Isolated splenic abscess in children, role of splenic preservation

Abstract

Purpose: Splenic abscess (SA) is rare life threatening clinical condition in children. Diagnosis is delayed because of its non-specific clinical presentation. It has a high mortality rate even in the era of antibiotics. This study aim to determine the role of splenic preservation in the management of isolated splenic abscess in children, and to compare different treatment modalities for it.

Methods: A retrospective cross-sectional study of 20 years was conducted including all children <14 years of age with the principal diagnosis of "Splenic abscess". We have excluded all splenic abscesses occurring after penetrating or blunt abdominal trauma.

Results: Total of 17 children were managed during the study period. Most of our patients were older than 10 years of age. Majority of patients had a significant delay in presentation. Fever, abdominal pain, and vomiting were the main mode of presentation. Splenomegaly on abdominal examination was present in 12 patients. 15 (88 %) children were managed conservatively; however, 2 children required surgical intervention.

Conclusion: Splenic abscess in children is a rare disease and its diagnosis is often delayed. Delay in diagnosis of SA in children can lead to life threatening complications. A high index of suspicion is needed to reduce delay in diagnosis. Children presenting with non-specific high grade fever vomiting and abdominal pain should be evaluated for SA. Timely ultrasound and CT scan will lead to earlier diagnosis. A conservative approach with intravenous antibiotics and early percutaneous drainage especially in immunocompetent children can preserve spleen to continue immune function.