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.
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。