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Splenic abscess--a changing trend in treatment.
1Department of Surgery, Veterans General Hospital, Taipei, National Yang Ming University, Taipei, Taiwan, Republic of China.
Summary
Percutaneous drainage is the preferred treatment for splenic abscesses larger than 4 cm, offering a 90% success rate. Antibiotics alone may be suitable for smaller splenic abscesses, while splenectomy is reserved for treatment failures.
Area of Science:
- Medical Imaging and Interventional Radiology
- Infectious Diseases
- Abdominal Surgery
Background:
- Splenic abscesses are rare but serious infections.
- Predisposing factors include remote infections, diabetes mellitus, and heart disease.
- Clinical presentation often involves fever, abdominal pain, and leukocytosis.
Purpose of the Study:
- To evaluate treatment outcomes for splenic abscesses.
- To determine the efficacy of different therapeutic modalities.
- To establish guidelines for managing splenic abscesses based on size.
Main Methods:
- Retrospective review of 15 patients with splenic abscesses treated between 1985 and 1995.
- Analysis of treatment strategies including antibiotics alone, percutaneous drainage, and splenectomy.
- Correlation of treatment success with abscess size and characteristics.
Main Results:
- Four patients with abscesses < 4 cm treated with antibiotics alone had one mortality.
- Nine of 10 patients (90%) with abscesses > 4 cm treated with percutaneous drainage were cured.
- Splenectomy was performed in two patients with refractory disease.
Conclusions:
- Percutaneous drainage guided by imaging (ultrasound or CT) is the treatment of choice for splenic abscesses > 4 cm.
- Antibiotic therapy alone can be considered for smaller splenic abscesses (< 4 cm).
- Splenectomy should be reserved for cases unresponsive to less invasive treatments.