The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

Abstract: Chronic mesenteric ischemia is a rare condition accounting for less than 1 in 1,000 hospital admissions secondary to abdominal pain. Usually, at least two of the three visceral vessels need to be affected before a patient develops symptoms. We describe a patient diagnosed with decompensated liver disease secondary to liver schistosomiasis and was admitted and managed as chronic mesenteric ischemia secondary to superior mesenteric artery (SMA) thrombosis and inferior mesenteric artery (IMA) atherosclerosis. With the patient’s consent, this case is presented to contribute to current knowledge about mesenteric ischemia. Case Description: A 47-year-old male diagnosed with liver cirrhosis secondary to liver schistosomiasis came in due to 1- month abdominal pain associated with 2 days’ melena, diarrhea, vomiting, and 1-day disorientation. Three days post admission, he was noted with resolution of melena, diarrhea, vomiting, and disorientation; however, persistence of abdominal pain prompted consideration of chronic mesenteric ischemia and was confirmed via plain computed tomography scan. Exploratory laparotomy revealed diffuse discoloration of the small bowel but with peristalsis, thrombosis at SMA, and atherosclerosis at IMA. Heparin drip was given as management for portal vein thrombosis. He recuperated well and eventually was discharged improved. Conclusion Chronic mesenteric ischemia is a rare clinical symptom that occurs in less than 1 of 1,000 hospitalizations that are caused by abdominal pain. It has vague abdominal symptoms and is associated with a high mortality rate of 60% to 100%. Prognosis depends on early detection and intervention, and surgical treatment remains the option of choice.
Human ; Liver Cirrhosis ; Mesenteric Ischemia