Splenic abscesses from 1987 to 1995.

BACKGROUND: Isolated splenic abscesses is an uncommon clinical entity that is being increasingly recognized as a cause of intraabdominal sepsis in a wide variety of clinical situations, and involving a wide range of organisms. The increasing incidence of immunosuppressed states in this decade due to the use of chemotherapy for oncology, immunosuppression therapy for transplantation, and acquired immune deficiency syndrome, has changed the disease pattern of splenic abscesses.

METHOD: Data from 287 cases reported in the English literature between 1987 and 1995 were collected, analyzed, and compared with two previous reviews of cases reported before 1987.

RESULTS: Staphylococcus, Salmonella, and Escherichia coli are the most common organisms cultured. Immunosuppressed states were present in 33.5% of cases, with intravenous drug abuse and acquired immune deficiency syndrome accounting for half these cases. Computerized tomography and ultrasonography are diagnostic, with a sensitivity of 92.2% and 87.2%, respectively. Nonoperative management has a success rate of less than 65%, but salvage splenectomy does not increase mortality compared with splenectomy as initial therapy.

CONCLUSIONS: Splenic abscesses are increasingly recognized with immunosuppressed states. Percutaneous radiologically guided drainage may be suitable in some cases, but splenectomy with appropriate antibiotics is the definitive treatment.