Splenic abscess
Introduction
Introduction to spleen abscess Abscess abscess (abscessofspleen) is a rare disease. The spleen is a high-selective filter and phagocytic activity center for microorganisms in the blood. It has immunity against local infection and is generally less susceptible to infection. Since the application of antibiotics, spleen abscesses are even more rare. The most common pathogens are Staphylococcus, Streptococcus, Anaerobic and Aerobic Gram-negative bacilli, including Salmonella; Candida is often infected with immunocompromised hosts. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: acute diffuse peritonitis
Cause
Cause of spleen abscess
(1) Causes of the disease
Suppurative infections of the spleen are generally secondary, but most of the primary lesions are not obvious, because the symptoms of the spleen abscess itself can appear only a few weeks or even months after the disappearance of the primary infection, so the patient is in the past Pre-infections are often not remembered. The common causes of spleen abscess are:
1 The most common is that the infected lesions in other parts are spread to the spleen by blood, accounting for 75% to 90% of the total number of cases, staphylococcal, streptococci or pneumococcal sepsis or sepsis, endocarditis And puerperal fever, is the most common precursor of spleen abscess, but in fact almost all purulent infections may be a precursor of spleen abscess, disseminated generally through the arteries, but intra-abdominal infection can also enter the spleen through the portal vein.
2 spleen injury or infarction, accounting for about 10% to 25% of spleen abscess, even small trauma can form spleen hematoma, and secondary infection caused by spleen abscess, spleen infarction can be caused by ligation of splenic artery, caused by embolism Pathological hemoglobinosis (abnormal hemoglobinemia or sickle cell disease) can also occur in spleen infarction, and the infarcted spleen is an ideal lesion for bacterial deposition or reproduction.
3 adjacent organs can also directly invade the spleen to cause abscess, but clinically less common, accounting for less than 10% of the cause of spleen abscess, perirenal abscess, underarm abscess, acute pancreatitis, stomach and colon tumors, etc. Direct invasion of the spleen causes spleen abscess.
4 immunosuppression or defects such as critical illness, long-term use of immunosuppressive drugs, AIDS patients may have spleen infection and abscess, in addition, spleen cysts can be secondary infection and converted into spleen abscess.
The spleen abscess is usually caused by staphylococcus, streptococcus or salmonella. In the case of extensive use of antibiotics, the pathogenic spectrum is also somewhat changed. Currently, fungi (such as Candida albicans) and anaerobic infections are more common. The spleen abscess is extremely rare.
(two) pathogenesis
Spleen abscess is caused by emboli, so the abscess may be multiple. The secondary infection of traumatic hematoma is usually single, but it is rare in clinical practice. The structure of spleen abs is no different from general abscess. However, because the abscess contains broken spleen tissue, the pus is often tan, and thicker than the general pus.
In the early stage of abscess, the spleen is not attached to the surrounding tissue. The longer the course of the disease, the inflammation has reached the surface of the spleen, and the dense adhesion between the spleen and the surrounding tissue is often caused. If the abscess affects the surface of the spleen, sometimes it can penetrate into the other. Organs, abdominal or abdominal wall, resulting in various internal and external hemorrhoids and peritonitis, and occasionally can also break through the diaphragm to cause empyema, but most of the spleen abscess is still confined within the spleen, and it itself as an infection, can pass Blood transports a bacterium embolism, which causes a metastatic abscess in other areas.
Prevention
Spleen abscess prevention
1. Actively treat infectious diseases and strengthen antibiotic treatment;
2, for abdominal trauma, especially the spleen is blunt or penetrating injury, should be debrided as soon as possible, anti-infection.
Complication
Spleen abscess complications Complications, acute diffuse peritonitis
Complications of untreated abscess include: abscess intraluminal hemorrhage, abscess ulceration into the abdominal cavity, intestine, trachea or chest cavity, spleen abscess can be a rare cause of endocarditis persistent bacteremia, with appropriate chemotherapy still does not help.
Patients with spleen abscess combined with liver, lung, kidney and other organ abscesses accounted for more than 25%, the condition is often heavier, about 34% of patients with spleen abscess rupture complicated with diffuse peritonitis, or penetrate the stomach, colon and small intestine, spleen trauma hematoma Secondary infection of the abscess often combined with major bleeding.
Symptom
Symptoms of spleen abscess Common symptoms Upper abdominal pain Leukocytosis Pleural effusion splenomegaly
Spleen abscess is rare, clinical manifestations are atypical, often lack of specific symptoms, the main symptoms are subacute onset fever and left side pain, often left pleural, flank, upper abdomen or lower chest pain and radiated to the left shoulder, There is often tenderness in the left upper abdomen, typical splenomegaly can be seen; very few can hear spleen friction, common leukocytosis, blood culture sometimes shows the growth of pathogenic bacteria.
Examine
Examination of spleen abscess
White blood cells and neutrophils often increase significantly, and there is a left shift of the nucleus, but it may not increase significantly due to long-term application of antibiotics. When combined with hypersplenism, leukocytes may also decrease, and bone marrow may be produced when the spleen is seriously infected. Naive cells and reticulocytes increase.
For clinical suspected spleen abscess, consider B-ultrasound or CT-guided mass puncture, spleen abscess can draw old blood or pus, puncture should be smear microscopy, bacterial culture and drug sensitivity test To guide further antibiotic applications.
1.B Ultra
Shows spleen enlargement, single or multiple round, oval or irregular anechoic dark areas in the spleen, uneven edges, thick wall, compared with spleen cysts, spleen abscess echo-free echo edge , fuzzy, no echo zone in the echo zone, visible liquid level, occasionally gas echo, no echo in the echo zone, about 60% of the lesion in the spleen, may be accompanied by left chest effusion.
2. Thoracic and abdominal X-ray film examination
More manifestations of non-specific signs, such as diaphragmatic elevation and movement limitation, spleen shadow enlargement, left pleural effusion and atelectasis, etc., if the liquid level appears in the spleen is a specific sign, but this situation is rare The sputum meal showed that the stomach and the transverse colon were displaced to the right front, and the stomach was bent and there was pressure and tear.
3. CT examination
The diagnostic accuracy is high, the sensitivity and specificity can reach 90%. Scanning examination reveals that the shape of the spleen is outwardly bulging, and the spleen is round or oval low-density area, the density is uneven, the edge is irregular, and the liquid level is visible in the abscess. Or gas, the abscess wall is equal to the spleen parenchyma, and the abscess wall can be enhanced when the scan is enhanced, but the content of the abscess is not enhanced, and scattered calcified plaques are visible in the spleen.
4. Arteriography
The sensitivity is high, and the abscess lesion within 2 cm can be found at the minimum. The spleen is enlarged by angiography. There is a blood vessel-free swelling mass in the spleen, the edge is rough, the swelling causes the blood vessel to shift, straighten and separate, and the capillary phase. The abscess showed an irregular and fuzzy filling defect. There was no staining and blood vessels around the abscess. There was no blood vessel or blood vessel lake, and the splenic vein was normal.
5. Radionuclide spleen scanning
The accuracy is high, up to 80% to 90%, but the lesions below 2cm can not be detected. The single abscess is characterized by a large radioactive defect area, and multiple small abscesses (<3cm) are images of uneven radionuclide uptake.
Diagnosis
Diagnosis and differentiation of spleen abscess
diagnosis
CT is the most reliable test, but X-ray examination can show the left upper abdominal mass and the extraintestinal gas in the abscess caused by the gas-producing bacteria; the displacement of other organs such as the kidney, colon and stomach; the left lateral squat elevation and left Lateral pleural effusion, ultrasound examination can show more than 2 ~ 3cm spleen abscess defect.
Differential diagnosis
Need to be differentiated from spleen hematoma, spleen infarction, spleen cyst, spleen metastatic carcinoma, hemangioma, lymphoma and other diseases.
Pancreatic abscess: Most patients have fever, abdominal pain and tenderness, nausea, vomiting, sometimes paralytic ileus, and episodes of pancreatitis soon after the onset of acute pancreatitis. Abscess, in these patients, fever, leukocytosis and abdominal signs that are common in acute pancreatitis cannot disappear as quickly as usual. If these symptoms and signs persist for more than 7 days, abscess should be suspected. Half of the cases can be touched. Lump.
Liver abscess: multiple abscesses caused by systemic bacteremia or biliary tract infection usually have an acute onset, and the main clinical features of the original disease causing abscess are its main symptoms. If it is a single abscess, its symptoms are several weeks. There is a subacute onset; there is fever, and sometimes the only clue, but most patients also have anorexia, nausea, weight loss and weakness. About half of the patients have pain or tenderness in the right upper quadrant and hepatomegaly; occasionally right Lateral pleural inflammatory chest pain; jaundice usually only occurs when the biliary tract is blocked.
