Peritonitis due to a ruptured splenic abscess.

Splenic abscess is a rare entity of which the incidence at autopsy is <0.7% [1]. However, recently it has been reported with much greater frequency, probably because of improved diagnostic techniques and an increase in the number of imrnunocompromised patients. Rupture into the peritoneal cavity is the most severe complication and is associated with mortality rates ranging from 50% to 100% [1,2]. We describe a case of generalized peritonitis due to a ruptured splenic abscess. An 87-year-old woman was admitted to our facility because of a 2-day history of fever and abdominal pain. The most remarkable aspects of her medical history were diabetes mellitus, cholecystectomy, and left hemicolectomy for neoplasm 3 years previously. Physical examination revealed a temperature of 38°C and mild left abdominal pain; other findings were unremarkable. Laboratory studies showed leukocytosis (leukocytes, 32.5 X 10 with 95% polymorphonuclear cells; the hematocrit was 35%, and the hemoglobin level was 10.5 g/L. Urinalysis showed numerous WBCs, and roentgenography of the chest revealed elevation of the left side of the diaphragm. Abdominal ultrasonography was negative. The patient was treated with antibiotics for possible urinary sepsis. Her abdominal symptoms were attributed to the same condition. After 2 days the abdominal pain worsened, and the abdomen was rigid, silent, and tender. The hematocrit decreased to 23%, and a CT scan showed splenomegaly with a large single collection inside, as well as perisplenic and pelvic fluid (figure 1). Laparotomy showed diffuse peritonitis caused by a freely ruptured splenic abscess, and a splenectomy was performed. Cultures of blood and of the peritoneal fluid yielded Bacteroides fragilis, which was susceptible to metronidazole. Histologic examination revealed normal parenchyma surrounding the abscess. Postoperative evolution was uncomplicated, and the patient was discharged on the fifteenth postoperative day.