What is Splenic Abscess?
A splenic abscess, or a pocket of infection in the spleen, isn’t a common health issue. However, if it’s not correctly identified, it can lead to death in more than 70% of cases. The good news is that with appropriate treatment, the chance of dying from this condition can be less than 1%. Today, with access to CT scans, not only can a splenic abscess be quickly diagnosed, but the scan also aids in treatment by helping to drain the infection.
What Causes Splenic Abscess?
Abscesses, which are pockets of pus, can form in the spleen. This usually happens when bacteria get into the bloodstream, especially if there are certain abnormalities caused by injuries, or if someone has a condition affecting their red blood cells called hemoglobinopathy. On other occasions, the abscess could be a side effect of a procedure where doctors block blood supply to treat an abnormal bulge (pseudoaneurysm) in an artery supplying the spleen, which is often a complication of acute pancreatitis- an inflammation of the pancreas.
People with weakened immune systems, such as from HIV infection, may also be at risk. In some cases, reports have stated that abscesses in the spleen may form from an infection in the surrounding areas. Other known risk factors for developing splenic abscesses include cancers, infections spreading from another part of the body, damage to the spleen due to lack of blood supply known as splenic infarction, and diabetes. Parasitic infections have also been found in the spleen.
In certain situations, an abscess in another part of the abdomen might spread to the spleen. This is often seen in cases of abscesses in the pancreas and diverticulitis (inflammation and infection in small pouches that can form in your digestive system), which can sometimes extend to the spleen.
Common organisms associated with a splenic abscess can be aerobic (need oxygen to survive), anaerobic (can survive without oxygen), or fungi, like Candida. In approximately 50% of cases, the abscess may contain more than one type of microorganism, however some less common organisms like Burkholderia, Mycobacterium, and Actinomycetes have also been linked to their formation.
Risk Factors and Frequency for Splenic Abscess
Splenic abscesses, or pockets of infection in the spleen, aren’t very common. They’re found in about 0.2% to 0.07% of autopsies. Despite being rare, they can be quite serious, particularly for individuals with weakened immune systems. The rate of spleen infections might be going up because of better detection methods, more illegal drug use through injections, and more people with compromised immune systems. These infections tend to be most common in adults during two periods – in their thirties and then again in their sixties. Out of all the cases of splenic abscesses in adults, about two-thirds have only one abscess, while the rest have multiple abscesses.
Signs and Symptoms of Splenic Abscess
A splenic abscess, or an infection in the spleen, often presents with several different symptoms. The most common symptom is fever, followed by abdominal pain and a tender mass that can be felt in the upper left section of the abdomen. Despite that, only one-third of people with a splenic abscess experience the typical trio of symptoms: fever, tenderness in the upper left abdomen, and an increased number of white blood cells (a condition known as leukocytosis).
During a physical examination, doctors might observe several other signs:
- Tightness or tension in the muscles in the upper left abdomen (muscle guarding)
- Swelling of the skin and tissues above the spleen (edema of the overlying soft tissues)
- Pain when the area between the ribs and spine is touched (costovertebral tenderness)
- An enlarged spleen (splenomegaly)
- Crackling sounds when the base of the left lung is listened to (left basilar rales)
- A dullness when the doctor knocks on the left base of the lung
Testing for Splenic Abscess
Diagnosing a splenic abscess, or a pocket of pus in your spleen, can be quite difficult for doctors.
Some of the things your doctor might do to diagnose this condition include ordering blood tests and imaging tests. Your blood work might show an increase in white blood cells and the presence of bacteria in your bloodstream.
In addition to blood tests, your doctor might perform plain chest X-rays. Certain signs in these images, such as a raised left side of the diaphragm (the muscle that helps with breathing) or fluid on the left side of your chest, can suggest a splenic abscess.
An ultrasound, a type of imaging that uses sound waves to create pictures of the inside of your body, can also be helpful. It can show an enlarged spleen or areas in the spleen where the sound waves don’t travel like they should – which could be a sign of an abscess. This test can be done right at your bedside and doesn’t take much time.
But the most accurate test for a splenic abscess is a CT scan, a type of X-ray that takes detailed pictures of your body from different angles. This test not only helps diagnose the abscess but also gives doctors a good idea of its size, location, and what the nearby structures look like, which can help them plan the best treatment.
In some cases, your doctor might use ultrasound or CT imaging to guide a needle to the abscess, so they can take a small amount of the pus to examine it more closely and confirm the diagnosis.
Treatment Options for Splenic Abscess
If a patient is diagnosed with a splenic abscess (a collection of pus in the spleen), hospitalization is usually required for treatment. As a part of the care, intravenous antibiotics are given to the patient to help control the infection, the specific type of antibiotics used is determined by the type of bacteria found in the abscess.
Commonly, the best treatment for a splenic abscess is a splenectomy, which is the removal of the spleen. However, new research indicates that the treatment approach can sometimes be decided based on the characteristics of the abscess. Patients, who are at a higher risk for surgery, may undergo percutaneous aspiration, which is a less intrusive method where a needle is used to drain the abscess. This method could also be used as a temporary solution before surgery to prevent the infection from becoming severe or life-threatening. The aspiration technique is best used when the abscess is singular or double, with a fully formed and thick wall and doesn’t contain interior partitions. It generally works better when the fluid inside the abscess is thin enough to be drained.
However, if the patient has multiple abscesses or a blood clotting disorder, a laparoscopic (minimally invasive) or regular open surgery may be the preferred treatment approach.
Percutaneous drainage, another way of draining the abscess using a needle, might be less successful in patients with multiple abscesses, ill-defined cavities (spaces) or if the abscess contains thick fluid or debris. It’s also not advisable in the following cases: if there are multiple small abscesses or debris-filled areas, if the patient has a blood clotting disorder, or if the cavities or spaces are not well-defined, if there’s widespread fluid in the abdominal cavity, or if it’s challenging to reach the abscess.
It is generally not advisable to use only medicinal treatment for a splenic abscess, and the strategy remains disputed. In patients who received only antibiotics, mortality rates exceeding 50% have been observed. However, if the abscess does not respond to the treatment, other causes such as fungi, actinomycetes (a type of bacteria), or Mycobacterium (another type of bacteria) should be explored. In some cases, these organisms have been known to respond well to specific treatments like antifungal medication. In some cases, the use of corticosteroids, drugs that lower inflammation in the body, could also be beneficial.
Lastly, in certain cases where drainages fail, open drainage might be required. This involves making an incision and directly accessing the abscess. The pathways for this technique can include through the abdomen, chest, or retroperitoneal space (the area behind the abdominal cavity).
What else can Splenic Abscess be?
Splenic abscesses can be caused by a range of infections, including bacterial, parasitic, fungal, and mycobacterial infections. The size of these abscesses can vary widely, from very tiny to several centimeters large. Typically, these abscesses are found in patients with weakened immune systems due to conditions such as blood cancers, a history of chemotherapy, intravenous drug use, and AIDS.
While considering what may be causing a splenic abscess, it’s important to also think about other potential causes that aren’t directly related to the spleen. These might include:
- Pneumonia
- Pneumothorax (a collapsed lung)
- Empyema (infection in the lung area)
- Splenic infarct (death of the spleen tissue due to lack of blood)
- Pulmonary embolism (a lung clot)
- Nephrouretrolitiasis (stones in the urinary system)
What to expect with Splenic Abscess
Today, the outlook for a splenic abscess (a pocket of pus in the spleen) has greatly improved compared to the past. This is largely due to safer, less intrusive treatments like percutaneous CT guided drainage, a procedure where a small, hollow tube uses X-ray guides to remove the pus from the spleen. This treatment not only avoids the potential complications of traditional open surgery, but it’s also less invasive.
Aside from this, laparoscopic splenectomy, a procedure where the spleen is removed through small incisions in the abdomen using a laparoscope, has shown to be an effective alternative to traditional open surgery. It allows for quicker recovery and shorter hospital stays. However, this option is typically reserved as a last resort treatment since most cases can be treated effectively with percutaneous guided drainage and antibiotics.
Possible Complications When Diagnosed with Splenic Abscess
Complications can arise from a splenic abscess, or a pocket of pus in the spleen. These might include:
- Pneumothorax, or collapsed lung
- Atelectasis, or partial lung collapse
- Life-threatening bleeding
- Left-sided collection of fluid in the chest
- Subphrenic abscess, or pus under the diaphragm
- Perforation, or hole in the stomach, small intestine, or large intestine
- Pancreatic fistula, an abnormal connection involving the pancreas
- Increased platelet count after spleen removal
- Pneumonia, or lung infection
Following the abscess, doctors help prevent respiratory problems by encouraging deep breathing exercises, managing pain appropriately, and aggressively treating any lung complications.
If pus forms under the diaphragm, it usually needs to be drained quickly.
Infection is always a risk after spleen removal, especially in younger patients. To protect themselves, these patients should receive immunizations against certain types of bacteria: Meningococcus, Streptococcus pneumoniae, and Haemophilus influenzae.
Recovery from Splenic Abscess
It is critical to monitor a patient’s recovery after treating a spleen abscess, as complications may arise later. Continual check-ups are necessary to identify and deal with these problems promptly.
Preventing Splenic Abscess
People should know what to expect after having their spleen removed. With the spleen gone, they become more susceptible to infections. This is why it’s important to talk with their primary doctor about getting vaccines. Even minor signs of infection or colds should be checked immediately. If they are given antibiotics to treat an infection, they must take them as instructed without changing the treatment plan. Lastly, it’s also a good idea to consider getting a medical ID bracelet that shows they’ve had a spleen removed.
