Spleen abscess is a limited accumulation of purulent exudate in the spleen from the surrounding tissues. The disease is characterized by increasing weakness, fever, nausea and vomiting. Pain sensations are localized in the left hypochondrium, radiate to the left half of the body, and increase when breathing. Diagnostics includes a surgeon’s examination, ultrasound or CT of the spleen, an overview radiography of the abdominal cavity, a blood test. Abscess refers to an emergency surgical pathology and requires urgent surgical intervention against the background of detoxification and antibacterial therapy. Percutaneous drainage of the abscess or removal of the spleen together with the focus of inflammation is performed.
ICD 10
D73.3 Splenic abscess
General information
An abscess of the spleen is a separate cavity filled with purulent contents. In abdominal surgery as an independent pathology occurs in 0.5-1% of cases. The disease often occurs a second time with suppuration of hematomas and spleen infarctions, with metastasis of infection from other organs through the bloodstream. Single abscesses can reach gigantic sizes, contain up to 3-5 liters of pus. Multiple ulcers in the spleen have a multicameral structure, are small in size, but tend to merge to form one large purulent cavity. Abscesses can be located in one of the poles of the spleen or occupy the entire area of the organ.
Causes of spleen abscess
Among the pathogens of the purulent process in spleen abscess, salmonella, streptococci, staphylococci predominate. Rarely pathogenic microflora is represented by gram-negative bacteria and fungi. The main causes leading to the formation of ulcers include:
- Infectious diseases. Generalization of the infectious process in malaria, typhoid and recurrent typhus, scarlet fever, diphtheria causes the formation of purulent foci in organs and tissues, including in the spleen.
- Injuries of the spleen. Bruises and injuries of the organ, occurring without rupture of the capsule, are accompanied by accumulation of blood under the shell. In these cases, an abscess occurs due to suppuration of the hematoma.
- The spread of purulent infection from other foci. The penetration of infection into the spleen by hematogenic path occurs in purulent-inflammatory diseases of other organs and systems (septic endocarditis, osteomyelitis, sepsis, pyelonephritis, cystitis). With cancer or stomach ulcer, left-sided paranephritis, abscesses of the abdominal cavity, there is a contact transition of pathogenic flora to the spleen.
- Echinococcosis of the spleen. An abscess can form due to the accumulation of echinococcus larvae in the lienal tissue and suppuration of a parasitic cyst of the spleen.
- Spleen infarction. As a result of thrombosis, embolism or prolonged spasm of the splenic arteries, acute ischemia and necrosis of part or all of the organ occur. Infection of the affected area leads to the development of an abscess.
The formation of an abscess is facilitated by diseases accompanied by a decrease in immunity (sickle cell anemia, chronic lymphocytic leukemia, leukemia, HIV infection).
Pathogenesis
The introduction of microbial pathogens into the spleen in most cases occurs through the bloodstream, less often – with direct injury to the organ or contact (with neighboring anatomical structures). Pathogens or purulent emboli settle in sinusoidal capillaries, where they multiply, causing the formation of an inflammatory infiltrate with necrosis phenomena.
As the focus of inflammation melts, an abscess cavity is formed, filled with fetid chocolate-colored pus or the color of “meat slops” with inclusions of splenic tissue sequesters. Cavities can have different sizes, structure and localization. When the abscess is located in the zone of the upper pole of the spleen, a reaction from the pleura is noted: pain in the left half of the chest, reactive pleurisy. The lower-polar localization of the abscess causes soreness in the left hypochondrium and tension of the abdominal muscles.
Symptoms of spleen abscess
The clinical picture is variable, it depends on the scale of the lesion and the localization of the purulent focus. The pathological process can have a pronounced character and rapid development. In this case, the course of the disease is characterized by pronounced weakness, an increase in body temperature (up to 39-40 ° C), chills, dizziness. Dyspeptic phenomena occur (nausea, vomiting, diarrhea).
Painful sensations of varying intensity are localized in the area of the left hypochondrium, often radiate into the left shoulder blade, arm, collarbone and intensify when breathing. With a large size of the abscess, there may be a protrusion of the abdominal wall on the left, splenomegaly. Abscessing can occur without specific signs and have an erased clinical picture. The breakthrough of the abscess is accompanied by peritoneal symptoms (adynamia, cold sweat, acrocyanosis, defiance of the abdominal wall muscles).
Complications
When the abscess of the spleen comes into contact with the loops of the intestine, fistulas form, which cause intestinal bleeding. The rupture of the abscess is accompanied by the ingress of purulent contents into the abdominal cavity and the development of spilled peritonitis. The penetration of pathogenic bacteria into the bloodstream causes sepsis. In rare cases, an abscess is opened into the lumen of the bronchi, stomach, intestines, followed by the release of purulent masses outside. When the purulent contents enter the pleural cavity, pleural empyema develops.
Diagnostics
Due to the variability of the clinical picture and the frequent absence of specific symptoms, the diagnosis of a spleen abscess causes difficulties. If a pathology is suspected, the following examinations should be carried out:
- A survey, an examination. It includes the study of the anamnesis of life and disease, physical examination (palpation, auscultation of the abdomen). During the examination of the surgeon, soreness in the hypochondrium on the left is revealed, an enlarged spleen is palpated.
- Instrumental diagnostics. First of all, an ultrasound of the spleen is performed, during which the abscess is defined as a hypoechoic or anechoic rounded shadow. On an overview radiography of the abdominal cavity, a darkening is visualized under the diaphragm on the left. Computed tomography (CT of the spleen) allows you to get accurate information about the size, localization of the abscess, additional formations and effusion in the abdominal or pleural cavity. Radionuclide scintigraphy (with citrate 67Ga) is performed to identify the focus of inflammation.
- Blood test (biochemistry). Non-specific types of research that determine the presence of an inflammatory process in the body. With an abscess in the blood test, leukocytosis with a shift of the leukocyte formula to the left, anemia, hypoproteinemia is noted.
Differential diagnosis of an abscess is carried out with acute inflammatory diseases of neighboring organs: left-sided paranephritis, inflammation of the descending colon and sigmoid colon (colitis, sigmoiditis), subdiaphragmatic abscess on the left. Hematomas and spleen infarctions are accompanied by similar symptoms. The breakthrough of the abscess is differentiated with a perforated ulcer, pancreatic necrosis and peritonitis of another genesis.
Treatment of spleen abscess
Treatment is carried out by specialists in the field of abdominal surgery. Upon confirmation of the diagnosis, urgent intervention is indicated. The tactics of surgical treatment depends on the localization and size of the purulent focus, the presence of complications and the general condition of the patient. Currently , the following types of surgical tactics are used:
- Percutaneous drainage and sanitation of the abscess. Under the control of ultrasound, the purulent contents are removed with a puncture needle and drugs are injected into the cavity of the abscess. To determine the pathogenic microflora, the resulting pus is examined. Manipulation is performed with single abscesses up to 4-5 cm and contraindications to laparotomy (severe somatic condition of the patient, diseases of the blood coagulation system).
- Splenectomy with revision of the abdominal cavity. Surgical removal of the spleen together with the abscess is carried out with large single or multiple ulcers, ineffectiveness of minimally invasive methods of treatment, the development of bleeding and peritonitis. In some cases, autotransplantation is performed with the return of part of the organ to the abdominal cavity to preserve immune function.
The choice of an operative approach depends on the location of the spleen abscess. Localization of the abscess in the upper part of the organ involves transthoracic access, in the lower part – transperitoneal. All patients in the postoperative period are prescribed antibacterial and painkillers. In case of a breakthrough of the abscess, massive anti-inflammatory and detoxification therapy is additionally indicated. During the rehabilitation period (1-2 months), you should refrain from playing sports, heavy physical activity, taking hot baths.
Prognosis and prevention
The prognosis for spleen abscess depends on the size of the abscess and the presence of complications. With timely surgery and competent postoperative care, the prognosis of the disease is satisfactory. Patients can switch to their usual routine after 2 months. The breakthrough of the abscess, the development of peritonitis and bacteremia lead to a sharp deterioration of the condition up to coma. Untimely treatment in 100% of cases leads to death.
Prevention of spleen abscess is aimed at timely diagnosis of diseases that serve as a pathogenetic and morphological basis for the formation of an abscess. Patients should not ignore the symptoms of the disease, and if they occur, consult a doctor in a timely manner.
