Splenic abscess - a changing trend in treatment

Fifteen patients with splenic abscesses were evaluated between 1985 and 199 5. The most common predisposing factors were remote infection, diabetes mel litus and heart disease. Common clinical presentations included leucocytosi s, fever, left upper quadrant abdominal pain and left pleural effusion. Fou r patients with splenic abscesses smaller than 4 cm in diameter were treate d with antibiotics alone, and 1 in this treatment group died. Among the 10 patients with splenic abscesses larger than 4 cm in diameter receiving perc utaneous drainage, 9 (90%) were successfully cured, including 8 with uniloc ular abscesses and 1 with multilocular abscesses. Two patients underwent sp lenectomy. In conclusion, percutaneous drainage using ultrasound or compute d tomography guidance may be recommended as the treatment of choice for spl enic abscess larger than 4 cm in diameter. Antibiotics alone may sometimes be considered for splenic abscesses smaller than 4 cm in diameter. Splenect omy is reserved for those cases where medical treatment has failed.