Management of splenic abscess in children by percutaneous drainage.
OBJECTIVE
Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics.


METHODS
Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. Ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. Ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew Escherichia coli in 1 case, Salmonella paratyphi A in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks.


RESULTS
All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy.


CONCLUSIONS
Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.
Choudhury S
Roy
R
Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India. roychouin@yahoo.co.in
Rajiv
Chadha
C
Pitamber
Sonker
S
Akshay
Sharma
S
Dharmendra
Singh
S
D000038:Abscess / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D004322:Drainage; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010284:Paratyphoid Fever / Q000188:drug therapy*; D012482:Salmonella paratyphi A / Q000302:isolation & purification; D013158:Splenic Diseases / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents