Kevin Bain, DO, Vadim Meytes, DO, David Parizh, DO, Sampath Kumar, MD. NYU Langone Hospital – Brooklyn
Introduction: Splenic abscess is a rare, potentially lethal condition, with autopsy studies showing incidence rates between 0.14 – 0.7%. Mortality rates ranging from 47-100% making early diagnosis and prompt intervention vital. Several case reports have documented post surgical splenic abscess, most notably after laparoscopic sleeve gastrectomy. To the best of our knowledge, there has not been any reported cases of splenic abscess arising after laparoscopic cholecystectomy. It is important to remember this disease process for expeditious targeted treatment in future cases.
Case Presentation: A 69 year-old female with past medical history significant for cholilithiasis, hypertension, and hyperlipidemia presented to the emergency department (ED) with a chief complaint of abdominal pain for two days. Labs and imaging were obtained which confirmed the diagnosis of choledocholithiasis and pancreatitis. ERCP was performed which showed a 1.5 cm stone causing obstruction, with several other smaller filling defects. The stones were removed after sphincterotomy. Post procedurally, the patient underwent an uncomplicated laparoscopic cholecystectomy on Hospital Day (HD) #5.
Post operatively, the patient had persistent leukocytosis peaking at 16.8 thousand on postoperative day (POD) #6. A CT scan was performed which showed a rim-enhancing splenic collection measuring 6.6 x 2.2 cm suggestive of an abscess.
Interventional radiology was consulted and aspirated 50 ml of purulent fluid. Cultures grew out Klebsiella pneumoniae and Enterobacter cloacae complex, and the patient was discharged home on Zosyn.
Discussion: Laparoscopic cholecystectomy has become the cornerstone in treatment of symptomatic biliary colic and acute cholecystitis. Of the many recognized complications of laparoscopic cholecystectomy, splenic abscess has not yet been reported in current literature.
The nonspecific signs and symptoms of splenic abscess make clinical diagnosis difficult. The classic triad of fever, palpable spleen and left upper quadrant pain are only seen in about two-thirds of patients. CT scan has been shown to be the most sensitive imaging modality for diagnosis of splenic abscess.
Current treatment options for splenic abscess are broken down into two subsets: percutaneous and surgical intervention. Percutaneous treatment includes image guided aspiration with or without placement of drainage catheter. Surgical intervention can be either laparoscopic or open and includes drainage of abscess with splenectomy or splenic conservation. The best treatment option remains unclear, and there is lacking prospective data demonstrating which modality is superior.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84833
Program Number: P111
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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