AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the re...AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed. RESULTS： There were 41 males and 26 females with the mean age of 54.14-14.1 years. Multiple splenic abscesses （MSA） account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients （35.8%） had extrasplenic abscesses, with leading site of liver （34.6%）, Microbiological cultures were positive in 58 patients （86.6%）, with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus （GNB） infection predominated （55.2%）, with leading pathogen of Klebslella pneumoniae （22.4%）, followed by gram positive coccus （GPC） infection （31%）. Splenectomy was performed in 26 patients （38.8%）, percutaneous drainage or aspiration in 21 （31.3%）, and antibiotic therapy alone in 20 patients （29.9%）. Eventually, 12 of 67 patients expired （17.9 %）. By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC （P=0.036）. Patients with GNB infection （P=0.009） and multiple abscesses （P=0.011） experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 ex- pired patients （16.3±3.2） was significantly higher than that of the 55 survivals （7.2 ± 3.8） （P〈 0.001）. CONCLUSION： MSA, GNB infection, and high APACHE Ⅱ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.展开更多
This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed...This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure,which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy,with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure,and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma,synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected,careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless,no definitive conclusions can be drawn because of the small number of cases.展开更多
Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality a...Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy:intravenous ceftazidime, eradication therapy: oral trimethoprim-sulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.展开更多
Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon per...Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation.The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis.Splenic abscess has a high rate of mortality when it is diagnosed late.Computed tomography resolved any diagnostic doubt,and subsequent surgery confirmed the diagnosis.展开更多
Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper q...Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.展开更多
Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100%if left untreated.Splenic abscess is also rarely encountered as a complicatio...Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100%if left untreated.Splenic abscess is also rarely encountered as a complication of typhoid fever.We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive therapies.Another case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and appropriate antibiotics.Being a rare entity in clinical practice,splenic abscess has been poorly studied.Haemalogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries.In multiple or multiloeulated abscesses aspiration usually does not succeed,which happened in our case.Splenectomy remains the definitive choice of treatment.However,Ultra sonography(USG) or CT-guided aspiration may be tried in selective cases.展开更多
文摘AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed. RESULTS： There were 41 males and 26 females with the mean age of 54.14-14.1 years. Multiple splenic abscesses （MSA） account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients （35.8%） had extrasplenic abscesses, with leading site of liver （34.6%）, Microbiological cultures were positive in 58 patients （86.6%）, with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus （GNB） infection predominated （55.2%）, with leading pathogen of Klebslella pneumoniae （22.4%）, followed by gram positive coccus （GPC） infection （31%）. Splenectomy was performed in 26 patients （38.8%）, percutaneous drainage or aspiration in 21 （31.3%）, and antibiotic therapy alone in 20 patients （29.9%）. Eventually, 12 of 67 patients expired （17.9 %）. By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC （P=0.036）. Patients with GNB infection （P=0.009） and multiple abscesses （P=0.011） experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 ex- pired patients （16.3±3.2） was significantly higher than that of the 55 survivals （7.2 ± 3.8） （P〈 0.001）. CONCLUSION： MSA, GNB infection, and high APACHE Ⅱ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.
基金Supported by grant from the University of Cagliari, Italy
文摘This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure,which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy,with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure,and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma,synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected,careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless,no definitive conclusions can be drawn because of the small number of cases.
文摘Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy:intravenous ceftazidime, eradication therapy: oral trimethoprim-sulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.
文摘Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation.The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis.Splenic abscess has a high rate of mortality when it is diagnosed late.Computed tomography resolved any diagnostic doubt,and subsequent surgery confirmed the diagnosis.
文摘Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.
文摘Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100%if left untreated.Splenic abscess is also rarely encountered as a complication of typhoid fever.We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive therapies.Another case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and appropriate antibiotics.Being a rare entity in clinical practice,splenic abscess has been poorly studied.Haemalogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries.In multiple or multiloeulated abscesses aspiration usually does not succeed,which happened in our case.Splenectomy remains the definitive choice of treatment.However,Ultra sonography(USG) or CT-guided aspiration may be tried in selective cases.
