Delayed intra splenic abscess after laparoscopic sleeve gastrectomy (LSG) is a very rare complication with poor manifestations. We present three cases of delayed intrasplenic abscess which were managed in our departmentof minimal invasive surgery. Splenic abscess may occur in the early post-operative period following LSG; it is usually an extra splenic event after the gastric leak or an infected hematoma. In our cases, two patients had an asymptomatic ischemic demarcation in the upper part of the spleen. This underlines the possible role of ischemia as a factor in abscess formation of late intrasplenic abscesses that enhanced by a state of transient immune suppression. Intrasplenic abscess complicating laparoscopic sleeve gastrectomy is different from early extra splenic abscesses. The exact causes are still unclear; the role of partial splenic ischemia has to be rolled out.

Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy

The spleen has been recently reported as one of the unusual extrapulmonary organs that can be affected by COVID-19. Different splenic lesions were described in COVID-19 patients. Herein, we summarize a few recent reports that have described splenic lesions in association with COVID-19. Splenic infarction was reported frequently, ruptured spleen and splenic abscess were also reported. Splenic involvement in COVID -19 can be caused through direct virus damage of the spleen and/or COVID-19 induced microvascular thrombosis and vasculitis.The hypercoagulable state induced by COVID-19 virus lead to splenic artery or vein thrombosis and splenic infarction development due to splenic hypoperfusion. The spleen may be an extrapulmonary target of COVID-19 virus and abdominal pain is alarming in COVID-19 infection, it may indicate a serious condition. Computed tomography (CT) abdomen is helpful in diagnosis of splenic complications secondary to COVID-19. Early diagnosis and intervention is life saving in most of these patients. Emergency surgical laparotomy and splenectomy is life-saving in these cases.

https://aeji.journals.ekb.eg/article_152936_da1812496741673bb5b47f3bcfbc41c5.pdf

The Spleen as an Extrapulmonary Target of COVID-19.

INTRODUCTION : Les abces superficiels representent un motif de consultation regulier en medecine generale, necessitant un peu de pratique pour une prise en charge optimale. Si leur traitement est relativement protocolise, qu’en est-il reellement en pratique ? L’objectif de notre etude est de determiner quelle est la pratique des medecins generalistes en region Bretagne concernant la prise en charge des abces superficiels. METHODE : Il s’agit d’une etude quantitative prospective a destination des medecins generalistes bretons. Nous avons inclus 388 medecins generalistes et avons etudie leur prise en charge concernant les abces superficiels a partir d’un questionnaire en ligne. RESULTATS : Parmi les 388 medecins ayant repondu, entre le 15 septembre et le 25 novembre 2017, 140 (36,08%) prescrivaient un antibiotique, 195 (50,26%) incisaient. Les medecins les plus âges incisaient plus (p 0,05). En revanche, les prescriptions d’antibiotiques etaient statistiquement les memes dans chacun des differents groupes. CONCLUSION : Cette etude montre un nombre de prescriptions d’antibiotiques trop important et trop peu d’incisions des abces superficiels, engendrant un retard a une prise en charge efficace des abces des tissus mous. Il conviendrait de rassurer les medecins generalistes sur la realisation d’incisions au cabinet et de rappeler les protocoles de prise en charge des abces superficiels.

https://dumas.ccsd.cnrs.fr/dumas-02140825/document

Qualité de la prise en charge des abcès superficiels par les médecins généralistes en région Bretagne, intérêt d’une formation

Pierce the ear and stab the spleen

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

Splenic abscess is septic collection which occurs after haematogenous spread or local dissemination. Splenic abscess is an uncommon and rare condition, more frequently affecting male and immunocompromised patients. There are no guidelines regarding its diagnosis and management. Computed tomography (CT) scan is highly sensitive and specific (95% and 92%, respectively) in the diagnosis of splenic abscess. Diagnosis is based on blood cultures which are positive in 24 to 80% of cases. Bacterial growth culture of abscess after drainage is more efficient (50-80%) and can be performed after surgery or percutaneous drainage under imaging, including CT scan. Microorganisms involved are frequently enterobacteriaceae, gram-positive cocci and anaerobes. This particular ecology leads to an empiric broad-spectrum antibiotic therapy, with a variable duration, from 10days to more than one month. Management remains very close to the one applied in case of liver abscesses. The role of splenectomy in the prevention of recurrence remains controversial. We reviewed the literature regarding splenic abscesses, from diagnosis to therapy.

P. Crenn

Papers

Abcès de la rate : du diagnostic au traitement