Jorge Enrique Barrón-Reyes1, Julio César Chávez-Galván1, Jesús Alejandro Martínez-Peralta1, Julio César López-Valdés2. 1. Hospital Regional «Licenciado Adolfo López Mateos», Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México. 2. Dirección General, Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México; Facultad de Medicina de Tampico «Dr. Alberto Romo Caballero», Universidad Autónoma de Tamaulipas, Tampico, Tamaulipas, México. Electronic address: jc.lopz@live.com.
Abstract
BACKGROUND: Splenic abscesses are rare entities; reports are commonly described in immunocompromised patients (72%) as: hematologic diseases, diabetes, endocarditis, acquired immunodeficiency syndrome, transplant patients and subjects who had abdominal trauma or splenic infarction. The main and most serious complication is the abscess rupture into the peritoneal cavity or adjacent organs (stomach or colon), which determines hemodynamic instability or septic state. CLINICAL CASE: Fifty-year-old man, who was admitted at Emergency Room due eight days' progressive, oppressive, and current pain; intensity 4/10, irradiated at hemi-back, which was higher intensity during the standing and decreased at supine position. It was accompanied by nausea and vomiting in two occasions. LABORATORY RESULTS: Hemoglobin 15.1g/dl, hematocrit 45.2%, platelets 176×103, 23.1×103 leukocytosis, neutrophils 92%. Simple abdominal radiographic studies revealed in 'ground glass' and radiopaque imagines. CONCLUSIONS: At presence of free air inside the abdominal cavity, is usually to think of a complicated diverticular disease, intestinal perforation or perforated peptic ulcer. The actual medical literature described very few cases of splenic abscess with pneumoperitoneum as cardinal manifestation. In our case, the splenic abscess was detected during exploratory laparotomy and only in retrospective the imaging studies were interpreted.
BACKGROUND: Splenic abscesses are rare entities; reports are commonly described in immunocompromised patients (72%) as: hematologic diseases, diabetes, endocarditis, acquired immunodeficiency syndrome, transplant patients and subjects who had abdominal trauma or splenic infarction. The main and most serious complication is the abscess rupture into the peritoneal cavity or adjacent organs (stomach or colon), which determines hemodynamic instability or septic state. CLINICAL CASE: Fifty-year-old man, who was admitted at Emergency Room due eight days' progressive, oppressive, and current pain; intensity 4/10, irradiated at hemi-back, which was higher intensity during the standing and decreased at supine position. It was accompanied by nausea and vomiting in two occasions. LABORATORY RESULTS: Hemoglobin 15.1g/dl, hematocrit 45.2%, platelets 176×103, 23.1×103 leukocytosis, neutrophils 92%. Simple abdominal radiographic studies revealed in 'ground glass' and radiopaque imagines. CONCLUSIONS: At presence of free air inside the abdominal cavity, is usually to think of a complicated diverticular disease, intestinal perforation or perforated peptic ulcer. The actual medical literature described very few cases of splenic abscess with pneumoperitoneum as cardinal manifestation. In our case, the splenic abscess was detected during exploratory laparotomy and only in retrospective the imaging studies were interpreted.
Authors: Efstathios T Pavlidis; Eirini K Martzivanou; Nikolaos G Symeonidis; Kyriakos K Psarras; Alexandra G Marneri; Kalliopi E Stavrati; Theodoros E Pavlidis Journal: J Surg Case Rep Date: 2021-04-13