Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients.
OBJECTIVE
To analyze the results of ultrasound guided percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess.


METHODS
Thirty-six patients (14 females and 22 males, with an average age of 54.1 +/- 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess > or = 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed.


RESULTS
Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure.


CONCLUSIONS
Percutaneous treatment of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those > or = 50 mm in diameter and for bilocular abscesses.
Zerem
Enver
E
Interventional Ultrasonography Department, The University Clinical Centar Tuzla, Trnovac BB, Tuzla 75000, Bosnia and Herzegovina. zerem@inet.ba
Bergsland
Jacob
J
D018784:Abdominal Abscess / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013158:Splenic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D013396:Suction / Q000379:methods; D013492:Suppuration / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014463:Ultrasonography
D000900:Anti-Bacterial Agents