Splenic Abscess Arising from a Dental Abscess in Healthy Man.
- Author:
Sang Tae CHOI
1
;
Jung Nam LEE
;
Keon Kuk KIM
;
Jung Yun JO
;
Ho Jin LEE
;
Se Hun PARK
;
Min CHUNG
Author Information
1. Department of Surgery, Gachon Medical School, Gil Medical Center, Incheon, Korea. bcon1218@hanmail.net
- Publication Type:Case Report
- Keywords:
Splenic abscess;
Splenectomy
- MeSH:
Abscess*;
Aged;
Blood Platelets;
Cholangiography;
Common Bile Duct;
Drug Therapy;
Echocardiography;
Embolism;
Emergency Service, Hospital;
Endocarditis, Bacterial;
Fever;
Humans;
Immunosuppression;
Laparotomy;
Leukocytes;
Male;
Mortality;
Neutrophils;
Sepsis;
Spleen;
Splenectomy;
Splenomegaly;
Streptococcus;
Suppuration;
Thromboembolism;
Toothache;
Vital Signs
- From:Journal of the Korean Surgical Society
2006;70(3):236-240
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Isolated splenic abscess of spleen is very rare, which is increasingly recognized with immunosuppressed states due to the use of chemotherapy to malignancy, immunosuppression for transplantation and AIDS recently. The most fre-quent cause of splenic abscess is septic embolism arising from bacterial endocarditis. While splenic abscess can be seen rarely in healthy men, it has a high rate of mortality when it is diagnosed lately. A healthy 66-year-old male patient who presented with a 7 month history of intermittent spiking fever, toothache was admitted to the emergency room with clinical and biochemical signs of sepsis. Vital sign were 90/60-112-20-38.9 degrees C. He had left subcostal tenderness, a 15 cm palpable spleen and no medical history except toothache. The laboratory values were as follows: leukocyte 289,200/mm(3)(segmented neutrophil 94.3 %), hemoglobin 10.5 g/dl, platelet 119,000/mm(3), AST/ALT 85/84 U/L, total bil-irubin 10.8 mg/dl, BUN/Creatinine 25/1.3 mg/dl. Streptococcus viridians grew in blood culture. Computerized tomography showed a splenomegaly with multifocal round or tubular shaped cystic lesions in spleen as well as infiltrative low density lesions in pancreatitic taie like intrasplenic pseudocysts, which was failed by ultrasound-guided aspiration due to multiple, small and scattered location. Echocardiography showed no evidence of intracardiac source of infective thromboembolism. Endoscopic retrograde cholangiography shows mild intrahepatic duct and common bile duct dilataton with no evidence of stone. Exploratory laparotomy was performed. The spleen being found enlarged and distal pan creas with probably pseudocystic involvement were removed. It was also noticed that there were cystic-like structure filled with pus on crosssectional surface. The result of pus cultures was no organism.
