Laparoscopic splenectomy and transdiaphragmatic drainage of splenic abscess communicated with the pleural space: A case report

Abstract

Introduction: Splenic abscess is a very rare pathology in the pediatric age, and the association with complications such as spontaneous drainage to the pleural cavity is even rarer. There is very little information in the literature regarding the best diagnostic and therapeutic approach. Case presentation: We present the case of an immunocompromised 16-year-old female patient with a splenic abscess that had spontaneous drainage to the left pleural cavity through the diaphragm and presented clinically as recurrent empyema. There was tomographic evidence of a significant pleural effusion on the left side and splenomegaly with a collection in the upper pole that extended to the left hemithorax through a defect in the diaphragm. Patient received successful treatment by laparoscopic splenectomy and transdiaphragmatic drainage of the pleural cavity. There were no complications and no recurrence of pleural effusion or subphrenic abscess on x-ray or ultrasound. At 6-month outpatient follow-up, she presented adequate clinical and radiological evolution. Conclusion: A trans-diaphragmatic pleural drain can be placed under laparoscopic vision in selected cases where a thoracic approach is not a safe option. This minimizes the probability of lung injury and air fistulas in a patient with severe inflammation and previous thoracic surgery.

Keywords

• Splenic abscess
• Subphrenic abscess
• Empyema
• Laparoscopy
• Case report