Splenic abscesses in the new millenium – a systematic review

• Published in: ANZ journal of surgery 2024-10, Vol.94 (10), p.1702-1709
• Main Authors: Ooi, Daniel Quan Hui, Ooi, Joshua Quan Chen, Ooi, London Lucien Peng Jin
• Format: Article
• Language: English
• Subjects: abdominal infections; Abscess - diagnosis; Abscess - etiology; Abscess - therapy; Abscesses; Anti-Bacterial Agents - therapeutic use; Antibiotics; COVID-19; COVID-19 - complications; Drainage - instrumentation; Drainage - methods; Embolization; Gastrointestinal surgery; Humans; Medical instruments; Metastases; Organisms; Patients; percutaneous drainage; Spleen; Splenectomy; Splenic artery; Splenic Diseases - diagnosis; Splenic Diseases - etiology; Splenic Diseases - therapy
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.19178

Background Isolated splenic abscesses are rare, but increasingly reported with newer organisms and changes in mechanisms involved. We conducted a comparative review of publications from 1900–1977, 1977–1986, 1987–1995, and 1996–2022. Methods A systematic search in Embase and PubMed resulted in 522 publications (1111 cases). Data was tabulated, analysed, and compared. Results Patient demographics and symptoms remain unchanged although more Asian patients were reported. Metastatic infections remain the main cause, but COVID‐19‐linked and iatrogenic causes post bariatric surgery and splenic artery embolization are increasingly reported. Aerobic organisms remain the commonest (68%), with a variety of exotic organisms reported. Splenectomy remains the definitive treatment, although antibiotics only and percutaneous aspiration/catheter‐drainage are increasingly used with reasonable outcomes, with salvage splenectomy for therapeutic failures not having significantly higher mortality than upfront splenectomy. Conclusions Isolated splenic abscesses continue to be uncommon, with diagnosis requiring a high degree of suspicion. Non‐surgical options for treatment can sometimes be definitive. Splenic abscesses are increasingly being reported with newer organisms and following interventions. Non‐surgical treatment options now offer reasonable outcomes, with salvage splenectomy results not that much worse than definitive splenectomy upfront.