title: [Pneumoperitoneum due to splenic abscess: a diagnostic challenge. Case Report].
abstract: BACKGROUND
  Splenic abscess is a rare clinic entity, its incidence has increased due to the rising number of clinical conditions involving immunosuppression. Endocarditis is the most frequent cause, and gram-positive aerobes are the main causal agents. Its clinical presentation is non-specific and delays diagnosis. Computed tomography scan is the method of choice, and the treatment is based on antibiotics and drainage, radiological or surgical, involving splenectomy in special cases that require it.
  
  
  METHODS
  A 55-year-old man with abdominal pain and fever. The analysis revealed leukocytosis 14,000/mm3, prothrombin activity 53%, and metabolic acidosis. Computed tomography scan showed a peri-hepatic pneumoperitoneum, liquid fluid, and peri-splenic bubbles, and slight trabeculation of fat around the duodenal bulb with pneumoperitoneum in this area. Patient underwent a median laparotomy, finding a purulent peritonitis due to a ruptured abscess in the spleen, splenectomy was performed. Fluid culture showed polymorphonuclears, with no microorganisms identified. The patient progressed and was discharged on the 5th post-operative day.
  
  
  CONCLUSIONS
  Splenic abscess is an uncommon condition, in which the diagnosis is delayed and mortality, in untreated patients, is high. Its association with pneumoperitoneum may confuse the diagnosis towards viscera perforation. Thus it must be suspected in the finding of unknown cause of pneumoperitoneum by complementary examinations. The treatment of choice is splenectomy, because the capsular rupture is the norm in all of them.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España. Electronic address: doctor@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Peña-Ros
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Méndez-Martínez
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: María
authors.initials: M
authors.lastname: Vicente-Ruiz
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Sánchez-Cifuentes
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España.
authors.forename: Nuria
authors.initials: N
authors.lastname: Martínez-Sanz
authors.affiliation: Cirugía General y del Aparato Digestivo, Universidad Católica San Antonio de Murcia, Murcia, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Albarracín Marín-Blázquez
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000038:Abscess / Q000150:complications* / Q000601:surgery; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004630:Emergencies; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012422:Rupture, Spontaneous; D013156:Splenectomy; D013158:Splenic Diseases / Q000150:complications* / Q000601:surgery; D013161:Splenic Rupture / Q000209:etiology / Q000601:surgery; D014062:Tongue Neoplasms / Q000532:radiotherapy / Q000601:surgery
keywords: Absceso esplénico; Infección; Infection; Neumoperitoneo; Pneumoperitoneum; Splenic abscess