Treatment of pyogenic splenic abscess: nonsurgical procedures

This paper reviews 10 cases of splenic abscess seen from January 1984 to December 1993. Predisposing conditions included preceding pyogenic infections, contiguous infection, trauma, and diabetes. Fever, chills and pain over the left upper quadrant of the abdomen were the most common symptoms. Routine laboratory tests uncovered common abnormalities which included marked leukocytosis and abnormal chest film with left pleural effusion. All 10 patients had a solitary abscess. Enterobacteriaceae and anaerobes were the most common offending organisms and one patient had polymicrobial infections. Nine of the 10 patients were successfully treated with percutaneous sonographically-guided drainage without significant complications. Only one patient underwent splenectomy because of rupture of the splenic abscess into the peritoneal cavity. All 10 patients survived. This review indicates that percutaneous drainage may replace splenectomy as the initial approach in cases of a solitary splenic abscess.