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Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2022; 23:417-429. [PMID: 35612434 DOI: 10.1089/sur.2022.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
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Affiliation(s)
- Barite Gutama
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jillian K Wothe
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mengli Xiao
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dawn Hackman
- University of Minnesota Health Sciences Library, Minneapolis, Minnesota, USA
| | - Haitao Chu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Davido B, Dinh A, Rouveix E, Crenn P, Hanslik T, Salomon J. [Splenic abscesses: From diagnosis to therapy]. Rev Med Interne 2017; 38:614-618. [PMID: 28196700 DOI: 10.1016/j.revmed.2016.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/23/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.
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Affiliation(s)
- B Davido
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - A Dinh
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France; Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Rouveix
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - P Crenn
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Service de gastro-entérologie, nutrition transversale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, 92200 Boulogne-Billancourt, France
| | - J Salomon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, hôpitaux universitaires Paris Île-de-France Ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Awotar GK, Luo F, Zhao Z, Guan G, Ning S, Ren J, Liu Y, Wang G, Liu P. Splenic abscess owing to cancer at the splenic flexure: A case report and comprehensive review. Medicine (Baltimore) 2016; 95:e4941. [PMID: 27661050 PMCID: PMC5044920 DOI: 10.1097/md.0000000000004941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/23/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset. METHODS We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction. RESULTS An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a Coloplast Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess. CONCLUSION This is the 13 case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear.
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Affiliation(s)
- Gavish K. Awotar
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Fuwen Luo
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Zhengdong Zhao
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Guoxin Guan
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Shili Ning
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Jinshuai Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Yaqing Liu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Guangzhi Wang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, 116023, P.R. China
| | - Pixu Liu
- The First Affiliated Hospital Collaborative Innovation Center of Oncology-Institute of Cancer Stem Cell, Dalian Medical University, Dalian City, Liaoning Province, P.R. China
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Ismail E, El Barni R, Lahkim M, Rokhsi R, Atmane E, El Fikri A, Bouchama R, Achour A, Zyani M. Splenic abscess in cancer chemotherapy. BMC Res Notes 2015; 8:665. [PMID: 26559779 PMCID: PMC4641425 DOI: 10.1186/s13104-015-1655-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Splenic abcess is an uncommon complication for cancer treatment. It occurs more frequently in immunocompromised patients. They are characterized by high mortality. The classic triad (fever, pain of the left hypochondrium, and sensitive mass left) is only present in one-third of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss, abdominal pain left, splenomegaly. Treatment options are limited, but must be discussed and adapted to the patient profile. CASE PRESENTATION We report the case of a 62-year-old Arabic male, diagnosed with metastatic lung adenocarcinoma, who, after several cycles of chemotherapy, presented symptoms and signs of splenic abcess. CONCLUSION Splenic abcess is rare situation, which must be actively researched, to have access to an optimal therapeutic approach.
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Affiliation(s)
- Essadi Ismail
- Medical Oncology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Rachid El Barni
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Mohamed Lahkim
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Redouane Rokhsi
- Radiology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Elmehdi Atmane
- Radiology Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | | | - Rachid Bouchama
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Abdessamad Achour
- General Surgery Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
| | - Mohamed Zyani
- Internal Medicine Unit, IBN SINA Military Hospital, Marrakesh, Morocco.
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Abstract
Splenic abscess is not an uncommon complication of patients with sickle-cell disease. Here we describe an 18 year-old boy with sickle cell disease and left upper quadrant abdominal pain. Computerized axial tomography revealed left sided free flowing pleural effusion and splenomegaly with liquefaction and possible gas formation. The splenic fluid grew an unusual organism known as Bacteroides distasonis. The patient received antimicrobial therapy and underwent a splenectomy with full recovery. The spleen was cystically infarcted and measured 22 x 16 x 5 cm. The capsule was thickened and covered by fibrinous exudate. Histopathologic examination of the spleen showed complete necrosis with reparative fibrosis. This case presents an unusual cause of splenic abscess due to Bacteroides distasonis with a subacute to chronic course. The presence of fever and left sided pleuritic chest pain in patients with sickle cell disease should raise the suspicion of splenic abscess.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Internal Medicine Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia.
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de Carvalho JS, Carranza-Tamayo CO, Romero GAS. [Chronic fever associated with splenic abscess due to Staphylococcus epidermidis]. Rev Soc Bras Med Trop 2007; 40:588-90. [PMID: 17992419 DOI: 10.1590/s0037-86822007000500019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 08/24/2007] [Indexed: 11/22/2022] Open
Abstract
Occult abscesses are frequent causes of chronic fever. Splenic abscesses are rare entities that are usually associated with underlying conditions such as abdominal surgery, endocarditis or immunodepression. We report on the case of a patient with prolonged fever caused by a splenic abscess, whose main differential diagnosis was visceral leishmaniasis. However, this condition was probably related to abdominal trauma. The treatment consisted of antibiotics followed by splenectomy.
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