Splenic necrosis requiring ultrasound-guided drainage following meningococcal septicaemia

Abstract

Splenic necrosis is an extremely rare complication in the context of meningococcal septicaemia and disseminated intravascular coagulopathy. We present the case of a previously healthy 22-year-old male who was diagnosed and treated for meningococcal septicaemia. He represented 4 days following discharge with significant splenic necrosis and associated abscess formation despite previously unremarkable imaging on his first admission. The splenic collection was successfully treated with ultrasound-guided percutaneous drainage. We discuss the leading causes of atraumatic splenic infarction and the recent shift towards treating splenic necrosis with minimally invasive procedure.

Figure 1:

Abdominal ultrasound performed on re-presentation revealed a grossly abnormal spleen (block arrow) with complete fluid replacement of the splenic tissue.

Figure 2:

Extensive splenic necrosis with associated abscess formation on the axial section of CT abdomen/pelvis (block arrow). The splenic collection was contained inside an expanded splenic capsule (arrowhead). There was no free fluid inside the abdominal cavity.

Figure 3:

Coronal section of the CT angiogram providing another view of the splenic collection (block arrow). No residual enhancing splenic tissue was present. There was no splenic artery aneurysm.