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Splenic Abscess (Drainage)

  • Posted on- Apr 16, 2018
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Antibiotics and splenectomy have traditionally been the recommended treatment for a splenic abscess. Splenic abscess is a very rare condition with an incidence of 0.3 to 0.8% in autopsy studies.

The clinical expression of an abscess is highly polymorphic. Its positive diagnosis is based on imaging the cure must be made in good time to ensure timely treatment which can be medical, interventional or surgical. The outcome of the treatment is usually favorable.

The abscess of the spleen is very rare but fatal in the absence of treatment. The incidence of splenic abscess condition after large series of the western autopsy is estimated to be up to 0.8%.

It is defined by the presence of one or more intraparenchymal or subcapsular collections of pus in the spleen. Its polymorphic symptomatology explains the difficulties of clinical diagnosis.

The diagnosis and treatment had been well known in the last century and has advanced in recent decades because of the development of medical imaging (such as CT, ultrasound etc.). Thus, the morbidity of spleen abscess has decreased greatly.

However, the need for splenectomy is now being questioned as the spleen has got important immunological functions such as prevention of infection.

Recent evidence has shown that percutaneous drainage of the splenic abscess is a safe and effective treatment modality for the splenic abscess.

Doctors reported a case of splenic abscess treated successfully by open drainage when percutaneous aspiration had failed.

Splenic abscess is an uncommon but potentially life-threatening disease. Earlier, splenectomy along with antibiotics was the established treatment for a splenic abscess.

However, recently there is a shifting trend towards drainage of splenic abscess either percutaneously under ultrasound guidance or by open drainage.

By this approach, splenectomy and its detrimental effects of increased chances of post-operative infections are prevented.

The doctors’ reported a case of a splenic abscess, which was successfully managed by open drainage with preservation of the spleen, after the attempts of ultrasound-guided percutaneous aspiration, had failed.

Splenic abscess is an uncommon surgical problem in the pediatric age group with 100% mortality if untreated. A splenic abscess may develop after generalized infection, hematological disorder and trauma.

The commonest cause is hematogenous seeding of the spleen from an infective focus elsewhere in the body. Infecting microorganisms include gram-positive bacteria, mycobacteria, fungi and anaerobes.

USG detects large abscesses easily but may miss the small abscesses. CT scan remains the gold standard for definitive diagnosis.

The standard treatment of splenic abscess has been splenectomy with antibiotics as it removes the complete focus of infection.

Recently, ultrasound-guided percutaneous aspiration of abscess has emerged as a safer alternative to splenectomy. This modality should be avoided in multiple or multiloculated abscesses and abscess due to contiguous infection.

In these cases where percutaneous drainage fails, open drainage is an alternate option, thereby preventing splenectomy and its dangerous effect of increased postoperative infections.

At first, the attempt of conservative treatment by intravenous antibiotics and percutaneous aspiration is made. On failure of percutaneous aspiration and no clinical response to the antibiotics, open drainage is done with preservation of the spleen.

In splenic abscess every attempt is to be made for splenic salvage and drainage of the abscess either percutaneously or operatively should be the preferred approach.


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