This is a report of our experience with 10 cases of splenic abscess in
patients with sickle cell disease (SCD). All presented with fever and
abdominal pain and were found to have a tender enlarged spleen. Two w
ere found to have a ruptured spleen and five of them were septicemic o
n presentation, Although both ultrasound and CT-scan of the abdomen we
re of diagnostic value, we found CT-scan more accurate and reliable in
the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be
used routinely in the evaluation of SCD patients who present with fev
er and abdominal pain, especially if they have a tender enlarged splee
n. Diagnostic aspiration under CT-scan or ultrasound guidance should b
e used in doubtful cases to differentiate between splenic abscess and
a large splenic infarct, All our patients were managed by peri operati
ve antibiotics and splenectomy with no mortality. Salmonella was the c
ommonest causative organism. Although CT-guided aspiration of splenic
abscess is being advocated recently, we feel splenectomy should be the
treatment of choice in patients with SCD as there is no point in pres
erving a nonfunctioning spleen that is present in the majority of pati
ents. CT-guided aspiration may be employed as a temporary measure for
those patients who are at high surgical risk with unilocular abscess.
(C) 1998 Wiley-Liss, Inc.