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Case Reports
. 2021 Feb:79:160-163.
doi: 10.1016/j.ijscr.2020.12.081. Epub 2021 Jan 15.

Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature

Giuseppe Evola  1 , Enrico Piazzese  2 , Roberto Cantella  2 , Marianna Iudica  2 , Gastone Veroux  2 , Salvatore Sarvà  2
Affiliations
Case Reports

Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature

Giuseppe Evola et al. Int J Surg Case Rep. 2021 Feb.

Abstract

Introduction and importance: Splenic abscess (SA) is an uncommon, life-threatening disease with about 600 reported cases in the literature. It is caused by various infective pathogens and generally occurs in immunocompromised patients. SA is a rare complication of non-typhoid Salmonella (NTS) infection. Diagnosis of ruptured SA is a challenge because the absence of specific symptoms and signs. Abdominal computed tomography (CT) scan represents the gold standard in diagnosing of SA. Splenectomy is the treatment of choice of ruptured SA with peritonitis.

Case presentation: A 26-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain and fever. Physical examination revealed severe and generalized abdominal pain on superficial and deep palpation with obvious muscle guarding and rebound tenderness. Abdominal CT scan showed ruptured SA. Laboratory tests reported anemia (hemoglobin 10.4 g/dl). The patient was taken emergently to the operating room for splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of NTS SA was made by pus cultures.

Clinical discussion: SA is a rare complication of NTS infection associated with high morbidity and mortality rates. Although different types of treatment of SA are reported in the literature, splenectomy represents the treatment of choice of ruptured SA.

Conclusion: NTS SA is difficult to diagnose because of its rarity and non-specific clinical presentation, often fatal if left untreated. Although there is no gold standard for treating SA, splenectomy with peritoneal lavage is mandatory in case of ruptured SA with peritonitis.

Keywords: Case report; Non-typhoid Salmonella; Peritonitis; Ruptured splenic abscess; Splenectomy; Splenic abscess.

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Figures

Fig. 1
Fig. 1
Abdominal CT scan showing a voluminous ruptured splenic abscess.
Fig. 2
Fig. 2
Voluminous ruptured splenic abscess with frank pus in the peritoneal cavity: operative findings.
Fig. 3
Fig. 3
(a,b). The ruptured abscess visualized at the upper pole of the surgically removed spleen.
Fig. 4
Fig. 4
Photomicrograph section of abscessed splenic cyst (haematoxylin and eosin, original magnification × 40).
Fig. 5
Fig. 5
Photomicrograph section of subcapsular splenic inflammation (haematoxylin and eosin, original magnification × 20).
See this image and copyright information in PMC

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