SPLENIC ABSCESS AND SICKLE-CELL DISEASE

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.