Splenic Abscess MATERIALS AND METHODS A retrospective review of the pathology database of Gachon University Gil Hospital, Incheon, Korea, identified 18 patients with splenic abscess over a 15 year period (1993-2008). The medical and pathologic records of each patient were reviewed. The data extracted for analysis included age, gen- der, signs and symptoms, predisposing conditions, bacterio- logic profile, type of treatment and the treatment outcome. The diagnosis of splenic abscess was established with an abdominal sonogram or computed tomography (CT) of the abdomen. Solitary and multiple lesions were categorized using imaging studies (Fig. 1). The patients then underwent the necessary treatment such as surgery, antibiotics and/or PCD. The bacteriologic profile was obtained from either blood culture or drained abscess culture. In addition, for pa- tients who underwent splenectomy, intraoperative cultures of the splenic abscess were performed. RESULTS There was a total 18 patients (14 males and four females) seen during the study period. The mean patient age was 47.2 years old. The three most common symptoms at pre- sentation were fever in five patients (27.8%), abdominal pain in 12 (66.7%) and a sensation of chills in five (27.8%). One patient (5.6%) presented with septic shock. Splenor- megaly was found in 14 patients (77.8%). The duration of symptoms from onset until establishment of a diagnosis ranged from 10 to 103 days with a median of 22 days. The majority of patients (61.1%) in our series had leukocytosis (a white blood cell count > 10,000 mm3). Fig. 1. Abdominal CT showing a loculated fluid collection in the lower pole of the spleen Three patients (16.7%) had pancreatitis. There were five patients (27.8%) with associated malignancies, including two (40%) with acute myelocytic leukemia, two (40%) with stomach neoplasm and one patient with non-Hodgkin’s lym- phoma (20%). Two patients’ abscesses (11.1%) were sec- ondary to endocarditis, and one (5.6%) was from a dental abscess. Three patients presented with coexisting liver ab- scesses (16.7%). Chest radiography was abnormal in 16 patients (88.8%); the most frequent finding was a left pleural effusion. Of the 18 patients, 12 (66.7%) underwent an abdominal sonograph- ic examination. Five patients (41.7%) had irregular anecho- ic abscesses with internal debris. The remaining seven (58.3%) showed mixed echoic patterns, which required an additional abdominal CT scan to confirm the diagnosis. Six patients (33.3%) were diagnosed according to the CT scan alone. A solitary abscess was observed in 12 patients (66.7%), while six had multifocal splenic abscess. The cul- tures from 10 patients (55.6%) had a single organism where- as one patient (5.6%) grew a polymicrobial culture. Seven patients (38.8%) showed negative blood cultures. A routine sputum culture for M. Tuberculosis was done but none of the patients tested positive. On the whole, Streptococcus viridians was the most common pathogen (27.8%), follow by Klebsiella pneumoniae (22.2%). One patient was diag- nosed with actinomycosis (Table 1). Three of the four pa- tients with Klebsiella pneumoniae had a single abscess pocket. The remaining one patient had a huge single ab- scess with multiple satellite abscess pockets. Eight patients (44.4%) received intravenous antibiotics as the only treatment modality for splenic abscess. The mor- tality rate during the inpatient period and the previous 90 days was 16.6%. Four of the deaths may have been related to splenic abscess, but underlying malignancies may also have contributed to these deaths. The range of length of in- hospital stay was 16-72 days (mean: 31 days). Four patients (22.2%) underwent PCD with a pigtail catheter (Table 2). The average duration of successful PCD was 27 days (range: 10-48 days). However, two patients underwent splenectomy due to inadequate drainage. None of the patients with multiple abscesses were indicated for PCD. We observed a patient with a gastrosplenic fisula, who was treated with antibiotics and EUS-guided transgas- tric drainage. Six patients with an average age of 63.3 under- went splenectomy. The mean age was significantly lower in the antibiotics-only group as compared to the other two groups (p < 0.05)(Table 2). The average size of the single ab- Yonsei Med J http://www.eymj.org Volume 52 Number 2 March 2011 289