SPLENIC ABSCESS - PRESENTATION, DIAGNOSIS AND MANAGEMENT

Splenic abscess is infrequently encountered. This paper reports on the diagnosis and management of six cases from Southern Saudi Arabia. Common presenting features were diffuse abdominal pain and fever. Signs localized to left upper quadrant of the abdomen were present in only two patients. The difficulty of diagnosis is signified by the fact that two cases were overlooked during initial surgery. The computed tomographic (CT) scan was quite accurate in three cases while ultrasound was reliable in five patients. Known causes of splenic abscess were present in four of the six patients. Two patients had gangrenous bowel and one each had bacterial endocarditis and sickle cell trait. All patients were managed by perioperative antibiotics and splenectomy. Review of the literature shows that splenectomy remains the treatment of choice while CT-guided aspiration is being increasingly employed especially for the poor-risk patients with unilocular abscesses.