancer in the spleen. Images 2-3 show positive immunostains for CK7 in image 2, CK20 in image 3. Image 4 shows the cancer in the liver biopsy (no normal liver is present). Image 5 shows non-enhancing hypoattenuated foci in the right and left lobes of the liver most consistent with multifocal liver abscesses. Image 6 shows splenomegaly with multiple hypoattenuated foci and a mass within the tail of the pancreas.

A salmonella: A rare cause of splenic abscess

Splenic abscess is a rare entity which often goes unrecognised. Only few cases are reported in literature. Often the clinical presentation is non-specific. We report a case of a 15yr old male who presented with fever, left-sided upper abdominal pain and leukopenia. Ultrasonography and Computerised Tomography of the abdomen revealed large splenic abscess. Ultrasound guided percutaneous drainage of the abscess was performed. Culture of the aspirated material was positive for Salmonella enterica serotype typhi and the patient’s condition improved after being treated with appropriate antibiotics. Proper clinical, radiological and microbiological evaluation is very much necessary in dealing with rare cases and for resolution of the symptoms of the patient.

Surgical management of splenic abscess complicated by pleural effusion in rural setting: A case report from rural Indonesia.

Introduction and importanceSplenic abscess is a potentially life-threatening disease. Antibiotics along with surgery are the gold standard therapy. We present a case of splenic-salvaged surgical management of a large splenic abscess in a rural setting, complying with the available resources.Case presentationA 35-year old female presented to the ER with a history of left hypochondrium pain and fever for seven days. Abdominal tenderness at the left hypochondrium with an enlarged spleen was found. Laboratory tests showed severe anemia, leukocytosis, and thrombocytosis. Chest X-ray suggested pulmonary tuberculosis with minimal left pleural effusion. Ultrasound revealed a large unifocal splenic abscess. Antibiotics were administered. Simplified percutaneous drainage was performed, followed by open surgery abscess drainage. The patient showed a smooth recovery.Clinical discussionPulmonary tuberculosis finding in a patient with splenic abscess suggested the potential etiology which itself is a rare finding. Spleen preservation surgery along with antibiotics is preferable to retain immunologic functions. In the rural setting, like Indonesia, where a pig-tail catheter set is not available, a simplified abscess drainage procedure is feasible. In patients with poor conditions, laparotomy and splenectomy approaches would lead to higher mortality and morbidity rates. Chest tube insertion may not be necessary for minimal pleural effusion in a splenic abscess as it may resolve naturally along with the abscess recovery.ConclusionLarge splenic abscess can be managed by abscess drainage if the lesion is unifocal, in a view of the spleen being salvageable in patients with poor general conditions.

An unusual case of abdominal pain and splenomegaly in a paediatric patient

Fusobacterium species are members of the oral microbiota and have been found to cause a wide spectrum of opportunistic infections. We describe the case of a previously healthy teenager with a large splenic abscess secondary to Fusobacterium nucleatum, successfully managed with percutaneous drainage and intravenous antibiotics. Identification of the organism was achieved using anaerobic culture of the aspirated fluid and matrix-assisted laser desorption/ionization time of flight, later confirmed by 16S ribosomal RNA metagenomic sequencing of the fluid. Fusobacteria are typically associated with oropharyngeal infections but are very rarely implicated in splenic abscesses. Aerobic and anaerobic blood cultures should be drawn when an intra-abdominal infection is suspected in a paediatric patient, and empiric antimicrobial therapy should be administered with coverage for gram-positive, gram-negative, and anaerobic bacteria.

Successful treatment of a splenic abscess secondary to migrant metallic wires in a horse

SummaryThis case report discusses a successful partial splenectomy for treatment of a splenic abscess in a horse. A 2‐year‐old Thoroughbred colt was hospitalised 5 weeks after an episode of severe colic that was followed by gradual weight loss and anorexia, pyrexia for 5 days and dehydration on the day of referral. A large splenic abscess was identified ultrasonographically. Following initial medical treatment, an exploratory laparotomy was performed. Multiple adhesions were released and a partial splenectomy conducted to remove the abscess. Migrant metallic wires penetrating from the small intestine into the splenic parenchyma were found to be the cause for the adhesions and the abscess. This paper summarises the potential advantages of utilising a partial vs. a total splenectomy and highlights the potential complications of these surgical procedure in equines.

Metastatic involvement of the spleen by endometrial adenocarcioma; a rare asylum for a common malignancy: a case report

BackgroundMetastatic involvement of the spleen by solid tumors is a rare clinical entity; those coming from endometrial adenocarcinomas are exceptionally rare. Spleen is an uncommon site for metastatic deposits due to its specific anatomy and microenvironment. Typically, splenic metastasis from endometrial carcinomas present months to years after curative surgery, chemotherapy or radiotherapy. The most common complaint in symptomatic patients is abdominal pain localized to the left hypochondrium. Most however, are asymptomatic only to be picked up on vigilant routine ultrasonography or computerized tomography during follow up. We report the case of a 54-year-old woman who presented to us after 50 months of total abdominal hysterectomy and bilateral salpingo-oophorectomy for an endometrial adenocarcinoma. She had severe abdominal pain localized to the left hypochondrium as the presenting complaint. To the best of our knowledge, this is the 1st case to be reported from Pakistan with 14 cases reported prior to our report. All past cases report the endometroid variant of endometrial adenocarcinoma as the primary tumor and our patient was a victim to the same variant.Case presentationA 54-year-old, nulliparous widowed woman presented with severe abdominal pain in the left hypochondrium for the last 4 months. The pain radiated to the left shoulder and was exacerbated with deep breathing. She had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy done 50 months back for stage 1a endometroid endometrial adenocarcinoma. Clinical examination revealed tenderness in the left hypochondrium but no visceromeglay was appreciable. Ultrasonography and computerized tomography revealed a space-occupying lesion within the spleen with associated splenomegaly. Computed tomography further suggested a large splenic abscess however the patient did not have fever, vomiting or leukocytosis which are the hallmarks of a splenic abscess. A splenectomy was performed for her complaints. On histopathology a metastatic adenocarcinoma was identified consistent with the primary tumor. The tumor was CK7, CA-125 and epithelial membrane antigen positive (EMA). The patient was then referred for further chemotherapy.ConclusionFrom this case we conclude, that although very rare, the spleen is a potential site for metastasis in endometroid endometrial adenocarcinoma. Since most patients are asymptomatic, routine examinations and imaging can identify its presence and avoid complications. If the practice is employed with vigilance, we may expect the clinical event to be diagnosed more frequently. The standard treatment is a classic splenectomy followed by chemotherapy.

Left-sided Chest Pain and Hemoptysis as Atypical Presentation of Splenic Abscess

Introduction: We report a case of diverticular and splenic abscess in a 51-year-old male presenting with left-sided chest pain and hemoptysis. Case: A 51-year-old Caucasian male with a history of alcoholism and diverticulitis presented to the hospital with complaints of left-sided chest pain and cough for 4-5 days' duration. He had a 1-day history of hemoptysis as well. CT chest (Figure 1) showed a large splenic abscess centered in the splenic parenchyma with subphrenic extension. Also visualized was a left pleural effusion that appeared directly contiguous with the abscess. CT abdomen showed a large pericolonic abscess secondary to diverticulitis. Physical exam showed the patient to be afebrile with stable vital signs, tender left upper quadrant, and coarse breath sounds in left lower lobe. Initial labs were essentially within normal limits.Figure 1Discussion: Splenic abscess is a rare entity with frequency of 0.14-0.7% in autopsy series. It may lead to life-threatening hemorrhage, erosion into hilar vessels, rupture into the peritoneal cavity, leading to diffuse peritonitis. Clinical manifestations may include left upper quadrant abdominal pain, fever, nausea, vomiting, and anorexia. Our patient presented with chief complaint of left-sided chest pain and hemoptysis leading our initial differential towards cardiopulmonary etiology. Diagnosis was made when imaging studies were performed. Therefore this case suggests that clinical presentation for splenic abscess can be nonspecific. Diverse etiologies have been discussed in literature which includes infective endocarditis with systemic embolization. Also, hematogenous spread from infective focus elsewhere in the body such as pancreatitis, diverticulitis, retroperitoneal, and subphrenic abscess. In this case, we suspect splenic abscess resulting from hematogenous spread from antecedent diverticulitis. Our patient initially had percutaneous drainage placed but due to clinical deterioration, splenectomy was performed. Due to narrow therapeutic window and high mortality with delayed treatment, we hope to bring this rare entity to the attention of most clinicians.

Multiple Large Splenic Abscesses Managed with Computed Tomography-guided Percutaneous Catheter Drainage in Children

Splenic abscess is a rare finding in children. Splenectomy combined with broad-spectrum antibiotics has been the treatment of choice for multiple splenic abscesses. Herein, we report the case of a 14-year-old girl with multiple large splenic abscesses that were successfully managed after two image-guided percutaneous drainage procedures and administration of intravenous antibiotics. Initially, an abscess located at the periphery in the lower pole of the spleen was aspirated under ultrasound guidance. Finally, another abscess located near the hilum of the spleen was drained under computed tomography guidance. To the best of our knowledge, this is the first report of multiple large splenic abscesses treated with computed tomography-guided percutaneous drainage.

Spontaneous abscesses of the spleen in an immunocompetent adult: Case report and review of the literature

Introduction: Splenic abscesses are typically associated with bacterial endocarditis or a contiguous abdominal infection. In this case, our patient was diagnosed with splenic abscesses without having an identifiable source of infection. To our knowledge, this is one of the rare reported cases of spontaneous splenic abscesses in a non­immunocompromised host. Case Report: An 82­year­old male was admitted with fever and fatigue for two weeks and was found to have leukocytosis and two large splenic abscesses on imaging studies. Extensive work­ up revealed no evidence of hematogenous spread from an endovascular source, no septic emboli in other organs and no proof of local spread from an infectious origin within the abdomen. Conclusion: Our case introduces an

Percutaneous ultrasound controlled drainage of large splenic abscesses

Because of the rare incidence of splenic abscesses and bleeding, only a few cases are described in the literature on percutaneous drainage of splenic abscesses. We report on eight cases (three male, five female, average age 74.1 +/- 10.76 years) of percutaneous, sonographically controlled catheter drainage of large splenic abscesses. Percutaneous, sonographically controlled drainage of splenic abscesses was feasible in all eight cases in the last 5 years (trocar technique, drain: 12-16 F, abscess contents 70-750 ml). In seven of eight cases, therapy with percutaneous, sonographically controlled drainage of the splenic abscess and rinsing of the abscess cavity over several days was successful. In two cases, however, a recurrent abscess had to be drained repeatedly with sonographic control, and this was successful. In one case a colitis-related fistula prevented successful drainage of an infected subcapsular splenic hematoma. The following splenectomy, however, proved the infected hematoma to be completely drained. In this study there were no complications like bleeding, injury of pleura or colon. The advantages of percutaneous drainage are: the spleen is not removed; conservative therapy is beneficial, particularly in multimorbid patients with a high surgical risk; there is no transmission of bacteria; the method is safe and effective.

Endocarditis protésica y absceso esplénico causados por Clostridium clostridiformis

We report the first case of Clostridium clostridiformis endocarditis in a 71 year old man with an aortic prosthetic valve. He was febrile with left upper quadrant pain and left lower lobe infiltrate in chest X ray. The diagnosis was made by gram-positive bacilli grown from three blood cultures. Transthoracic and transesophageal echocardiogram showed a paraaortic abscess. A computed tomographic scan of the abdomen revealed a large splenic abscess. He received penicillin G 4 million units every 4 hours intravenously. A successful percutaneous drainage guided computed tomographic scan was performed. The patient remained febrile and a new computed tomographic scan of the abdomen revealed residual splenic abscess. A splenectomy was performed. The patient defervesced on the second day of surgery and remained afebrile during the remainder of his hospitalization. He has returned for medical follow-up and two years later the patient is asymptomatic.

IMO 1407 Percutaneous ultrasound-guided catheter drainage of large splenic abscesses

IMO 1407 Percutaneous ultrasound-guided catheter drainage of large splenic abscesses