Splenic Abscess in Immunocompetent Patients Managed Primarily without Splenectomy: A Series of 7 Cases

Splenic abscesses are rare in immunocompetent adults. Despite advances in diagnosis and treatment, these abscesses are still potentially life threatening. Various factors have been reported to predispose otherwise immunocompetent adults to splenic abscesses. Splenectomy was once considered the "gold standard" treatment. However, the trend is shifting to a conservative approach.

We describe seven cases of splenic abscess in immunocompetent adults, the cause of which ranged from tuberculosis to salmonella and was as rare as Plasmodium vivax. All the patients presented with fever (median duration = one month; range = one week to six years) and abdominal pain, and most also had weight loss. All patients were in their third to fifth decades of life. The patients were successfully treated with appropriate antibiotic therapy, after which they were clinically normal.

A microbiological diagnosis of splenic abscess is of utmost importance. In this series, all patients underwent percutaneous aspiration. This was performed under radiologic guidance (either ultrasonography or computed tomography). Only one patient required diagnostic splenectomy. Irrespective of whatever surgical or nonsurgical drainage measures are employed, appropriate antibiotic therapy is the cornerstone of management. The dose and duration of antibiotic therapy depend on the causative organism and its sensitivity pattern.