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Splenic abscess is an uncommon but potentially life-threatening disease. Recent advances in radiology have affected the diagnosis and management of this disease entity. The purpose of this study was to review our experience in managing these patients. We retrospectively reviewed the medical records of 51 patients with splenic abscess as seen in a tertiary medical center between 1998 and 2003. We analyzed the demographics, clinical manifestations, etiology, predisposing factors, diagnostic modalities, bacteriologic profile, treatment, and outcome of these patients. The mean age was 59.9 ± 14.2 years (ranging from 21–89 years). The male:female ratio was 29:22. Common symptoms included fever (82%), abdominal pain (71%), and nausea and vomiting (46%). The majority of these patients (83%) had leukocytosis. Thirty-six patients had associated parenchymal liver diseases and 26 patients had diabetes mellitus. Abdominal sonogram or computed tomography was performed to establish the diagnosis. Most cultures from the abscess cavities grew gram-negative enteric bacilli. Patients were treated with antimicrobial therapy only (n = 33), additional percutaneous drainage with a pigtail catheter (n = 11), or splenectomy (n = 7), and the survival rates were 48 per cent, 45 per cent, and 100 per cent, respectively. Splenic abscess should be considered in a patient with fever, left upper abdominal pain, and leukocytosis. Splenectomy appears to have better treatment outcome than percutaneous drainage or intravenous antibiotics alone.

The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the outcome of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with isolated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. Hemodynamically unstable patients underwent the abdominal exploration and stable patients were evaluated with CT scans of abdomen and pelvis. Patients underwent SAE based on the findings of CT scans, including contrast extravasation or large hemoperitoneum. For initially stable patients, there were no differences in nonoperative management success rate between Groups A and B in regards to injury severity score ≥16, age, or grades of splenic injury ≥3. In comparison, among patients with large hemo-peritoneum found by abdominal CT, Group B had significantly better nonoperative management success rates (P < 0.05). SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate.