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Abstract：
BACKGROUND: Splenic abscess is a rare clinic entity, its incidence has increased due to the rising number of clinical conditions involving immunosuppression. Endocarditis is the most frequent cause, and gram-positive aerobes are the main causal agents. Its clinical presentation is non-specific and delays diagnosis. Computed tomography scan is the method of choice, and the treatment is based on antibiotics and drainage, radiological or surgical, involving splenectomy in special cases that require it.
METHODS: A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day.
CONCLUSIONS: Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
METHODS: A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day.
CONCLUSIONS: Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
摘要：
背景：脾脓肿是一种罕见的临床实体，由于涉及免疫抑制的临床疾病数量增加，其发病率增加。心内膜炎是最常见的病因,革兰氏阳性需氧菌是主要的致病因子。其临床表现是非特异性的，延迟诊断。计算机断层扫描是首选方法，治疗基于抗生素和引流，放射科或外科，在特殊情况下需要脾切除术。
方法：一名55岁的男性，患有腹痛和发热。分析显示白细胞增多14,000/mm3，凝血酶原活性53％，和代谢性酸中毒.计算机断层扫描显示肝周气腹，液体流体,和脾周气泡，十二指肠球周围有轻微的脂肪小梁，该区域有气腹。患者接受了正中剖腹手术，发现由脾脓肿破裂引起的化脓性腹膜炎，进行脾切除术。液体培养显示多核型，没有发现微生物。患者进展并在术后第5天出院。
结论：脾脓肿是一种罕见的疾病，其中诊断延迟和死亡，在未经治疗的患者中，是高的。它与气腹的关系可能会混淆内脏穿孔的诊断。因此，在通过补充检查发现不明原因的气腹时，必须怀疑它。选择的治疗方法是脾切除术，因为囊膜破裂是所有这些的常态。
方法：一名55岁的男性，患有腹痛和发热。分析显示白细胞增多14,000/mm3，凝血酶原活性53％，和代谢性酸中毒.计算机断层扫描显示肝周气腹，液体流体,和脾周气泡，十二指肠球周围有轻微的脂肪小梁，该区域有气腹。患者接受了正中剖腹手术，发现由脾脓肿破裂引起的化脓性腹膜炎，进行脾切除术。液体培养显示多核型，没有发现微生物。患者进展并在术后第5天出院。
结论：脾脓肿是一种罕见的疾病，其中诊断延迟和死亡，在未经治疗的患者中，是高的。它与气腹的关系可能会混淆内脏穿孔的诊断。因此，在通过补充检查发现不明原因的气腹时，必须怀疑它。选择的治疗方法是脾切除术，因为囊膜破裂是所有这些的常态。
