Splenic abscess

Introduction – The splenic abscess

The splenic abscess is relatively rare. As with liver abscesses, the cause is usually pathogens that have entered the bloodstream. Bacterial sources in the body that cause a splenic abscess can result from endocarditis, chronic tonsillitis or other chronic bacterial inflammation of the body. Another inflammatory pathway of a splenic abscess is the penetration of the pathogens from outside, e.g. after abdominal injuries resulting from an accident.

Diagnosis

Here too, in addition to the patient interview and physical examination, ultrasound is very important, as it can show the sonographic signs typical of abscesses.

Symptoms

As with the other abscesses, the inflammatory picture is in the foreground with a splenic abscess, which consists of chills, fever, increase of the signs of inflammation in the blood count. In the further course of the disease a septic full picture can develop, which can be life-threatening. This occurs especially if the abscess is seen and treated too late.

Complication

The abscess can break through with the pus flowing into the abdominal cavity, which is called an acute abdomen and is a life-threatening condition that must be treated immediately. The spleen is strongly perfused with blood and thus there is also the danger of a life-threatening bleeding in case of a perforation but also after surgical treatment of the spleen. Patients who have already suffered from endocarditis should definitely receive a prophylactic antibiotic cover to prevent the formation of an abscess.

Therapy and treatment

A splenic abscess is a serious disease which, if left untreated, leads to death within a very short time. For this reason, a rapid diagnosis and a rapid start of treatment are crucial for a positive outcome of the disease. First, the patient is administered antibiotic therapy to fight the infection underlying the splenic abscess.

In addition, the splenic abscess can be punctured and the purulent secretion drained. The drainage is inserted either surgically or nowadays mainly CT-guided. In severe cases it may be necessary to surgically remove parts or all of the spleen (partial splenectomy or splenectomy).

Life without a spleen is quite possible, since the spleen is not a vital organ. However, since the spleen is an important organ of the immune system, patients after a splenectomy have an increased risk of developing sepsis (blood poisoning). This clinical picture is known as OPSI syndrome (overwhelming post-splenectomy infection).

Initially, conservative treatment with antibiotics can also be attempted. If this does not work, a surgical drainage with wound irrigation of the abscess cavity is necessary. In severe cases the spleen must be removed completely (splenectomy).

In order to diagnose a splenic abscess, the physician may perform an ultrasound examination, among other things. This is a non-invasive method in which a sonographic device is used to scan the spleen lying in the upper abdomen via the abdominal wall and to display it in a 2D image. The abscess can be clearly distinguished from the healthy spleen tissue by its capsule of connective tissue, which appears as a white structure in the ultrasound, and the dark cavity underneath.

Sonography can be used to determine the location of the abscess in the spleen. In addition, the size can be precisely measured with the aid of the device. A splenic abscess can be visualized by computer tomography (CT).

The advantages of CT are that the examination has a high contrast, which allows the internal organs to be depicted very well. The CT is prepared within a few minutes, but the examination is associated with a certain radiation exposure for the patient. With the help of a CT, controlled puncture and drainage of the abscess on the spleen can also be performed.

This method reduces possible complications, such as the malfunctioning of neighboring organs, and enables successful treatment. As an alternative to surgical removal of the entire spleen, the physician may consider puncturing the abscess followed by drainage of the secretion. In the past, drainage of the splenic abscess was performed as part of a surgical procedure.

Today, CT-guided percutaneous drainage of the abscess cavity is considered the standard therapy.The splenic abscess is punctured through the skin and the purulent secretion is drained through a drain. The simultaneous control by means of CT allows the exact localization of the abscess and reduces the risk of a malfunction.