title: Splenic abscess: outcome and prognostic factors.
abstract: OBJECTIVE
  To determine the spectrum of presentation, treatment outcome and prognostic factors of splenic abscess in a tertiary care hospital.
  
  
  METHODS
  Case-series.
  
  
  METHODS
  Department of General Surgery, the Aga Khan University Hospital, Karachi, from July 1988 to July 2007.
  
  
  METHODS
  The records of 27 patients with splenic abscess, diagnosed from 1988 to 2007, were retrieved through ICD-10 coding system. The demographic data, physical and radiological findings, treatment modalities, bacteriology reports, morbidity and mortality were collected on a proforma.
  
  
  RESULTS
  There were 12 males and 15 females with a mean age of 43.52+/-17.49 years. Common symptoms were fever (92.6%), abdominal pain (55.6%) and malaise (29.6%). Majority of patients (89%) had leukocytosis and 63% patients had associated diseases with which they were admitted. The most common pathogenic organism was Staphylococcus species and gram-negative rods. Ultrasound was used as a preliminary diagnostic modality, which was often followed by CT scan. Thirteen patients were treated with intravenous antibiotics, 8 underwent percutaneous drainage and 6 patients required splenectomy with respective survival rates of 84%, 87.5% and 83%. Mortality rate was 14.81% but no statistically significant difference between 3 treatment groups was manifested. There was significant difference between treatment groups regarding the size of the abscess (p=0.01) and hospital stay (p=0.04). Splenectomy was done when abscess size was >10 cm and hospital stay were increased in the radiological drainage group.
  
  
  CONCLUSIONS
  Splenic abscess is an uncommon surgical entity. High index of suspicion and liberal use of radiological studies is essential for timely diagnosis. Most of the patients could be cured with non-operative treatment. Splenectomy is a safe procedure for patients with abscess size more than 10 cm and patients not responding to non-operative treatment.
authors.affiliation: Department of Surgery, The Aga Khan University Hospital, Karachi. rehman.alvi@aku.edu
authors.forename: Abdul Rehman
authors.initials: AR
authors.lastname: Alvi
authors.forename: Shazia
authors.initials: S
authors.lastname: Kulsoom
authors.forename: Ghina
authors.initials: G
authors.lastname: Shamsi
mesh_terms: D000038:Abscess; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013158:Splenic Diseases / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome