Splenic abscess: Clinical History

Spleen Specimen

  • A 23-year old man had complained of right lower quadrant abdomonal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest.
  • The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea.
  • The onset of fever and vomiting promted a visit to the emergency room. His temperature was 101 F, pulse was 90/minute, and palpation of the right lower abdomen elicited severe pain.
  • The white blood count was 23,000/mm with a distinct left shift, including 5% metamyelocytes.
  • Emergency surgery was performed for a large peri-appendiceal abscess. During surgery, multiple abscesses were noted in the spleen, which was removed (see photograph).
  • Recovery was uneventful following 5 days of adjuvant clindamycin therapy.

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