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[Pneumoperitoneum due to splenic abscess: a diagnostic challenge. Case Report]
Emilio Peña-Ros1, Marcelino Méndez-Martínez1, María Vicente-Ruiz1
1Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
Background:
Splenic abscess is a rare clinic entity, its incidence has increased due to the rising number of clinical conditions involving immunosuppression. Endocarditis is the most frequent cause, and gram-positive aerobes are the main causal agents. Its clinical presentation is non-specific and delays diagnosis. Computed tomography scan is the method of choice, and the treatment is based on antibiotics and drainage, radiological or surgical, involving splenectomy in special cases that require it.
Clinical Case:
A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day.
Conclusions:
Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
Insights
Splenic abscess is a rare condition often diagnosed late. This case highlights its association with pneumoperitoneum, complicating diagnosis and necessitating splenectomy for ruptured abscesses.
Area of Science:
- Abdominal Surgery
- Infectious Diseases
- Radiology
Background:
- Splenic abscess incidence rises with immunosuppression.
- Endocarditis and gram-positive aerobes are common causes.
- Non-specific symptoms delay diagnosis.
Observation:
- A 55-year-old male presented with abdominal pain and fever.
- CT scan revealed pneumoperitoneum and peri-splenic bubbles.
- Laparotomy confirmed a ruptured splenic abscess with purulent peritonitis.
Findings:
- Splenectomy was performed due to abscess rupture.
- Fluid cultures were negative for microorganisms.
- Patient recovered and was discharged post-operatively.
Implications:
- Pneumoperitoneum associated with splenic abscess can mimic visceral perforation.
- Suspect splenic abscess with unexplained pneumoperitoneum.
- Splenectomy is often the treatment of choice for ruptured splenic abscess.
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