SPLENIC ABSCESSES

Splenic abscesses are rare and account for only 2 to 5.4% of all intra -abdominal suppurations. Hematogenous dissemination during septicemia or endocarditis, infection of an infarct or post-traumatic hematoma, a nd spread of a neighboring infection are the mechanisms that can lead to development of a splenic abscess. Hemoglobinopathies, diabetes mell itus, and immune depression are the main risk factors. Clinical sympto ms are often inconspicuous and nonspecific, and until recently the dia gnosis was often established only upon autopsy. Painful enlargement of the spleen in a febrile patient should suggest a splenic abscess. The most common causative agents are Staphylococcus aureus, streptococci, and Gramnegative rods. Ultrasonography and computed tomography readil y demonstrate the abscess. and can be used to guide percutaneous aspir ation and/or drainage and to monitor the course. Percutaneous aspirati on or drainage with appropriate antimicrobial therapy usually ensures recovery. Splenectomy is indicated if percutaneous drainage fails.