Dalak Apsesi
Özet
Dalak, bağışıklık sisteminin retiküloendotelyal kolunun bir parçasıdır. Dalak apseleri nispeten nadirdir ve otopsi serilerinde görülme sıklığı %0,2-0,7 olarak belirlenmiştir. Dalak apseleri genellikle çeşitli bölgelerden kaynaklanan bakteriyemik enfeksiyonlara bağlı olarak gelişir. Bazen dalak travması sonrası veya komşu enfeksiyon odağından yayılma veya iyatrojenik olarak ortaya çıkabilir. Streptokoklar, Stafilokoklar, Salmonella spp. ve Escherichia coli dalak apsesinin başlıca etkenleridir. Fakat çeşitli başka mikroorganizmalara bağlı da dalak apsesi gelişebilir. Ateş, bazen dalak apsesinin tek belirtisi olabilir ve vakaların %95'inde ateş mevcuttur. Bunun dışında karın ağrısı, bulantı, kusma, lökositoz gibi nonspesifik belirti ve bulgular görülebilir. Dalak apsesinin tanısı uygun görüntüleme çalışmaları ile konulur. Bilgisayarlı tomografi (BT), özellikle intravenöz kontrast madde ile çekilirse, dalak apsesinin saptanmasında en duyarlı yöntem gibi görünmektedir. Tedavi edilmeyen veya uygun olmayan/yetersiz tedavi alan dalak apsesinin mortalitesi yüksektir. Uygun antibiyotik tedavisi ile birlikte splenektomi, geleneksel tedavi yöntemidir. Son yıllarda dalak apselerinin BT rehberliğinde ve ultrasonografi rehberliğinde perkütan aspirasyonuna ilişkin deneyim artmıştır, seçilmiş vakalarda başarılı sonuçlar vermektedir. Dalak apsesinden şüphelenildiği anda cerrahi veya perkütan drenaj uygulanana dek geniş spektrumlu ampirik antibiyotik tedavisine başlanmalıdır. Optimal antibiyotik tedavisi süresi herhangi bir klinik çalışmada belirlenmemiştir.
Referanslar
Bernabeu-Wittel M, Villanueva JL, Pachón J, et al. Etiology, clinical features and outcome of splenic microabscesses in HIV-infected patients with prolonged fever. European Journal of Clinical Microbiology and Infectious Diseases. 1999;18(5):324-329. doi: 10.1007/pl00015013
Altemeier WA, Culbertson WR, Fullen WD, et al. Intra-abdominal abscesses. The American Journal of Surgery. 1973;125(1):70-79.
Ooi DQH, Ooi JQC, Ooi LLPJ. Splenic abscesses in the new millenium - a systematic review. ANZ Journal of Surgery. 2024. doi: 10.1111/ans.19178
Alonso Cohen MA, Galera MJ, Ruiz M, et al. Splenic abscess. World journal of surgery. 1990;14(4):513-6; discussion 516-517. doi: 10.1007/BF01658678
Paris S, Weiss SM, Ayers WH, et al. Splenic abscess. The American surgeon. 1994;60(5):358-361.
Nelken N, Ignatius J, Skinner M, et al. Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. The American Journal of Surgery. 1987;154(1):27-34. doi: 10.1016/0002-9610(87)90285-6
Chun CH, Raff MJ, Contreras L, et al. Splenic abscess. Medicine (Baltimore). 1980;59(1):50-65. doi:10.1097/00005792-198001000-00003
Lee WS, Choi ST, Kim KK. Splenic Abscess: A Single Institution Study and Review of the Literature. Yonsei Medical Journal. 2011;52(2):288-292. doi: 10.3349/ymj.2011.52.2.288
Lee MC, Lee CM. Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution. Canadian Journal of Infectious Diseases and Medical Microbiology. 2018;2018:8610657. doi:10.1155/2018/8610657
McOwat L, Wong KF, Varughese GI, et al. Splenic abscess as a potential initial manifestation of quiescent infective endocarditis in a patient with bronchopneumonia. BMJ Case Reports. 2015;2015:bcr2014206794. doi: 10.1136/bcr-2014-206794.
Fernández Guerrero ML, Álvarez B, Manzarbeitia F, et al. Infective endocarditis at autopsy: a review of pathologic manifestations and clinical correlates. Medicine (Baltimore). 2012;91(3):152-164. doi: 10.1097/MD.0b013e31825631ea
Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. The American Journal of Surgery. 1997;174(1):87-93. doi: 10.1016/s0002-9610(97)00030-5
Green BT. Splenic abscess: report of six cases and review of the literature. The American surgeon. 2001;67(1):80-85.
Hung SK, Ng CJ, Kuo CF, et al. Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department. PloS One. 2017;12(11):e0187495. doi: 10.1371/journal.pone.0187495
Sillar JR, Bannan AM, Dahlenburg L. Splenic abscess complicating gastroenteritis due to Salmonella Virchow in an immunocompetent host. The Medical Journal of Australia. 2015; 203 (3): 148-149. doi: 10.5694/mja15.00068
Chen CY, Yang PJ. Splenic Tuberculosis. The New England Journal of Medicine. 2023;388(4):e6. doi: 10.1056/NEJMicm2206174
Rolain JM, Chanet V, Laurichesse H, et al. Cat scratch disease with lymphadenitis, vertebral osteomyelitis, and spleen abscesses. Annals of the New York Academy of Sciences. 2003;990:397-403.
Nakamura M, Kurimoto M, Kato T, Kunieda T. Cat-scratch disease presenting as a solitary splenic abscess in an elderly man. Case Rep. 24 Mart 2015;2015:bcr2015209597. doi: 10.1111/j.1749-6632.2003.tb07399.x.
Liu YH, Liu CP, Lee CM. Splenic abscesses at a tertiary medical center in Northern Taiwan. Journal of microbiology, immunology, and infection. 2014;47(2):104-108. doi: 10.1016/j.jmii.2012.08.027
Seng P, Quenard F, Menard A, Heyries L, Stein A. Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing. International Journal of Infectious Diseases. 2014;29:238-240. doi: 10.1016/j.ijid.2014.09.014
Sangchan A, Mootsikapun P, Mairiang P. Splenic abscess: clinical features, microbiologic finding, treatment and outcome. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2003;86(5):436-441.
Ng CY, Leong EC, Chng HC. Ten-year series of splenic abscesses in a general hospital in Singapore. Annals of the Academy of Medicine, Singapore. 2008;37(9):749-752.
Chang KC, Chuah SK, Changchien CS, et al. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan. World Journal of Gastroenterology. 2006;12(3):460-464. doi: 10.3748/wjg.v12.i3.460
Lee CH, Leu HS, Hu TH, et al. Splenic abscess in southern Taiwan. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2004;37(1):39-44.
Chiang IS, Lin TJ, Chiang IC, et al. Splenic abscesses: review of 29 cases. The Kaohsiung journal of medical sciences. 2003;19(10):510-515. doi: 10.1016/S1607-551X(09)70499-1
Tomar LR, Rajendran R, Pandey SK, et al. Splenic abscess: Plasmodium vivax with secondary Escherichia coli infection. Tropical doctor. 2015;45(2):143-145. doi: 10.1177/0049475514561507
Chandran J, Agarwal I, Rose W. Klebsiella splenic abscess complicating Plasmodium vivax malaria. The Pediatric infectious disease journal. 2015;34(5):551. doi: 10.1097/INF.0000000000000674
André MFJ, Piette JC, Kémény JL, et al. Aseptic abscesses: a study of 30 patients with or without inflammatory bowel disease and review of the literature. Medicine (Baltimore). 2007;86(3):145-161. doi: 10.1097/md.0b013e18064f9f3
Johnson JD, Raff MJ, Drasin GF, et al. Radiology in the diagnosis of splenic abscess. Reviews of Infectious Diseases. 1985;7(1):10-20. doi: 10.1093/clinids/7.1.10
Changchien CS, Tsai TL, Hu TH, et al. Sonographic patterns of splenic abscess: an analysis of 34 proven cases. Abdominal imaging. 2002;27(6):739-745. doi: 10.1007/s00261-002-0013-7
Schattner A, Adi M. Dangerous Proximity: Splenic Infarction After Abdominal Abscess. The American Journal of Medicine. 2015;128(2):e7-8. doi: 10.1016/j.amjmed.2014.10.024
Buecker A, Neuerburg JM, Adam GB, et al. MR-guided percutaneous drainage of abdominal fluid collections in combination with X-ray fluoroscopy: initial clinical experience. European radiology. 2001;11(4):670-674. doi: 10.1007/s003300000693
Venkataramu NK, Gupta S, Sood BP, et al. Ultrasound guided fine needle aspiration biopsy of splenic lesions. British Journal of Radiology. 1999;72(862):953-956. doi: 10.1259/bjr.72.862.10673946
Tarantino L, Giorgio A, de Stefano G, et al. Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen. Abdominal imaging. 2003;28(5):602-608. doi: 10.1007/s00261-003-0035-9
Splenic abscess. In: The Sanford Guide to Antimicrobial Therapy[mobile app]. 2024.
Gerzof SG, Robbins AH, Johnson WC, et al. Percutaneous catheter drainage of abdominal abscesses: a five-year experience. The New England journal of medicine. 1981;305(12):653-657. doi: 10.1056/NEJM198109173051201
Liu KY, Shyr YM, Su CH, et al. Splenic abscess--a changing trend in treatment. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie. 2000;38(3):55-57.
Kang M, Kalra N, Gulati M, et al. Image guided percutaneous splenic interventions. European journal of radiology. 2007;64(1):140-146. doi: 10.1016/j.ejrad.2007.02.011
Ferraioli G, Brunetti E, Gulizia R, et al. Management of splenic abscess: report on 16 cases from a single center. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2009;13(4):524-530. doi: 10.1016/j.ijid.2008.08.024
Choudhury SR, Debnath PR, Jain P, et al. Conservative management of isolated splenic abscess in children. Journal of pediatric surgery. 2010;45(2):372-375. doi: 10.1016/j.jpedsurg.2009.10.074
Faruque AV, Qazi SH, Arshad M, et al. Isolated splenic abscess in children, role of splenic preservation. Pediatric surgery international. 2013;29(8):787-790. doi: 10.1007/s00383-013-3336-2
Sreekar H, Saraf V, Pangi AC, et al. A Retrospective Study of 75 Cases of Splenic Abscess. The Indian journal of surgery. 2011;73(6):398-402. doi: 10.1007/s12262-011-0370-y
Referanslar
Bernabeu-Wittel M, Villanueva JL, Pachón J, et al. Etiology, clinical features and outcome of splenic microabscesses in HIV-infected patients with prolonged fever. European Journal of Clinical Microbiology and Infectious Diseases. 1999;18(5):324-329. doi: 10.1007/pl00015013
Altemeier WA, Culbertson WR, Fullen WD, et al. Intra-abdominal abscesses. The American Journal of Surgery. 1973;125(1):70-79.
Ooi DQH, Ooi JQC, Ooi LLPJ. Splenic abscesses in the new millenium - a systematic review. ANZ Journal of Surgery. 2024. doi: 10.1111/ans.19178
Alonso Cohen MA, Galera MJ, Ruiz M, et al. Splenic abscess. World journal of surgery. 1990;14(4):513-6; discussion 516-517. doi: 10.1007/BF01658678
Paris S, Weiss SM, Ayers WH, et al. Splenic abscess. The American surgeon. 1994;60(5):358-361.
Nelken N, Ignatius J, Skinner M, et al. Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature. The American Journal of Surgery. 1987;154(1):27-34. doi: 10.1016/0002-9610(87)90285-6
Chun CH, Raff MJ, Contreras L, et al. Splenic abscess. Medicine (Baltimore). 1980;59(1):50-65. doi:10.1097/00005792-198001000-00003
Lee WS, Choi ST, Kim KK. Splenic Abscess: A Single Institution Study and Review of the Literature. Yonsei Medical Journal. 2011;52(2):288-292. doi: 10.3349/ymj.2011.52.2.288
Lee MC, Lee CM. Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution. Canadian Journal of Infectious Diseases and Medical Microbiology. 2018;2018:8610657. doi:10.1155/2018/8610657
McOwat L, Wong KF, Varughese GI, et al. Splenic abscess as a potential initial manifestation of quiescent infective endocarditis in a patient with bronchopneumonia. BMJ Case Reports. 2015;2015:bcr2014206794. doi: 10.1136/bcr-2014-206794.
Fernández Guerrero ML, Álvarez B, Manzarbeitia F, et al. Infective endocarditis at autopsy: a review of pathologic manifestations and clinical correlates. Medicine (Baltimore). 2012;91(3):152-164. doi: 10.1097/MD.0b013e31825631ea
Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. The American Journal of Surgery. 1997;174(1):87-93. doi: 10.1016/s0002-9610(97)00030-5
Green BT. Splenic abscess: report of six cases and review of the literature. The American surgeon. 2001;67(1):80-85.
Hung SK, Ng CJ, Kuo CF, et al. Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department. PloS One. 2017;12(11):e0187495. doi: 10.1371/journal.pone.0187495
Sillar JR, Bannan AM, Dahlenburg L. Splenic abscess complicating gastroenteritis due to Salmonella Virchow in an immunocompetent host. The Medical Journal of Australia. 2015; 203 (3): 148-149. doi: 10.5694/mja15.00068
Chen CY, Yang PJ. Splenic Tuberculosis. The New England Journal of Medicine. 2023;388(4):e6. doi: 10.1056/NEJMicm2206174
Rolain JM, Chanet V, Laurichesse H, et al. Cat scratch disease with lymphadenitis, vertebral osteomyelitis, and spleen abscesses. Annals of the New York Academy of Sciences. 2003;990:397-403.
Nakamura M, Kurimoto M, Kato T, Kunieda T. Cat-scratch disease presenting as a solitary splenic abscess in an elderly man. Case Rep. 24 Mart 2015;2015:bcr2015209597. doi: 10.1111/j.1749-6632.2003.tb07399.x.
Liu YH, Liu CP, Lee CM. Splenic abscesses at a tertiary medical center in Northern Taiwan. Journal of microbiology, immunology, and infection. 2014;47(2):104-108. doi: 10.1016/j.jmii.2012.08.027
Seng P, Quenard F, Menard A, Heyries L, Stein A. Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing. International Journal of Infectious Diseases. 2014;29:238-240. doi: 10.1016/j.ijid.2014.09.014
Sangchan A, Mootsikapun P, Mairiang P. Splenic abscess: clinical features, microbiologic finding, treatment and outcome. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2003;86(5):436-441.
Ng CY, Leong EC, Chng HC. Ten-year series of splenic abscesses in a general hospital in Singapore. Annals of the Academy of Medicine, Singapore. 2008;37(9):749-752.
Chang KC, Chuah SK, Changchien CS, et al. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan. World Journal of Gastroenterology. 2006;12(3):460-464. doi: 10.3748/wjg.v12.i3.460
Lee CH, Leu HS, Hu TH, et al. Splenic abscess in southern Taiwan. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2004;37(1):39-44.
Chiang IS, Lin TJ, Chiang IC, et al. Splenic abscesses: review of 29 cases. The Kaohsiung journal of medical sciences. 2003;19(10):510-515. doi: 10.1016/S1607-551X(09)70499-1
Tomar LR, Rajendran R, Pandey SK, et al. Splenic abscess: Plasmodium vivax with secondary Escherichia coli infection. Tropical doctor. 2015;45(2):143-145. doi: 10.1177/0049475514561507
Chandran J, Agarwal I, Rose W. Klebsiella splenic abscess complicating Plasmodium vivax malaria. The Pediatric infectious disease journal. 2015;34(5):551. doi: 10.1097/INF.0000000000000674
André MFJ, Piette JC, Kémény JL, et al. Aseptic abscesses: a study of 30 patients with or without inflammatory bowel disease and review of the literature. Medicine (Baltimore). 2007;86(3):145-161. doi: 10.1097/md.0b013e18064f9f3
Johnson JD, Raff MJ, Drasin GF, et al. Radiology in the diagnosis of splenic abscess. Reviews of Infectious Diseases. 1985;7(1):10-20. doi: 10.1093/clinids/7.1.10
Changchien CS, Tsai TL, Hu TH, et al. Sonographic patterns of splenic abscess: an analysis of 34 proven cases. Abdominal imaging. 2002;27(6):739-745. doi: 10.1007/s00261-002-0013-7
Schattner A, Adi M. Dangerous Proximity: Splenic Infarction After Abdominal Abscess. The American Journal of Medicine. 2015;128(2):e7-8. doi: 10.1016/j.amjmed.2014.10.024
Buecker A, Neuerburg JM, Adam GB, et al. MR-guided percutaneous drainage of abdominal fluid collections in combination with X-ray fluoroscopy: initial clinical experience. European radiology. 2001;11(4):670-674. doi: 10.1007/s003300000693
Venkataramu NK, Gupta S, Sood BP, et al. Ultrasound guided fine needle aspiration biopsy of splenic lesions. British Journal of Radiology. 1999;72(862):953-956. doi: 10.1259/bjr.72.862.10673946
Tarantino L, Giorgio A, de Stefano G, et al. Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen. Abdominal imaging. 2003;28(5):602-608. doi: 10.1007/s00261-003-0035-9
Splenic abscess. In: The Sanford Guide to Antimicrobial Therapy[mobile app]. 2024.
Gerzof SG, Robbins AH, Johnson WC, et al. Percutaneous catheter drainage of abdominal abscesses: a five-year experience. The New England journal of medicine. 1981;305(12):653-657. doi: 10.1056/NEJM198109173051201
Liu KY, Shyr YM, Su CH, et al. Splenic abscess--a changing trend in treatment. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie. 2000;38(3):55-57.
Kang M, Kalra N, Gulati M, et al. Image guided percutaneous splenic interventions. European journal of radiology. 2007;64(1):140-146. doi: 10.1016/j.ejrad.2007.02.011
Ferraioli G, Brunetti E, Gulizia R, et al. Management of splenic abscess: report on 16 cases from a single center. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2009;13(4):524-530. doi: 10.1016/j.ijid.2008.08.024
Choudhury SR, Debnath PR, Jain P, et al. Conservative management of isolated splenic abscess in children. Journal of pediatric surgery. 2010;45(2):372-375. doi: 10.1016/j.jpedsurg.2009.10.074
Faruque AV, Qazi SH, Arshad M, et al. Isolated splenic abscess in children, role of splenic preservation. Pediatric surgery international. 2013;29(8):787-790. doi: 10.1007/s00383-013-3336-2
Sreekar H, Saraf V, Pangi AC, et al. A Retrospective Study of 75 Cases of Splenic Abscess. The Indian journal of surgery. 2011;73(6):398-402. doi: 10.1007/s12262-011-0370-y
