Splenic abscess and sickle cell disease

Abstract

This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease (SCD). Ali presented with fever end abdominal pain end were found to have a tender enlarge spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation. Although both ultrasound and CT-scan of the abdomen were of diagnostic value, we found CT-scan more accurate and reliable in the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be used routinely in the evaluation of SCD patients who present with and abdominal pain, especially if they have a tender enlarged spleen. Diagnostic aspiration under CT-scan or ultrasound guidance should be used in doubtful cases to differentiate between splenic abscess and a large splenic infarct. All our patients were managed by perioperative antibiotics and splenectomy with no mortality, Salmonella was the commonest causative organism. Although CT-guided aspiration of splenic abscess being advocated recently, we feel splenectomy should be the treatment of choice in patients with SCD as there is no point in preserving a non- functioning spleen that is present in the majority of patients. CT-guided aspiration may be employed as a temporary measure for those patients who are at high surgical risk with unilocular abscess.