Conditions in this group
This group includes splenic abscess, multiple splenic abscesses, splenic candidiasis, splenic tuberculosis, and splenic involvement by sarcoidosis. The most common condition with a direct surgical relevance is splenic abscess.
How they develop and how they are diagnosed
An abscess may develop when microorganisms reach the spleen through the bloodstream, after bacteremia or infective endocarditis. Other risk factors include immunosuppression, diabetes mellitus, malignancy, recent trauma, or splenic infarction. Fever, chills, malaise, and pain in the upper left abdomen are characteristic but not always present. Blood tests and cultures support the diagnosis. CT is the most important imaging examination for localization and treatment planning.
Treatment
Treatment begins with targeted antimicrobial therapy. Depending on the size, number, and location of the abscesses, image-guided percutaneous drainage may be needed. Splenectomy is considered when safe drainage is not possible, when infection is not controlled, or when there is rupture or extensive destruction of the organ. In sarcoidosis, surgical treatment is rare and is mainly limited to diagnostic uncertainty or severe symptoms.
Frequently asked questions
Is a splenic abscess urgent?
Yes. Fever and abdominal pain in a patient with risk factors require prompt assessment.
Are antibiotics enough?
They may be enough for some small or selected collections, but drainage or surgical treatment is often required.
Why is the source of infection investigated?
Treatment must address not only the abscess but also the cause that led to the spread of microorganisms to the spleen.
When to seek medical attention
Fever with chills and pain in the upper left abdomen, pain at the tip of the left shoulder, or pain in the left lower chest that worsens with breathing should be assessed the same day. Act even faster if you have a heart valve problem, recent bloodstream infection, diabetes, a weakened immune system, or have had a recent injury to the spleen. A splenic abscess can become life-threatening if treatment is delayed, but it responds well when found early.
What the assessment involves
Blood tests show the level of inflammation. Blood cultures are taken before antibiotics start, because they often identify the organism. Contrast CT is the key test and shows the size, number and position of abscesses. An ultrasound scan of the heart (echocardiogram) is often done to look for an infected valve, the commonest source of spread to the spleen. When the picture suggests tuberculosis or a fungal infection, specific tests are added.
Treatment and recovery
Treatment combines targeted antibiotics, which are usually given first by drip and continued for several weeks in total, with treatment of the source of infection. A single, well-defined abscess can often be drained through the skin under ultrasound or CT guidance. Removal of the spleen is considered for multiple abscesses, abscesses that do not respond to drainage, rupture, or a spleen that is badly damaged. Fungal and tuberculous infections are treated with specific long-term medicines, with surgery reserved for complications.
Follow-up includes repeat blood tests and a repeat scan to confirm the abscess has resolved. If the spleen has been removed, the vaccination and fever advice in the splenectomy article applies.
More questions about splenic infections
Who is most at risk of a splenic abscess?
People with a bloodstream infection or an infected heart valve, diabetes, a weakened immune system, a recent injury or infarction of the spleen, and people who inject drugs.
Will I lose my spleen?
Not necessarily. The spleen is kept where treatment works. If it is removed, vaccination and a clear plan for fever protect you afterwards.
Can a splenic abscess come back?
It can if the source of infection is not found or the abscess was not fully drained. That is why follow-up scans and blood tests are part of treatment.
