SPLENIC ABSCESS IN THE INTENSIVE-CARE UNIT

Background and Methods: From 1980 through 1990, nine patients develope d de novo splenic abscess during their stay in our intensive care unit (ICU), representing the first series of such reported cases. Results: All nine patients were septic prior to the diagnosis of splenic absce ss. The signs and symptoms of splenic abscess commonly described in th e literature were of little help in detecting this pathology in ICU pa tients. Mean +/- SD platelet count, however, increased significantly, from 274 X 10(9)/L +/- 50 X 10(9)/L at admission to 647 X 10(9)/L +/- 94 X 10(9)/L at diagnosis. At diagnosis, left pleural effusion was pre sent in all patients. Only three patients had detectable left upper qu adrant tenderness. Abdominal computed tomographic scans, when used, we re diagnostic in all cases. All patients were treated by splenectomy; eight had a solitary abscess. Six abscesses were caused by enteric org anisms, two by Staphylococcus au-reus, and one by Streptococcus epider midis. Eight patients (89%) had had the offending organism previously isolated from their blood or from another infected site. Mortality was 45%. Conclusions: Splenic abscess, although a rare clinical entity, d oes occur de novo in ICU patients and is associated with significant m ortality. Unexplained thrombocytosis in a septic ICU patient with pers istent left pleural effusion is suggestive of splenic abscess. Previou s culture and sensitivity results are useful in guiding perioperative antibiotic choices.