Pneumoperitoneum as a result of a ruptured splenic abscess

Pneumoperitoneum Caused by a Ruptured Splenic Abscess Mimicking Gastrointestinal Perforation: A Case Report

INTRODUCTION

Splenic abscess is a rare but potentially life-threatening condition that can rupture, leading to pneumoperitoneum and symptoms that mimic gastrointestinal perforation in rare cases. This can significantly complicate accurate diagnosis and prompt treatment. A splenic abscess can become life-threatening by rupturing, which may cause diffuse peritonitis or sepsis.

CASE PRESENTATION

A 68-year-old man with uncontrolled diabetes presented with fever, chills, and abdominal pain. Initial evaluation at a previous hospital, including computed tomography (CT), suggested a lower gastrointestinal perforation, leading to his transfer to our facility. CT revealed a non-enhancing lesion with gas in the spleen and free intraperitoneal air; however, there was no clear evidence of gastrointestinal perforation. An emergency exploratory laparotomy was performed, which revealed purulent ascites and a ruptured splenic abscess without any gastrointestinal perforation. After thorough lavage to eliminate contamination, open abdominal management was initiated owing to a need for catecholamine support and an inability to completely rule out the possibility of gastrointestinal perforation. A second-look laparotomy confirmed that there was no further contamination or gastrointestinal tract perforation. Blood and abscess cultures revealed Escherichia coli, leading us to initiate targeted antibiotic therapy. The patient recovered successfully and was discharged on postoperative day 40 without any recurrence. Ruptured splenic abscess with pneumoperitoneum is rare and poses significant diagnostic challenges, particularly in patients with diabetes, owing to its clinical similarity to gastrointestinal perforation. This study highlights the utility of exploratory laparotomy and staged open abdominal management when gastrointestinal perforation cannot be ruled out.

CONCLUSIONS

Physicians should consider ruptured splenic abscesses in patients with pneumoperitoneum, particularly those with diabetes. Exploratory laparotomy with staged open abdominal management may represent an effective approach that facilitates safe monitoring and targeted treatment, thereby reducing the risk of fatal complications.

Ruptured splenic abscess as an extremely rare cause of pneumoperitoneum: A comprehensive review with a case report

Splenic abscess leading to rupture and pneumoperitoneum is a very rare condition that is limited to a few case reports. In this study, we first introduced a case of an adolescent girl with a medical history of diabetes mellitus who presented with left upper quadrant abdominal pain and fever. Ultrasound revealed an abscess in the spleen and a computed tomography (CT) scan of the abdomen revealed evidence of pneumoperitoneum secondary to the rupture of this abscess. The patient underwent splenectomy without postoperative complications. Secondly, we reviewed and discussed the current literature on this topic which predominantly denotes that the pneumoperitoneum following splenic abscess rupture mostly occurs in the immunocompromised status, without a specific predominant infectious agent but the culprit is a gas-forming organism, acute abdomen ensues if the diagnosis is delayed, diagnosis is via abdominal CT when there is hemodynamic stability otherwise exploratory laparotomy uncovers the diagnosis, and splenectomy with broad-spectrum antibiotic therapy is the mainstay of treatment.

Large-volume pneumoperitoneum and septic peritonitis secondary to splenic abscess rupture in a dog

An 11-year-old spayed female American pit bull terrier mixed breed dog was presented because of hyporexia and abdominal distension. The dog had large-volume free peritoneal gas on imaging and septic neutrophilic exudate on abdominocentesis. Exploratory laparotomy revealed a ruptured splenic mass draining purulent material. A splenectomy was performed and the abdomen was lavaged. Culture samples grew an anaerobic Gram-positive rod. The dog was discharged 4 days after surgery with no residual problems noted 1 week later. To our knowledge, this is the first report of large-volume pneumoperitoneum and septic peritonitis secondary to rupture of a splenic abscess.

Ruptured splenic abscess causing pneumoperitoneum: a rare cause revisited

We present a case report of splenic abscess causing pneumoperitoneum in a case of uncontrolled diabetes. The patient presented with chronic pain abdomen and fever which later evolved to acute abdomen during the course of hospital stay. An X-ray showed pneumoperitoneum and exploratory laparotomy was performed under a strong clinical suspicion of hollow viscus perforation. The patient was treated with antibiotics and had an uneventful recovery.