Splenic rupture in a patient with pelvic abscess and sepsis

A 49-year-old man underwent appendicectomy through a Lanz incision for necrotic appendicitis. He subsequently developed pelvic abscess in the postoperative period, which was drained under computed tomography (CT) guidance. The bacteriology of pus swabs taken during appendicectomy and abscess drainage revealed coliforms. Six days after appendicectomy, the patient had an acute collapse due to rupture of the spleen, which was treated by splenectomy. CT of the abdomen at the time of abscess drainage had confirmed a normal spleen. Histopathological examination of the spleen revealed nonspecific acute splenitis--red pulp congested and infiltrated with neutrophils complicated by rupture. We postulate the abdominal source of sepsis and associated inflammatory response as the cause for the splenic pathology and rupture.