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Kawahara N, Kojima M, Morishita K. Pneumoperitoneum Caused by a Ruptured Splenic Abscess Mimicking Gastrointestinal Perforation: A Case Report. Surg Case Rep 2025; 11:24-0098. [PMID: 40356802 PMCID: PMC12066237 DOI: 10.70352/scrj.cr.24-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 03/24/2025] [Indexed: 05/15/2025] Open
Abstract
INTRODUCTION Splenic abscess is a rare but potentially life-threatening condition that can rupture, leading to pneumoperitoneum and symptoms that mimic gastrointestinal perforation in rare cases. This can significantly complicate accurate diagnosis and prompt treatment. A splenic abscess can become life-threatening by rupturing, which may cause diffuse peritonitis or sepsis. CASE PRESENTATION A 68-year-old man with uncontrolled diabetes presented with fever, chills, and abdominal pain. Initial evaluation at a previous hospital, including computed tomography (CT), suggested a lower gastrointestinal perforation, leading to his transfer to our facility. CT revealed a non-enhancing lesion with gas in the spleen and free intraperitoneal air; however, there was no clear evidence of gastrointestinal perforation. An emergency exploratory laparotomy was performed, which revealed purulent ascites and a ruptured splenic abscess without any gastrointestinal perforation. After thorough lavage to eliminate contamination, open abdominal management was initiated owing to a need for catecholamine support and an inability to completely rule out the possibility of gastrointestinal perforation. A second-look laparotomy confirmed that there was no further contamination or gastrointestinal tract perforation. Blood and abscess cultures revealed Escherichia coli, leading us to initiate targeted antibiotic therapy. The patient recovered successfully and was discharged on postoperative day 40 without any recurrence. Ruptured splenic abscess with pneumoperitoneum is rare and poses significant diagnostic challenges, particularly in patients with diabetes, owing to its clinical similarity to gastrointestinal perforation. This study highlights the utility of exploratory laparotomy and staged open abdominal management when gastrointestinal perforation cannot be ruled out. CONCLUSIONS Physicians should consider ruptured splenic abscesses in patients with pneumoperitoneum, particularly those with diabetes. Exploratory laparotomy with staged open abdominal management may represent an effective approach that facilitates safe monitoring and targeted treatment, thereby reducing the risk of fatal complications.
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Affiliation(s)
- Naoki Kawahara
- Trauma and Acute Critical Care Centre, Institute of Science Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Mitsuaki Kojima
- Trauma and Acute Critical Care Centre, Institute of Science Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Centre, Institute of Science Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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Inagaki K, Hashimoto M, Hashimoto N, Suzuki K, Koyanagi N, Kitahara R, Iimuro K, Suzuki A, Furusawa S, Tsuji M, Akahori T. Splenic abscess caused by Lancefieldella rimae successfully managed with percutaneous drainage and antibiotics: A case report. Radiol Case Rep 2024; 19:4818-4823. [PMID: 39228956 PMCID: PMC11367418 DOI: 10.1016/j.radcr.2024.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 09/05/2024] Open
Abstract
A 29-year-old man with diabetic nephropathy presented with fever and chills 4 days postdischarge following hospitalization for hyperglycemia. Abdominal computed tomography revealed a splenic abscess. Percutaneous drainage was performed, and intravenous meropenem was administered. Subsequent culture of the drained abscess identified Lancefieldella rimae. Based on the antimicrobial susceptibility results, the patient was switched to oral levofloxacin. This combined treatment led to the resolution of the abscess, with no recurrence after 6 months. This is the first case of a splenic abscess caused by L. rimae successfully managed by prompt percutaneous drainage and appropriate antibiotics.
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Affiliation(s)
- Koji Inagaki
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Chutoen General Medical Center, Shizuoka, Japan
| | - Nanako Hashimoto
- Department of Radiology, Chutoen General Medical Center, Shizuoka, Japan
| | - Kenji Suzuki
- Department of Clinical Laboratory, Chutoen General Medical Center, Shizuoka, Japan
| | - Norihito Koyanagi
- Department of Clinical Laboratory, Chutoen General Medical Center, Shizuoka, Japan
| | - Rie Kitahara
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Keita Iimuro
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Akira Suzuki
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Shin Furusawa
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Masashi Tsuji
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
| | - Toshiyuki Akahori
- Department of Nephrology, Chutoen General Medical Center, Shizuoka, Japan
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Çorbaci K, Gürleyik MG, Aktaş A. Splenic abscess: treatment options in a disease with high mortality. BMC Infect Dis 2024; 24:1222. [PMID: 39478455 PMCID: PMC11526607 DOI: 10.1186/s12879-024-10122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 10/25/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Spleen abscess is a rare and serious condition. Splenectomy and imaging-guided percutaneous catheter drainage (PCD) are the methods used in the treatment, but there is still a debate about the appropriate treatment for the patient. METHODS The results of 16 patients treated for spleen abscesses in our clinic between 2012 and 2021 were reviewed. The patients were divided into two groups according to splenectomy and PCD. RESULTS In the study, PCD was performed in 11 patients (68.75%), but three of these patients required splenectomy due to inadequate drainage. The patients who underwent splenectomy were significantly younger than the patients who underwent PCD (p < 0.05). One patient underwent PCD and 2 patients underwent splenectomy after PCD died. CONCLUSION Spleen abscess is a serious clinical picture that requires a multidisciplinary approach and is life-threatening. New clinical studies are needed for a treatment algorithm that will provide good results.
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Affiliation(s)
- Kadir Çorbaci
- General Surgery, Osmaneli Mustafa Selahattin Çetintaş State Hospital, Camicedit, İstanbul Cd. 60 / A, 11500 Osmaneli, Bilecik, Turkey.
| | - Meryem Günay Gürleyik
- Department of General Surgery, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Selimiye, Tıbbiye Cd No:23, 34668 Üsküdar, Istanbul, Turkey.
| | - Ayşegül Aktaş
- Department of General Surgery, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Selimiye, Tıbbiye Cd No:23, 34668 Üsküdar, Istanbul, Turkey
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4
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Jiang Y, Cheng C, Lin Y. Man with left-sided flank pain. J Am Coll Emerg Physicians Open 2024; 5:e13326. [PMID: 39421272 PMCID: PMC11483588 DOI: 10.1002/emp2.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/17/2024] [Indexed: 10/19/2024] Open
Affiliation(s)
- Yu‐Xuan Jiang
- Department of Emergency MedicineTaoyuan Armed Forces General Hospital, National Defense Medical CenterTaoyuanTaiwan (ROC)
| | - Chun‐Gu Cheng
- Department of Emergency MedicineTaoyuan Armed Forces General Hospital, National Defense Medical CenterTaoyuanTaiwan (ROC)
- Department of Emergency MedicineTri‐Service General Hospital, National Defense Medical centerTaipeiTaiwan (ROC)
| | - Yen‐Yue Lin
- Department of Emergency MedicineTaoyuan Armed Forces General Hospital, National Defense Medical CenterTaoyuanTaiwan (ROC)
- Department of Emergency MedicineTri‐Service General Hospital, National Defense Medical centerTaipeiTaiwan (ROC)
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5
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Wang W, Zhai WH, Zhang Y, Tao L, Li Y, Jiang TX, Zhang JP. Splenic abscess secondary to COVID-19 acute infection: A case report and literature review. Medicine (Baltimore) 2024; 103:e39194. [PMID: 39093790 PMCID: PMC11296440 DOI: 10.1097/md.0000000000039194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Splenic abscess is relatively rare in clinical practice as an invasive disease. However, during the continuous prevalence of coronavirus disease 2019 (COVID-19), the incidence rate of splenic abscess showed an upward trend. However, because the etiology of splenic abscess is not specific, it is easy to be covered by the respiratory symptoms of COVID-19, resulting in omission or delay in diagnosis. If splenic abscesses cannot be treated in a timely manner, the mortality rate can reach 100%. Therefore, it is important to fully understand the correlation between COVID-19 and the development of splenic abscesses. PATIENT CONCERNS A female patient, 71 years of age, was admitted to our hospital because of cough and sputum for 1 week and fever for 2 days. According to the positive results of novel coronavirus nucleic acid and chest computed tomography, novel coronavirus pneumonia was diagnosed. On the 4th day after treatment, abdominal distension and vomiting were observed. Abdominal ultrasound indicated splenomegaly and mixed echo masses in the spleen and abdominal computed tomography indicated 2 new round low-density lesions were found in the spleen. DIAGNOSES The patient was diagnosed with secondary splenic abscess after COVID-19 infection. INTERVENTIONS The patient and her family members refused to undergo ultrasound-guided splenic puncture drainage and splenectomy. In terms of treatment, she was given meropenem combined with vancomycin to continue anti-infection treatment. OUTCOMES The patient's body temperature and infection indicators gradually increased, and the scope of splenic abscess continued to expand. The infection worsened and progressed to septic shock. The patient abandoned rescue drugs and invasive treatment, and died on the 9th day after admission. LESSONS This case introduces the clinical characteristics of secondary splenic abscess caused by COVID-19 from the aspects of etiology, disease course, clinical manifestations, auxiliary examinations, and treatment methods. The focus is on improving the understanding of clinical doctors about secondary splenic abscesses caused by COVID-19, providing reference for early diagnosis and timely treatment.
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Affiliation(s)
- Wei Wang
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Wen-Hui Zhai
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Ying Zhang
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Li Tao
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Yun Li
- Emergency Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Tong-xue Jiang
- Outpatient Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
| | - Jin-ping Zhang
- Medical Department, 305 Hospital of People's Liberation Army, Beijing, People’s Republic of China
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Tooza S, Lee N. A Splenic Abscess in a Trauma Setting: A Case Report and Comprehensive Literature Review. Cureus 2024; 16:e54866. [PMID: 38405653 PMCID: PMC10894503 DOI: 10.7759/cureus.54866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 02/27/2024] Open
Abstract
A splenic abscess is rare after trauma, and it has been reported with high mortality rates. Treatment options include antibiotics, percutaneous pigtail drain, or surgical intervention; however, there are no specific guidelines for the treatment of splenic abscesses in trauma settings. We report a 69-year-old male who came in with a splenic abscess after angioembolisation for a splenic laceration after having a right hemicolectomy. Our case presents new information and current recommendations for the management of splenic abscesses based on a comprehensive literature review.
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Affiliation(s)
- Salam Tooza
- General Surgery, John Hunter Hospital, Newcastle, AUS
| | - Nicholas Lee
- Trauma Surgery, John Hunter Hospital, Newcastle, AUS
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7
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Chadha A, Joshi S, Ghumman JK. Conservative Management of a Rare Contiguously Spread Splenic Abscess. Cureus 2023; 15:e50747. [PMID: 38239539 PMCID: PMC10794161 DOI: 10.7759/cureus.50747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Splenic abscess is a rare condition that generally results from hematogenous spread and affects individuals with hemoglobinopathies or immunocompromising conditions. Although optimal management has recently been under contention, this condition was traditionally managed with splenectomy. We present a rare case of a 58-year-old male with chronic pancreatitis that developed a splenic abscess via a contiguous spread of a pancreatic pseudocyst. His condition was complicated by septic shock. The splenic abscess was managed with antibiotics, image-guided percutaneous drainage, and notably without surgical intervention.
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Affiliation(s)
- Arjun Chadha
- Internal Medicine, McLaren Macomb Medical Center, Mount Clemens, USA
| | - Saakshi Joshi
- Internal Medicine, McLaren Macomb Medical Center, Mount Clemens, USA
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8
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Meyer HJ, Mehdorn M. [Diagnostics and treatment of splenic abscesses]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:981-986. [PMID: 37917403 DOI: 10.1007/s00104-023-01990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
A splenic abscess is a rare disease found in less than 1% of all autopsy studies. Several different diseases are associated as a predisposing factor, such as septic bacteremia due to endocarditis or diverticulitis, previous splenic trauma, immunosuppressive medication or diseases. The reported mortality in the literature is up to 24.5% in correctly diagnosed and treated cases. The diagnostic work-up primarily comprises sonography and computed tomography as well as a percutaneous puncture for determination of the pathogen. In most cases, a percutaneous interventional drainage treatment is sufficient and a splenectomy is necessary only in refractory cases.
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Affiliation(s)
- Hans-Jonas Meyer
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, 04103, Leipzig, Deutschland.
| | - Matthias Mehdorn
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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9
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Meetschen M, Bücker A, Nikolaou K, Salhöfer L, Zensen S, Schaarschmidt BM, Wetter A, Haubold J. Complications Of Image-Guided Drainage. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:553-554. [PMID: 37732592 PMCID: PMC10546882 DOI: 10.3238/arztebl.m2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Mathias Meetschen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Arno Bücker
- Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Luca Salhöfer
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M. Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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10
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Wiik Larsen J, Thorsen K, Søreide K. Splenic injury from blunt trauma. Br J Surg 2023; 110:1035-1038. [PMID: 36916679 PMCID: PMC10416674 DOI: 10.1093/bjs/znad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Johannes Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- SAFER Surgery, Stavanger University Hospital, Stavanger, Norway
- STING, Stavanger Trauma Investigation Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kenneth Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- SAFER Surgery, Stavanger University Hospital, Stavanger, Norway
- STING, Stavanger Trauma Investigation Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- SAFER Surgery, Stavanger University Hospital, Stavanger, Norway
- STING, Stavanger Trauma Investigation Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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11
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Moghimi Z, Sadeghian E, Notash AY, Sobhanian E. Splenic abscess due to non-operative management of splenic injury: a case report. J Med Case Rep 2023; 17:305. [PMID: 37454091 DOI: 10.1186/s13256-023-04026-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Splenic abscess is a rare disease, with incidence of 0.2-0.7% in previous studies. It often appears with left upper quadrant abdominal pain, fever, chills. Splenic abscess often happens because of hematogenous spreading of infections, endocarditis, angioembolization and some other rare reasons. Treatment relies on one of these two methods: percutaneous drainage or surgery. CASE PRESENTATION A 68-year-old diabetic Asian female (Asian woman) presented with generalized abdominal pain, low blood pressure, tachycardia, fever, lethargy and elevated level of blood sugar. She had history of conservative therapy in intensive care unit due to blunt abdominal trauma and splenic injury. She had a huge splenic abscess in ultrasonography and computed tomography scan so she went under splenectomy. Our patient had a splenic abscess without performing any intervention like angioembolization. CONCLUSION Immune compromised patients who are selected for nonoperative management after splenic injury need close follow up and evaluating about abscess formation for at least 2 weeks. Early diagnosis and treatment with two methods including percutaneous drainage or splenectomy should be considered and it depends on patient's risk factors, vital signs, general conditions and presence or absence of sepsis.
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Affiliation(s)
- Zahra Moghimi
- Department of Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Sadeghian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ehsan Sobhanian
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Cairl N, Sharp V. Splenic abscess secondary to COVID-19 infection - A case report. Int J Surg Case Rep 2022; 101:107807. [PMID: 36455347 PMCID: PMC9705012 DOI: 10.1016/j.ijscr.2022.107807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicholas Cairl
- Department of Surgery, Trinity Health Ann Arbor, 5301 McAuley Dr, Ypsilanti, MI 48197, United States of America,Corresponding author.
| | - Victoria Sharp
- Trinity Health IHA Medical Group, Trauma & Surgical Critical Care, Trinity Health Ann Arbor, 5301 McAuley Dr, Ypsilanti, MI 48197, United States of America
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13
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Podda M, De Simone B, Ceresoli M, Virdis F, Favi F, Wiik Larsen J, Coccolini F, Sartelli M, Pararas N, Beka SG, Bonavina L, Bova R, Pisanu A, Abu-Zidan F, Balogh Z, Chiara O, Wani I, Stahel P, Di Saverio S, Scalea T, Soreide K, Sakakushev B, Amico F, Martino C, Hecker A, de'Angelis N, Chirica M, Galante J, Kirkpatrick A, Pikoulis E, Kluger Y, Bensard D, Ansaloni L, Fraga G, Civil I, Tebala GD, Di Carlo I, Cui Y, Coimbra R, Agnoletti V, Sall I, Tan E, Picetti E, Litvin A, Damaskos D, Inaba K, Leung J, Maier R, Biffl W, Leppaniemi A, Moore E, Gurusamy K, Catena F. Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document. World J Emerg Surg 2022; 17:52. [PMID: 36224617 PMCID: PMC9560023 DOI: 10.1186/s13017-022-00457-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. METHODS Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. RESULTS Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I-II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II-III, AAST Grades III-V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries-WSES Class I, AAST Grades I-II) to 3 days (for high-grade splenic injuries-WSES Classes II-III, AAST Grades III-V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48-72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV-V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48-72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. CONCLUSION This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.
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Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy.
| | - Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Marco Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Francesco Virdis
- Trauma and Acute Care Surgery Department, Niguarda Hospital, Milan, Italy
| | - Francesco Favi
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
| | - Johannes Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital University of Bergen, Stavanger, Norway
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Nikolaos Pararas
- Department of General Surgery, Dr Sulaiman Al Habib/Alfaisal University, Riyadh, Saudi Arabia
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Raffaele Bova
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
| | - Adolfo Pisanu
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Fikri Abu-Zidan
- Department of Applied Statistics, The Research Office, College of Medicine and Health Sciences United Arab Emirates University, Abu Dhabi, UAE
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Osvaldo Chiara
- Trauma and Acute Care Surgery Department, Niguarda Hospital, Milan, Italy
| | | | - Philip Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, USA
| | - Salomone Di Saverio
- Department of Surgery, San Benedetto del Tronto Hospital, AV5, San Benedetto del Tronto, Italy
| | - Thomas Scalea
- Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital University of Bergen, Stavanger, Norway
| | - Boris Sakakushev
- Research Institute of Medical University Plovdiv/University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Francesco Amico
- Trauma Service, John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Newcastle, Australia
| | - Costanza Martino
- Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl della Romagna, Lugo, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Nicola de'Angelis
- Unit of General Surgery, Henri Mondor Hospital, UPEC, Créteil, France
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Andrew Kirkpatrick
- General, Acute Care and Trauma Surgery Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Emmanouil Pikoulis
- General Surgery, Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Denis Bensard
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital, Pavia, Italy
| | - Gustavo Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP, Brazil
| | - Ian Civil
- Director of Trauma Services, Auckland City Hospital, Auckland, New Zealand
| | | | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Raul Coimbra
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | - Edward Tan
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Kenji Inaba
- University of Southern California, Los Angeles, USA
| | - Jeffrey Leung
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
- Milton Keynes University Hospital, Milton Keynes, UK
| | | | - Walt Biffl
- Division of Trauma and Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, La Jolla, CA, USA
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Fausto Catena
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
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