Splenic Abscess with Aortic Thrombosis and Right Renal Artery Thrombosis

Abstract

Splenic abscess is an uncommon condition encountered with an incidence of around 0.1-0.7%. The most common cause of infection of the spleen is usually from the hematogenous route resulting from endocarditis or seeding from sites of infection. Splenic abscess is unusual and mostly involves the splenic vessels. The diagnosis is often missed due to lack of or non-specific clinical symptoms. Authors present a rare case scenario of a 50-year-old female patient who presented with pain in abdomen. On examination, there was tenderness in left hypochondrium region along with splenomegaly. Ultrasonography (USG) abdomen-pelvis revealed splenic abscess. Since patient had raised WBC count and Random Blood Sugar (RBS), she was started on antibiotics and hyperglycaemic management was started. USG guided Percutaneous Drainage (PCD) of the abscess was done. Contrast Enhanced Computed Tomography (CECT) abdomen-pelvis showed splenic abscess with drainage catheter in-situ and thrombosis in abdominal aorta involving the right renal artery causing renal infarcts. Patient’s bilateral lower limb Colour Doppler test revealed decreased arterial flow in right lower limb. Prothrombin time was deranged, thus anti-platelets were started and which was later shifted onto oral anti-coagulant therapy. Successive USGs revealed resolution of the abscess, so PCD was removed. Right kidney showed vascularity and no thrombosis was noted in aorta. Due to singular nature of the splenic abscess and early detection of thrombus on CT scan, the present case responded well to PCD and conservative management, which lead to complete resolution of abscess and prevented the likely complications of thrombosis.

Keywords

• anticoagulant
• colour doppler
• prothrombin time
• splenomegaly