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Covert splenic abscess: a continuing challenge.

R A Pomerantz, F E Eckhauser, J W Thornton

    The American Surgeon
    |July 1, 1986
    PubMed
    Summary
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    Splenic abscess, a rare cause of sepsis, has high mortality, especially covert types. Overt splenic abscesses are treatable with splenectomy, while covert abscesses are often fatal due to multiple organ failure.

    Area of Science:

    • Medicine
    • Surgery
    • Infectious Diseases

    Background:

    • Splenic abscess is an uncommon cause of intra-abdominal sepsis.
    • High mortality rates are associated with splenic abscess, particularly silent or covert forms.

    Purpose of the Study:

    • To analyze the clinical presentation and outcomes of patients with overt versus covert splenic abscesses.
    • To compare the diagnostic challenges and treatment efficacies for different types of splenic abscess.

    Main Methods:

    • Retrospective analysis of clinical data from patients with splenic abscess over a thirty-year period.
    • Categorization of patients into overt (n=5) and covert (n=7) splenic abscess groups.
    • Comparison of patient demographics, etiologies, clinical features, diagnostic methods, and treatment outcomes.

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    Main Results:

    • Overt splenic abscesses (average age 44.5) presented with localized sepsis, diagnosed preoperatively in 80%, and had 0% mortality after splenectomy.
    • Covert splenic abscesses (average age 56.1) were associated with multiple organ failure, less common trauma etiology, and 86% mortality, often without timely diagnosis.
    • Solitary abscesses were characteristic of overt cases, while multiple abscesses were found in covert cases.

    Conclusions:

    • Splenic abscess presents a spectrum of disease, with solitary lesions being diagnosable and treatable via splenectomy.
    • Multiple abscesses, typically covert, are linked to multiple organ failure and high lethality.
    • The efficacy of splenectomy for covert splenic abscess remains undetermined.