SPLEENIC ABCESS: RARE SPECTRUM OF DIAGNOSIS IN IMMUNOCOMPETENT PATIENT WITH URINARY TRACT INFECTION

Spleenic abscess is a rare entity, with a reported frequency of 0.05-0.7%.Its reported mortality is still high, up to 47%, and has the potential to reach 100% among patients who do not receive antibiotic treatment. It is more common in the presence of infection at different primary sites, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Immunosuppression and trauma are well-known risk factors. Recently, intravenous drug abusers and alcoholics have shown an increased incidence compared to other high-risk groups. However, encountering this entity in general population is uncommon. Clinical examination and laboratory findings are not constant; thus, imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. If untreated, the mortality reaches almost 100%. Treatment includes conservative measures and surgical interventions. Spleenectomy has been the preferred approach in most centers. More recent studies have suggested the use of advanced and alternative options, including laparoscopic surgical and percutaneous interventions. Changing trends, in view of the importance of immunological role of spleen, have emphasized more on spleen preserving protocols, especially in children and young patients, and in cases of solitary abscess with a thick wall. Conducted a literature review by analysis of various high-risk groups, presentation, diagnosis and treatment of splenic abscess and have presented a case report here. Spleenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one - third of the cases. Diagnosis is mostly done by imaging, either Abdominal Sonography or CT Scan. So far no prospective study has been done to rationalize the management, probably due to paucity of cases. Antibiotics alone or with percutaneous drainage under imaging control are successful in many cases. Failed aspirations and splenic abscesses with concomitant pathologies need spleenectomy. Spleenectomy and complete removal of the source of the infection is still the mainstay of treatment. Detailed review of the available literature of the clinical problem and various methods of treatment of spleenic abscesses are discussed in this article.