Splenic abscess after splenic blunt injury angioembolization.

Abstract

INTRODUCTION:

Splenic Angioembolization (SAE), during Nonoperative Management (NOM) of Blunt Splenic Injury (BSI), is an effective therapy for hemodynamically stable patients with grade III, IV, and V OIS splenic injuries. We report a case of a patient with a blunt abdominal trauma due to an accidental fall, who presented splenic abscess a week after SAE and a review of the literature.

CASE REPORT:

A 38-year-old male arrived at Emergency after an accidental fall with contusion of the left upper quadrant of the abdomen. Abdominal CT scan revealed the fracture of the lower splenic pole with intraparenchymal pseudoaneurysms (OIS spleen injury scale IV). Considering the hemodynamic stability, NOM was undertaken and SAE was performed. After a week, the patient developed a splenic abscess confirmed by Abdominal CT; therefore, splenectomy was performed. There was no evidence of bacterial growing in the perisplenic hematoma cultures but the histological examination showed multiple abscess and hemorrhagic areas in the spleen.

DISCUSSION:

Splenic abscess after SAE during NOM of BSI is a rare major complication. The most frequently cultured organisms include Clostridium perfringens, Alpha-Hemoliticus Streptococcus, gram-positive Staphylococcus, gram-negative Salmonella, Candida, and Aspergillus. This case represents our first reported splenic abscess after SAE.

CONCLUSION:

SAE is a very useful tool for BSI managing; splenic abscess can occur in a short time, even if it is a rare major complication, so it may be useful to monitor patients undergoing SAE, focusing not only on the hemodynamic parameters but also on the inflammatory and infectious aspects.

• Authors: Dario Tartaglia, Christian Galatioto, Piero Vincenzo Lippolis, Matteo Modesti, Desirée Gianardi, Andrea Bertolucci, Monica Cucinotta, Giuseppe Zocco, Massimo Seccia
• Journal: Annali italiani di chirurgia (Ann Ital Chir) Vol. 85 Issue ePub (Nov 03 2014) ISSN: 2239-253X [Electronic] Italy
• PMID: 25362884 (Publication Type: Case Reports, Journal Article)

Topics

• Abdominal Abscess (etiology)
• Adult
• Aneurysm (etiology, therapy)
• Embolization, Therapeutic (adverse effects)
• Humans
• Male
• Spleen (injuries)
• Splenic Artery
• Splenic Diseases (etiology, microbiology)
• Wounds, Nonpenetrating (complications)