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[Splenic abscess. Apropos of 5 cases]
B Fall1, A Dansokho, D Tetimian
1Clinique Chirurgicale, C.H.U. de Dakar, Hôpital A. Le Dantec, Sénégal.
Abstract:
Spleen abscesses are infrequent, and are encountered in 0.4 to 0.7%-of the autopsy series. They are diagnosed late and their prognosis is poor. The authors report about 5 cases of spleen abscesses observed at Dakar's University Surgical Clinic over a period of 30 years. The patients were young adults, including one case of sickle-cell anemia. In spite of numerous clinical signs in all cases, the abscess was diagnosed late. In three patients, ultrasound allowed establishing the diagnosis and initiating percutaneous treatment, with no success in two cases. The procedure had consisted in total splenectomy in all cases. One patient died 2 months after surgery, after the evacuation of a hematoma in the splenic compartment. The other 4 patients, seen 7, 4, 3 months and 15 years after total splenectomy, no longer presented with any symptom. The authors emphasize the rarity of spleen abscesses; the fact that the diagnosis is often established late, in spite of the progress made in non-invasive medical imaging, including CT and ultrasound; the physiopathology, etiology and treatment of the disease, the latter still being surgical.
Insights
Spleen abscesses are rare but often diagnosed late, leading to poor prognoses. Surgical intervention, like splenectomy, remains the primary treatment, with most patients recovering well post-surgery.
Area of Science:
- Medicine
- Surgery
- Radiology
Background:
- Spleen abscesses are uncommon, with autopsy prevalence ranging from 0.4% to 0.7%.
- Delayed diagnosis and poor prognosis are characteristic of spleen abscesses.
Observation:
- A 30-year retrospective study at Dakar's University Surgical Clinic identified 5 spleen abscess cases.
- Patients were young adults, with one case of sickle-cell anemia.
- Despite varied symptoms, diagnosis was consistently delayed.
Findings:
- Ultrasound aided diagnosis in three patients, but percutaneous treatment failed in two.
- All patients underwent total splenectomy.
- One patient died post-operatively due to a splenic hematoma; four patients recovered fully after splenectomy.
Implications:
- Spleen abscess diagnosis remains challenging despite advances in imaging like CT and ultrasound.
- Surgical management, specifically splenectomy, is crucial for spleen abscess treatment.
- Early detection and prompt surgical intervention are vital for improving patient outcomes in spleen abscess cases.