Splenic abscess in the intensive care unit

H. S. Ho and D. H. Wisner
Department of Surgery, University of California at Davis Medical Center, Sacramento.

BACKGROUND AND METHODS: From 1980 through 1990, nine patients developed de novo splenic abscess during their stay in our intensive care unit (ICU), representing the first series of such reported cases. RESULTS: All nine patients were septic prior to the diagnosis of splenic abscess. The signs and symptoms of splenic abscess commonly described in the literature were of little help in detecting this pathology in ICU patients. Mean +/- SD platelet count, however, increased significantly, from 274 x 10(9)/L +/- 50 x 10(9)/L at admission to 647 x 10(9)/L +/- 94 x 10(9)/L at diagnosis. At diagnosis, left pleural effusion was present in all patients. Only three patients had detectable left upper quadrant tenderness. Abdominal computed tomographic scans, when used, were diagnostic in all cases. All patients were treated by splenectomy; eight had a solitary abscess. Six abscesses were caused by enteric organisms, two by Staphylococcus aureus, and one by Streptococcus epidermidis. Eight patients (89%) had had the offending organism previously isolated from their blood or from another infected site. Mortality was 45%. CONCLUSIONS: Splenic abscess, although a rare clinical entity, does occur de novo in ICU patients and is associated with significant mortality. Unexplained thrombocytosis in a septic ICU patient with persistent left pleural effusion is suggestive of splenic abscess. Previous culture and sensitivity results are useful in guiding perioperative antibiotic choices.