Splenic Abscess Treatment & Management

Early supportive care and parenteral broad-spectrum antibiotics are of paramount importance while further diagnostic and therapeutic arrangements are made. [2]Antibiotic coverage should target the presumed bacterial strains. Medical management as the only treatment of selected splenic abscesses has been advocated in several studies but remains controversial. The published literature suggests that most patients in this category have contiguous infections in the abdomen; the mortality in this group has been reported to be approximately 50%.[14

Besides the more common organisms isolated from splenic abscesses, mycobacteria, Candida, and Aspergillus should also be considered; these organisms account for a small but significant number of splenic abscesses in patients who are immunocompromised. Fungal abscesses are known to respond more favorably to antifungal treatment, because they result more often from a disseminated infection

A retrospective multicenter French study of 10 pediatric and adult patients investigated the effect of corticosteroid therapy on individuals with symptomatic chronic disseminated candidiasis that persisted despite the administration of antifungal treatment.  In addition to finding evidence that corticosteroid therapy can effectively resolve the symptoms and inflammatory response associated with the infection, the study’s authors also reported that hepatosplenic microabscesses in the patients decreased or disappeared.

Surgical options

Invasive treatment of splenic abscess includes the following three options:

Percutaneous drainage

Percutaneous drainage is indicated for easily accessible uniloculated or biloculated abscesses with otherwise favorable features, as described previously, and also for surgical patients at very high risk who cannot tolerate general anesthesia or surgery. [3031 The procedure includes a risk of iatrogenic injury of the spleen, colon (splenic flexure), stomach, left kidney, and diaphragm.

Calcified walls of the abscess, the presence of other intra-abdominal cysts with intraluminal daughter cysts, and an origin from endemic areas (eg, the Mediterranean basin, Eastern Europe) should raise a suspicion for Echinococcus granulosus. [7Percutaneous drainage of such suppurative cysts increases the risk of hydatid seeding and anaphylaxis and is therefore contraindicated.

Other iatrogenic complications resulting from percutaneous drainage include hemorrhage, pleural empyema, pneumothorax, and enteric fistula. 

Splenectomy

Splenectomy has long been considered the standard treatment of splenic abscess. Depending on the patient population, open splenectomy has a mortality of 0-17% and a morbidity of 28-43%. [33 The procedure removes the septic source and the diseased organ. The surgeon can explore and manage coexisting septic collections.

Laparoscopic splenectomy is safe and effective in selected patients. It can be performed with no morbidity or mortality, and patients who have undergone the procedure reportedly have a shorter hospital stay.

Dr. Kareem

Source link