Introduction
A spleen abscess (or splenic abscess) occurs when bacteria or fungi from elsewhere in the body travel via the blood stream into the spleen tissue where they multiply.
Symptoms of spleen abscess
A spleen abscess can cause a fever and left upper abdominal pain. The physician often notices left chest pain. A pleuritic condition in the lining of the left lower lung cavity, called “pleurisy” can coexist. The pleurisy comes from irritation of the left diaphragm. On deep palpation the left upper abdomen is tender and spleen enlargement is palpable.
The physician will likely order some X-rays, which confirm a splenic enlargement. A CT scan will show the details of the splenic abscess and the displacement of the neighboring organs (colon, stomach, kidney, and elevated left-sided diaphragm). If a CT scan is not available, an ultrasound study would show a larger abscess of more than 2.5 cm (= 1 inch) in diameter. Blood cultures often would isolate the offending pathogen. Most commonly the lab result is a staphylococcus or streptococcus. But the Lab physician may find other bacteria such as anaerobes or Salmonella or the yeast bug Candida albicans. This travels with AIDS patients or with other immunocompromised patients. Other blood tests also show signs of an infection because of a leukocytosis.
Treatment of spleen abscess
Like with any other abscess, the pus has to be drained and the infection needs to be treated with appropriate antibiotics. Ignoring a spleen abscess will only lead to deterioration of the patient and eventual death of septicemia.
The surgeon will likely attempt a percutaneous (needle through the skin into the spleen) insertion of a catheter into the abscess cavity. The catheter is then hooked up to a vacuum for a period of time until the drain no longer produces pus and blood tests show that the infection has subsided. The original infection that lead to the spleen abscess on the first place also needs to be found and treated. Occasionally there is a subacute bacterial endocarditis where bacteria grow on degenerated heart valve leaves and are shed from time to time to distant organs such as the spleen. An artificial heart valve such as a porcine valve may have to be considered to prevent reoccurrence of other abscesses throughout the body.
References
1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada
2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.
3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.
4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.
5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.
6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.
7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
