Abscess of the spleen (according to ICD-10 - D73.3) is a special formation in this organ, which consists of a capsule that limits the purulent exudate from the surrounding tissue. As a result of its formation, the patient develops symptoms of increasing intoxication, which is expressed in fever, and, in addition, in severe weakness, pain in the left hypochondrium and vomiting.
Causes of spleen abscess
Why does this pathology occur?
Staphylococci and streptococci often become the cause of a purulent, and at the same time, an inflammatory process in the spleen. Thus, the primary cause of the formation of a purulent cavity is an infectious process, which is most often caused by such microscopic organisms as staphylococcus, streptococcus and salmonella. In rarer situations, the infectious agent is one or anotherGram-negative bacteria along with fungi. Specialists distinguish the following basic causes of an abscess in the tissues of the spleen:
- The presence of infectious diseases in the form of typhoid or relapsing fever, malaria, diphtheria, scarlet fever and the like.
- The patient has open injuries and bruises of the spleen.
- Metastatic abscesses of the spleen in sepsis.
- Due to postpartum sepsis, infectious left-sided paranephritis, gastric ulcer.
- In the presence of abscesses in the abdominal cavity, and, in addition, against the background of cystitis, osteomyelitis, pyelonephritis, sepsis, stomach cancer, etc.
- Against the background of a spleen infarction.
- Due to inflammatory diseases of the urogenital area.
- In the presence of benign or malignant tumors of this organ.
- In the presence of echinococcosis of the spleen (that is, with suppuration of the spleen cyst).
- Due to impaired venous circulation.
Symptomatology of this dangerous pathology
The occurrence of a spleen abscess is variable and directly depends on the area of localization of purulent foci, their size, and, in addition, on the scale of the affected tissues. This process can occur rapidly and is usually accompanied by intense manifestations. Symptoms of a spleen abscess:
- Rapid increase in temperature to high levels (usually over thirty-nine degrees).
- The patient has severe weakness and chills.
- The appearance of tachycardia.
- Significant deterioration orabsolute lack of appetite.
- The onset of headache and dizziness.
- The appearance of severe indigestion along with vomiting, nausea and diarrhea. The pathogenesis of a splenic abscess actively proceeds against the background of these symptoms.
- Occurrence of dry mouth and thirst.
- The appearance of signs of reactive pleurisy along with pain in the left side of the chest when the abscess is localized in the upper region of the organ.
- The presence of tension in the abdominal muscles and pain in the left hypochondrium, in the case of the location of the pathological focus in the lower region of the organ.
- The occurrence of pain sensations of various localization and intensity. Such pain is always felt brighter in the left hypochondrium, becomes much stronger when breathing, and can radiate to the shoulder blade and left collarbone.
Possible complications due to pathology
In some cases, when the spleen abscess comes into contact with the walls of the intestine, fistulas form, provoking vascular ruptures along with bleeding. When the purulent area ruptures and the exudate flows into the abdominal region, the patient develops peritoneal symptoms in the form of cold sweat, adynamia, bluing of the mucous membranes and muscle tension in the region of the anterior abdominal wall.
What is this process accompanied by?
Sometimes the rupture of an abscess may be accompanied by the ingress of pus into the lumen of the stomach, urinary organs, bronchi and intestines. Subsequently, in such patients, purulent exudate may be found in sputum, feces or vomit, as well as inurine.
Pleural empyema
In case of pus flowing into the pleural region, the patient develops pleural empyema. Diffuse peritonitis, which is caused by a breakthrough of the abscess in the abdominal region, leads to the penetration of the pathogen into the blood, then the patient soon develops sepsis.
Diagnosis of this disease
Find out exactly the location along with the size of the abscess of the spleen will help to conduct computed tomography. This is the most effective diagnostic method. Identification of abscess of the spleen without the use of instrumental methods of examination is often difficult. In order to confirm the diagnosis, the following studies are carried out:
- Ultrasound examination of the spleen reveals signs of low echogenicity of the organ. The spleen may look like a dark spot. Blood clots along with gas bubbles can be detected directly in the abscess cavity.
- An overview of the chest and abdomen is also taken. In the case of gas in the abscess cavity, darkening of the subphrenic space is detected in patients on the left.
- Computed tomography gives the most accurate picture of the location of the pathological focus.
- Isotope radionuclide scintigraphy visualizes the exact location as well as the structure of the abscess in a clear two-dimensional image produced by radiation.
Lab tests for abscess
Lab tests for an abscesscarried out to confirm the diagnosis. They are helpful diagnostic tools. We are talking about a biochemical and clinical analysis of blood, as well as the study of feces.
Abscess of the spleen - treatment of pathology
Treatment of pathology is only surgical. The need for surgical intervention is explained by the fact that the appearance of pus in this organ, along with the threat of rupture of the cavity, is always a serious risk to the general he alth of the patient. The operation can be performed using different methods. It is carried out in a planned or urgent manner. True, even a planned type of intervention does not mean at all that it can be postponed for a long time. The technique of surgical treatment of abscess of the spleen directly depends on the area of localization of the formed purulent area.
Types of operations for this disease
So, there are the following types of operations:
- Percutaneous drainage and debridement of abscess. This operation can be performed in the presence of single abscesses no larger than five centimeters in size, as well as in case of contraindications to classical access to the organ through laparotomy. The intervention is carried out under the mandatory control of computed tomography or ultrasound. A puncture needle is inserted into the abscess, then the pus is removed and an antibiotic is injected into the cavity.
- Performing a splenectomy. This technique involves the absolute removal of an organ with an abscess. Indications for the appointment of this technique are casesmultiple abscesses along with complete purulent fusion of the tissues of the spleen. Such an operation is performed in cases where the patient does not have peritonitis, and the spleen tissues are not fused with other organs (that is, when the organ remains completely mobile). At the end of the intervention, the patient is prescribed serious antibiotic therapy. Sometimes after the operation, the patient undergoes another intervention, which consists in the return of a he althy part of the organ. Such a measure is required to maintain immunity.
Surgical access to the diseased organ during laparotomy is chosen depending on the location of the purulent cavity:
- When the purulent cavity is located in the lower pole, the operation is performed by the transperitoneal method after an incision in the abdominal wall.
- When the purulent cavity is in the upper pole, the operation is performed by the transthoracic method immediately after the chest incision.
After the operation, the patient is prescribed symptomatic therapy, which consists in taking painkillers. Detoxification agents, antibiotics, transfusion of protein hydrolysates and blood products are also additionally prescribed. Further, the patient is recommended a rehabilitation course of therapy along with the observance of certain rules that provide a sparing regimen. For example, avoid taking baths, saunas, driving a car, exercising and working.
Recoverypatients after surgery for this pathology
What are the consequences of a spleen abscess? Let's take a closer look at this issue.
Absolute recovery of the patient after timely and uncomplicated treatment usually takes approximately thirty to forty-five days. In most situations, patients fully return to their rhythm of life after two months. But in the event that the disease is additionally complicated by peritonitis, an abscess rupture or sepsis, then the patient's general condition may deteriorate sharply, up to coma. In this regard, the further forecast can be extremely disappointing. Untimely surgical intervention in one hundred percent of cases leads to the death of the patient.
Prevention of this disease
Carrying out timely and adequate treatment of infectious diseases of different localization is one of the methods for preventing spleen abscess disease. The main preventive measures aimed at preventing the occurrence of pathology are the timely detection of its diseases and the prevention of all kinds of injuries. In addition, patients with diseases of this organ should adhere to the following tips:
- It is necessary to promptly treat all pathologies that can cause infection in the spleen.
- Regular immune treatments required.
- You should have regular check-ups with a doctor, and, in addition, take blood tests, following all the recommendations of a specialist.
- Requiredreduce to a minimum the consumption of alcoholic beverages, as well as the number of cigarettes smoked. And it is better to give up these habits.
- It is recommended to adhere to proper nutrition, which should provide the body with all the necessary components and trace elements.
- It is equally important to observe the water regime, that is, take at least two liters of fluid per day.
Thus, following all the above recommendations, you will be able to protect yourself from such a serious and dangerous condition as a spleen abscess.
