[An unusual spleen abscess in a 13-year-old girl after appendectomy]

Spleen abscess is not frequent in children. It may be caused by haematogenous seeding of the spleen with bacteria from primary septic focus; by direct spread of infection from adjacent structures, or by secondary infection in an area of the spleen damaged by infarction, trauma or parasitic infestation. A 13-year-old girl with spleen abscess following appendectomy is presented. Uneventful appendectomy was followed by prolonged unexplained sepsis that could not be controlled with high intravenous doses of different antibiotics. One month after appendectomy, exploration of the postoperative wound, pericecal and Douglas region was done, but neither pus or intra-abdominal foreign body were found. Abdominal ultrasonography and Nuclear Magnetic Resonance (NMR) revealed multiple spleen abscesses in the upper pole and the hilus region 44 days after appendectomy. Splenectomy with left subphrenic space drainage was performed, and an accessory spleen, 29 x 12 mm, was left intact. Left subphrenic abscess was revealed by echosonography 10 days later (5 days after abdominal drain has been removed), and image-guided percutaneous abscess drainage was therefore performed. Continous irrigation of the abscess cavity with adequate antibiotic solution, through pigtail drain left in position, was installed for next 12 days until the wash out was clear and sterile. Drain was removed and the patient discharged. Four months after discharge the patient was asymptomatic.