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World J Gastroenterol. Dec 7, 2006; 12(45): 7341-7345
Published online Dec 7, 2006. doi: 10.3748/wjg.v12.i45.7341
Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients
Enver Zerem, Jacob Bergsland
Enver Zerem, Jacob Bergsland, Interventional Ultrasonography Department, University Clinical Centar Tuzla, Bosnia and Herzegovina
Correspondence to: Enver Zerem, Interventional Ultraso-nography Department, The University Clinical Centar Tuzla, Trnovac bb, Tuzla 75000, Bosnia and Herzegovina. zerem@inet.ba
Telephone: +387-61898202 Fax: +387-35266485
Received: September 15, 2006
Revised: September 28, 2006
Accepted: November 6, 2006
Published online: December 7, 2006

AIM: To analyze the results of ultrasound guided percu-taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess.

METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed.

RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure.

CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.

Keywords: Interventional ultrasound, Needle aspiration, Catheter drainage, Spleen preservation