Surgical management of splenic abscess complicated by pleural effusion in rural setting: A case report from rural Indonesia

INTRODUCTION AND IMPORTANCE: Splenic abscess is a potentially life-threatening disease. Antibiotics along with surgery are the gold standard therapy. We present a case of splenic-salvaged surgical management of a large splenic abscess in a rural setting, complying with the available resources. CASE PRESENTATION: A 35-year old female presented to the ER with a history of left hypochondrium pain and fever for seven days. Abdominal tenderness at the left hypochondrium with an enlarged spleen was found. Laboratory tests showed severe anemia, leukocytosis, and thrombocytosis. Chest X-ray suggested pulmonary tuberculosis with minimal left pleural effusion. Ultrasound revealed a large unifocal splenic abscess. Antibiotics were administered. Simplified percutaneous drainage was performed, followed by open surgery abscess drainage. The patient showed a smooth recovery. CLINICAL DISCUSSION: Pulmonary tuberculosis finding in a patient with splenic abscess suggested the potential etiology which itself is a rare finding. Spleen preservation surgery along with antibiotics is preferable to retain immunologic functions. In the rural setting, like Indonesia, where a pig-tail catheter set is not available, a simplified abscess drainage procedure is feasible. In patients with poor conditions, laparotomy and splenectomy approaches would lead to higher mortality and morbidity rates. Chest tube insertion may not be necessary for minimal pleural effusion in a splenic abscess as it may resolve naturally along with the abscess recovery. CONCLUSION: Large splenic abscess can be managed by abscess drainage if the lesion is unifocal, in a view of the spleen being salvageable in patients with poor general conditions.