MED13 Bacteremia with splenic and hepatic abscesses in a patient three years after splenorrhaphy. (Medicine).

MED13 BACTEREMIA WITH SPLENIC AND HEPATIC ABSCESSES IN A PATIENT THREE YEARS AFTER SPLENORRHAPHY. Thomas Richard, MD, and Tomas Ferguson, MD. Brooke Army Medical Center, Fort Sam Houston, Tex.

Over the past several decades, the surgical approach to splenic trauma has become increasingly more conservative. Emphasis has now been placed on splenic repair and preservation to prevent the potentially devastating complications of postsplenectomy infections and sepsis. Many reports have described short-term outcomes in the treatment of splenic trauma patients having splenectomy, splenorrhaphy, or observation. However, little has been reported about long-term complications of splenorrhaphy. A 44-year-old woman came to the emergency department with fever, hypotension, and abdominal pain. She reported a history of splenorrhaphy, esophageal rupture and multiple rib fractures that were treated in 1997. The patient was resuscitated and had multiple imaging studies. CT scan of the abdomen revealed multiple liver and spleen enhancing abnormalities that were thought to be consistent with infection or postoperative changes. The patient was empirically started on antibiotics. Ultimately, blood and liver aspirate cult ures both grew gram-positive cocci. The patient failed to defervesce despite aggressive antibiotic therapy. Because of the question of splenic abnormalities, the general surgery consultant recommended splenectomy when her clinical status declined. The patient had embolization of her splenic artery followed by splenectomy. Pathology of splenic specimens confirmed the presence of abscesses that contained chains of gram-positive cocci and acute inflammation. The patient continued her long course of intravenous antibiotics with good clinical response before discharge. In our review of the literature, many studies address short-term postoperative complications of splenorrhaphy, but few studies address the long-term complications. One documented case illustrated a latent Staphylococcus aureus infection originating from the site of splenorrhaphy in a pediatric patient. Our case is the first adult case report of a postsplenorrhaphy patient with longterm infectious complications. Splenic repair and preservation have b ecome more popular in the surgical approach to splenic trauma in an attempt to decrease infectious complications. While the primary cause of our patient's bacteremia remains uncertain, our case provides an illustration that surgical repair of the spleen may result in an increased long-term risk of future infection and abscess formation.