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Splenic abscess in the intensive care unit

H S Ho1, D H Wisner

  • 1Department of Surgery, University of California at Davis Medical Center, Sacramento.

Archives of Surgery (Chicago, Ill. : 1960)
|August 1, 1993
PubMed
Summary

Splenic abscesses can occur de novo in intensive care unit (ICU) patients, presenting a rare but serious condition. Unexplained high platelet counts and left pleural effusion in septic ICU patients may indicate this abscess.

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Abdominal Surgery

Background:

  • Splenic abscess is a rare clinical entity.
  • This study reports the first series of de novo splenic abscess cases in intensive care unit (ICU) patients.

Purpose of the Study:

  • To describe the characteristics, diagnosis, and outcomes of de novo splenic abscess in ICU patients.
  • To identify potential indicators for early diagnosis in this specific patient population.

Main Methods:

  • Retrospective case series of nine patients admitted to the ICU between 1980 and 1990 who developed de novo splenic abscess.
  • Analysis of clinical presentation, laboratory findings, diagnostic imaging (abdominal CT scans), causative organisms, treatment (splenectomy), and mortality.

Main Results:

  • All patients were septic prior to diagnosis; conventional symptoms were often unhelpful.
  • Significant thrombocytosis (platelet count increase) was observed.
  • Left pleural effusion was present in all cases; left upper quadrant tenderness was infrequent.
  • Abdominal CT scans were diagnostic.
  • Common causative organisms included enteric organisms, Staphylococcus aureus, and Streptococcus epidermidis.
  • Mortality rate was 45%.

Conclusions:

  • De novo splenic abscess in ICU patients is associated with high mortality.
  • Persistent left pleural effusion and unexplained thrombocytosis in septic ICU patients suggest splenic abscess.
  • Prior culture data aids in selecting appropriate antibiotics for perioperative management.

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