Splenobronchial fistula: interventional radiologic management

A rare case of splenobronchial fistula formation post-embolisation therapy following acute blunt trauma

We present the case of a 26-year-old male who was referred to the Emergency department with frank haemoptysis, fever and abdominal pain. He had suffered from an acute splenic rupture secondary to blunt abdominal trauma 3 weeks previously, when he was treated with transfemoral embolisation therapy. On this previous admission his splenic injury was initially not detected owing to CT scanning technique focussed on imaging the thorax rather than the abdomen. On readmission, the initial chest X-ray pointed towards a likely pneumonia or empyema. However, upon CT scanning, the cause was found to be a splenic abscess that had extended through the diaphragm, pleura and entered the bronchial space, forming a ‘splenobronchial’ fistula. This is a rare complication of splenic artery embolisation. The aim of this case report is to raise awareness of the complications that acute trauma and embolisation therapy may cause.

Splenic abscesses from 1987 to 1995

BACKGROUND

Isolated splenic abscesses is an uncommon clinical entity that is being increasingly recognized as a cause of intraabdominal sepsis in a wide variety of clinical situations, and involving a wide range of organisms. The increasing incidence of immunosuppressed states in this decade due to the use of chemotherapy for oncology, immunosuppression therapy for transplantation, and acquired immune deficiency syndrome, has changed the disease pattern of splenic abscesses.

METHOD

Data from 287 cases reported in the English literature between 1987 and 1995 were collected, analyzed, and compared with two previous reviews of cases reported before 1987.

RESULTS

Staphylococcus, Salmonella, and Escherichia coli are the most common organisms cultured. Immunosuppressed states were present in 33.5% of cases, with intravenous drug abuse and acquired immune deficiency syndrome accounting for half these cases. Computerized tomography and ultrasonography are diagnostic, with a sensitivity of 92.2% and 87.2%, respectively. Nonoperative management has a success rate of less than 65%, but salvage splenectomy does not increase mortality compared with splenectomy as initial therapy.

CONCLUSIONS

Splenic abscesses are increasingly recognized with immunosuppressed states. Percutaneous radiologically guided drainage may be suitable in some cases, but splenectomy with appropriate antibiotics is the definitive treatment.