Despite the fact that a splenic abscess is rarely encountered in clinical practice, the importance of early recognition lies in the fact that mortality rates are as high as 47% despite treatment, whereas virtually all patients die in the absence of proper therapy [1]. Many studies have confirmed that the presence of one or more comorbidities, such as diabetes mellitus, endocarditis, pancreatitis, liver disease, and various disorders causing immunosuppression (including human immunodeficiency virus infection and hematologic malignancies) predisposes to a poorer prognosis [2] [3] [4] [5]. A splenic abscess can be seen in patients of all ages, but middle-aged and older adults comprise the majority of cases [2] [3] [6] [7]. In addition, some reports have established a slight predominance toward male gender [2] [3] [4] [5]. The clinical presentation starts with a fever of unknown origin, sometimes with chills, that is accompanied by abdominal pain in the majority of cases [2] [6] [7]. Pain is usually confined to the upper left quadrant, but diffuse, as well as left chest wall pain, have been described in a significant number of cases [2] [3] [5] [7]. Nausea and vomiting are important constituents of the clinical presentation as well [2] [7]. Splenomegaly, although frequently present, is not always observed during the physical examination [5].

• Fever

  There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever. [ncbi.nlm.nih.gov]

  Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function. [mayoclinic.pure.elsevier.com]

• Malaise

  We describe the case of a 79-year-old man who presented with general malaise and a high fever. The physical examination findings were unremarkable. Of note, the lymph nodes were not enlarged. [ncbi.nlm.nih.gov]

  Common symptoms were fever (92.6%), abdominal pain (55.6%) and malaise (29.6%). Majority of patients (89%) had leukocytosis and 63% patients had associated diseases with which they were admitted. [ecommons.aku.edu]

  Specific symptoms of abdominal abscesses depend on the location of the abscess, but most people have constant discomfort or pain, feel generally sick (malaise), and often have a fever. [msdmanuals.com]

  Symptoms are malaise, fever, and abdominal pain. Diagnosis is by CT. Treatment is with drainage, either surgical or percutaneous. Antibiotics are ancillary. [merckmanuals.com]

• Weight Gain

  He completed the treatment for 6 months and had a weight gain of 13 kg during this period. [jacpjournal.org]

• Splenomegaly

  He was initially diagnosed as having splenomegaly due to Plasmodium vivax (P. vivax), but was later found to have a splenic abscess due to Escherichia coli (E. coli). This was successfully managed by catheter drainage (CD) and antibiotic treatment. [ncbi.nlm.nih.gov]

  Figure 1: (a) Abdominal CT scan demonstrates splenomegaly with multiple hypodense areas (white arrows). [ijmm.org]

  Abdominal contrast-enhanced computed tomography (CECT) showed mild splenomegaly with multiple patchily enhancing splenic space occupying lesions (SOLs), of which the largest measured 6.4 cm × 4.8 cm. [ccij-online.org]

• Massive Splenomegaly

  Splenic lymphoma with massive splenomegaly: Case report with review of literature. World J Clin Cases 2014;2:478-81. 8. Ahmann DL, Kiely JM, Harrison EG Jr, Payne WS. Malignant lymphoma of the spleen. [ccij-online.org]

  splenomegaly Reviewer: Jaleh Mansouri, M.D. [pathologyoutlines.com]

• Tender Spleen

  She had normal heart sounds, a palpable but non-tender spleen and was febrile. Investigations The chest X-ray on admission supported the clinical diagnosis of consolidation in the right middle and lower lobe. [casereports.bmj.com]

• Pleural Effusion

  The patient is unresponsive to treatment and manifests with fever, cough, dyspnea and pleural effusion. An abdominal CT shows splenomegaly, hypodensity in the ileum and inferior pole. [go.gale.com]

  Computerized axial tomography revealed left sided free flowing pleural effusion and splenomegaly with liquefaction and possible gas formation. The splenic fluid grew an unusual organism known as Bacteroides distasonis. [ncbi.nlm.nih.gov]

• Sputum

  The doctor might also use a device called a bronchoscope, a thin tube with a light and a camera on the end, to get samples of sputum or lung tissue for more tests if: Antibiotics aren’t helping. He thinks your airways are blocked. [webmd.com]

  Induced sputum and bronchoalveolar lavage were negative for acid-fast bacilli (AFB). Ultrasonography (USG) abdomen showed several hypoechoic foci in the spleen [Figure 1] a. [jacpjournal.org]

  Investigations showed a persistently raised ESR, a negative Mantoux Test, a negative smear of sputum for AFB. Stool examination showed no amoeba, cyst or ova. Casoni’s Test was negative. [jpma.org.pk]

  Dyspnea, cough, or sputum production may be attributed by the patient and caregiver to nicotine abuse, as most patients who abuse intravenous drugs are smokers. 54 Drug users have a 10-fold higher risk of contracting community-acquired pneumonia than [ahcmedia.com]

• Abdominal Pain

  Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function. [mayoclinic.pure.elsevier.com]

  Two days after admission he developed generalized abdominal pain and distension. Pain was not associated with vomiting. Patient was transferred to surgical unit for features of peritonitis. [ncbi.nlm.nih.gov]

  Fever, abdominal pain, nausea, vomiting, and a poor general condition in severe cases is the typical clinical presentation. [symptoma.com]

• Left Upper Quadrant Pain

  When such patients have fever and left upper quadrant pain, splenic abscess should be considered. [ncbi.nlm.nih.gov]

  We report a case of a 60-year-old female who presented with shortness of breath and left upper quadrant pain and was diagnosed with splenic abscess associated with colon cancer. This type of presentation necessitates an early surgical intervention. [gastrores.org]

• Upper Abdominal Pain

  Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function. [mayoclinic.pure.elsevier.com]

  He presented with left upper abdominal pain of three months' duration. The pain was dull, aching and non-radiating. There were no other associated features. Before this presentation, he was receiving oral steroids for a month. [ncbi.nlm.nih.gov]

  abdominal pain, fever, nausea, vomiting and anorexia. [16], [17], [18] The diagnosis should be suspected in a patient presenting with fever, upper abdominal pain, nonspecific chest findings and leukocytosis. [3] On physical examination, tenderness over [atmph.org]

• Left Flank Pain

  Splenic abscesses should be considered as a possible source of infection in patients presenting with unexplained fevers and left upper quadrant or left flank pain. [mja.com.au]

• Hypertension

  A 64-year-old woman with a medical history of morbid obesity, chronic hepatitis C, essential hypertension, multiple episodes of abdominal cellulitis, diabetes mellitus type 2 on insulin, intravenous and subcutaneous drug abuse presented to the emergency [ncbi.nlm.nih.gov]

  […] can happen without warning and which can be life-threatening Biliary complications, which can occur when a large cyst blocks the common bile duct, causing skin, mucous membranes, and whites of the eyes to appear yellow (obstructive jaundice) Portal hypertension [my.clevelandclinic.org]

  Examples include: a. in allergic reactive diseases: active rheumatism, polyarteritis nodose b. in non-allergic reactive diseases: malignant hypertension. Deposition of immune complexes & fibrin in arterial wall results in fibrinoid necrosis. [howmed.net]

  In our study three patients had diabetes, five patients had cardiovascular problems (hypertension, PAD, coronary artery disease, ischemic stroke ...) and one case was operated for a gastric cancer. [ghrnet.org]

• Tachycardia

  On examination, he was found to have a fever (temperature, 39.3°C), sinus tachycardia (heart rate, 154 beats/min), tachypnoea (respiratory rate, 28 breaths/min), hypotension (blood pressure, 97/66 mmHg), decreased breath sounds at the left base of his [mja.com.au]

  On physical examination, the patient was febrile with pallor and tachycardia. Per-abdominal examination revealed a tender splenomegaly without any other lump or ascites. [atmph.org]

  Tachycardia is usually present. The classic abdominal signs are tenderness on palpation, guarding and rebound tenderness. The tenderness will be maximal over the area of pathology. [patient.info]

  If patient present with sepsis : Hypotension Tachycardia Increased capillary refill time Signs of sepsis indicate that splenic abscess is most likely due to bacterial cause than fungal source. [3] Heart New onset murmur may be present Lungs Left sided [wikidoc.org]

  Failure of antibiotic treatment is indicated by deteriration in the condition of patient with increasing spikes of fever, marked tachycardia, localized guarding in the left hypochondrium and signs of overwhelming peritonitis. [jemds.com]

• Left Shoulder Pain

  We present a case of a 21-year-old woman admitted to the emergency department with the chief complaint of left shoulder pain related to splenic abscess. [ncbi.nlm.nih.gov]

  Case 2 A 35-year-old female obese patient underwent LSG. 75 days later, the patient was admitted to the hospital due to LUQ abdominal pain, left shoulder pain, and fever. [karger.com]

• Hematuria

  […] fistula, colovesical fistula, contamination, CR potpourri, Crohns disease, CT, cystogram, descending colon, diarrhea, diverticular disease, diverticulitis, drainage catheter, enterocutaneous fistula, fallopian tube, female, fistula tract, Foley catheter, hematuria [sages.org]

  There were no complaints of cough, dyspnea, hemoptysis, chest pain, headache, dysuria, hematuria, altered bowel habits, joint pains, and rash. Bowel and bladder habits were normal. [jacpjournal.org]

The life-threatening risk of a splenic abscess must be considered by the physician in the differential diagnosis of unexplained fever, upper left quadrant abdominal pain, and confirmed immunosuppression [7]. For this reason, a properly obtained patient history is of critical importance. Furthermore, a detailed palpation of the abdomen can aid in identifying the underlying cause. Auscultation of the lungs is very important, as both dullness and rales may be heard in the left basilar region [5]. The next step is a full laboratory workup where leukocytosis is a common finding [2] [3] [5]. Blood cultures or microbiological investigation of aspirated abscess material is recommended, and principal pathogens that have been identified in the literature include Gram-positive (Streptococci, Staphylococci, Enterococci) and Gram-negative (Enterobacteriaceae, Brucella, etc.) bacteria [4] [5] [7] [8] [9]. Imaging studies, however, are the cornerstone in solidifying the diagnosis. Abdominal ultrasonography, often chosen as the first-line study, can reveal solitary (or less commonly multiple) abscesses in the splenic parenchyma [1] [3] [4] [6]. Pleural effusions and infiltrations of the lower lungs are additional findings on ultrasonography, but also on plain radiography, although nonspecific findings are more common on a chest X-ray [5] [7]. Computed tomography (CT) is performed as a superior method to confirm an abscess in the spleen and is thus considered the gold standard of splenic abscess imaging [1] [3] [5] [10].

• Left Pleural Effusion

  It revealed evidence of left basal pneumonitis with pleural effusion and raised left hemidiaphragm ( Fig-1 ). In view of above findings, ultrasound examination of abdomen was carried out. [ncbi.nlm.nih.gov]

  X ray A plain abdominal radiograph can show a Soft tissue mass in the left upper quadrant, displacement of the gastric bubble, elevation of the left hemidiaphragm or a left pleural effusion.[3]. [explainmedicine.com]

  As a result, the pleural effusion observed is interpreted, as in this case, as a clinical sign of pneumonia, thus delaying the real diagnosis. [archbronconeumol.org]

  […] upper quadrant (33 patients), left pleural effusion and splenomegaly (both 27 patients), all of which were present in our patient. [mja.com.au]

  In a retrospective study of 75 cases, splenomegaly was found only in 41 cases. (2) Left pleuritic pain and reactionary left pleural effusion can be seen. Irritation of under surface of diaphragm can lead to left soulder tip pain or hiccoughs. [jemds.com]

• X-Ray Abnormal

  Abscesses near the diaphragm may result in chest x-ray abnormalities such as ipsilateral pleural effusion, elevated or immobile hemidiaphragm, lower lobe infiltrates, and atelectasis. CBC and blood cultures should be done. [merckmanuals.com]

• Enlargement of the Spleen

  Scudder laid great stress upon the action of polymnia uvedalia in enlargement of the spleen, and other observers have confirmed his conclusions, especially upon that form induced by chronic malaria. [henriettes-herb.com]

• Thrombocytosis

  Two months later he developed recurrent thrombophlebitis and fatal thromboembolism associated with thrombocytosis. [annals.org]

  Splenomegaly was present in 12 (67%), leukocytosis in 9 (50%), and thrombocytosis in 12 (67%) patients. Associated diseases were thalassemia (1), tuberculosis (1), and typhoid fever (9). Solitary and multiple SAs were seen in equal numbers. [ncbi.nlm.nih.gov]

  In cases of splenectomy, thrombocytosis occurs in more than 50% of cases. A very high platelet count (>1,000,000/μL) necessitates intervention to minimize the incidence of thrombotic complications. [emedicine.medscape.com]

  Peripheral blood film confirmed neutrophilia and thrombocytosis. This finding was persistent on repeated samples. The patient was treated for pneumonia with intravenous antibiotics as per hospital guidelines. [casereports.bmj.com]

• Neutrophilia

  Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is a hypersensitivity reaction with symptoms and laboratory findings of fever; neutrophilia; leukocytosis; an abrupt onset of tender, erythematous, and violaceous inflammatory [jaoa.org]

  Full blood count revealed a markedly raised white cell count of 90.4×10 9 /L (4.0–11×10 9 /L) and neutrophilia of 84.9×10 9 /L (2.0–7.5×10 9 /L). Peripheral blood film confirmed neutrophilia and thrombocytosis. [casereports.bmj.com]

  Investigations showed a white cell count of 16 × 10 9 /L (reference interval [RI], 4.0–11.0 × 10 9 /L), with a predominant neutrophilia (neutrophils, 14 × 10 9 /L [RI, 2.0–7.0 × 10 9 /L]). [mja.com.au]

• Lymph Node Hyperplasia

  General ========================================================================= Also called angiofollicular lymph node hyperplasia Usually no prominent splenomegaly Micro description ================================================================== [pathologyoutlines.com]

• Pleural Effusion

  The patient is unresponsive to treatment and manifests with fever, cough, dyspnea and pleural effusion. An abdominal CT shows splenomegaly, hypodensity in the ileum and inferior pole. [go.gale.com]

  Computerized axial tomography revealed left sided free flowing pleural effusion and splenomegaly with liquefaction and possible gas formation. The splenic fluid grew an unusual organism known as Bacteroides distasonis. [ncbi.nlm.nih.gov]

Prior to 1970, diagnosis was one of exclusion, and delay in treatment was frequent. Recently, diagnosis has been facilitated by splenic scintiscans, ultrasonography, and computerized axial tomography. [mayoclinic.pure.elsevier.com]

Antibiotics are inadequate as a sole treatment, and percutaneous drainage is usually only a temporary solution. Splenectomy is still the standard treatment in most cases. [ncbi.nlm.nih.gov]

Although splenectomy controls local splenic suppuration, the ultimate prognosis rests on the underlying process predisposing the patient to development of splenic infection. [mayoclinic.pure.elsevier.com]

But owing to imaging technique, diagnosis and prognosis have improved nowadays. [ijamhrjournal.org]

[…] one or more comorbidities, such as diabetes mellitus, endocarditis, pancreatitis, liver disease, and various disorders causing immunosuppression (including human immunodeficiency virus infection and hematologic malignancies) predisposes to a poorer prognosis [symptoma.com]

Splenic abscess is an uncommon entity in children, more so of tubercular etiology in immunocompetent patients. The few cases reported have usually revealed solitary abscesses in the spleen. [ncbi.nlm.nih.gov]

We could not find out the etiology and pathophysiologic mechanism of splenic abscess in our patient. [ijamhrjournal.org]

Etiology Intra-abdominal abscesses are classified as intraperitoneal, retroperitoneal, or visceral (see table Intra-Abdominal Abscesses ). Many intra-abdominal abscesses develop after perforation of a hollow viscus or colonic cancer. [merckmanuals.com]

The aim of this article is to review the pathogenesis, epidemiology, diagnostic modalities and methods of treatment for this disease. Different imaging modalities facilitate diagnosis, with computed tomography being the cornerstone. [link.springer.com]

Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol. 2005; 40 :914–20. 3. Sharma SS, Mamtani MR, Sharma MS, Kulkarni H. [tropicalgastro.com]

Epidemiology The incidence depends on the cause. In a hospital setting the prevalence of SBP is around 10%. [ 3 ] Three studies of patients with perforated appendicitis found an incidence of postoperative abscess formation of 20%. [patient.info]

Cheng AC, Currie BJ (2005) Melioidosis: epidemiology, pathophysiology, and management. ClinMicrobiol Rev 18:383-416. Rao PS, Dhawan R, Shivananda PG (2002) Burkholderiapseudomallei infections: case reports of five cases. Tropical Doctor 32:174-175. [acmicrob.com]

References 1 Clostridium difficile : recent epidemiologic findings and advances in therapy, Pharmacotherapy, 2007, vol. 27 (pg. 1029 - 39 ) 2 Biology of Clostridium difficile : implications for epidemiology and diagnosis, Annu Rev Microbiol, 2011, vol [academic.oup.com]

[…] diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment. for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology [allnurses.com]

We could not find out the etiology and pathophysiologic mechanism of splenic abscess in our patient. [ijamhrjournal.org]

Cheng AC, Currie BJ (2005) Melioidosis: epidemiology, pathophysiology, and management. ClinMicrobiol Rev 18:383-416. Rao PS, Dhawan R, Shivananda PG (2002) Burkholderiapseudomallei infections: case reports of five cases. Tropical Doctor 32:174-175. [acmicrob.com]

The pathophysiology of splenic abscesses is still poorly understood, it may be better defined by the progress of medical imaging, however, three hypotheses as to it origin are still discussed: Hematogenous: comes from other infective focus through blood [ghrnet.org]

The clinical presentation and management of this case is reported and comments are made on surgical aspects of SGV division during fundoplication to prevent this potentially dangerous situation. [ncbi.nlm.nih.gov]

Can a dental abscess be prevented? Most dental abscesses are preventable, as most are a complication of tooth decay or gum disease. Both of these can be prevented with good oral hygiene. Briefly, this means regular tooth brushing and flossing. [patient.info]

Primary Prevention Primary prevention for splenic abscess can prevent in specific cases especially patients who are at high risk such as immunocompromised patients (e.g. recipients of renal transplants or patients on immunosuppressive drugs for other [wikidoc.org]

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