Absceso esplénico: ¿drenaje percutáneo o esplenectomía?
DOI:
https://doi.org/10.30944/20117582.206Palabras clave:
bazo, enfermedades del bazo, absceso, drenaje, esplenectomía, laparoscopíaResumen
El absceso esplénico es una entidad poco común, su incidencia es de 0,2 a 0,7 %. El trabajo diagnóstico temprano y el tratamiento oportuno han permitido un mayor número de resultados exitosos. El tratamiento convencional ha sido la esplenectomía; sin embargo, por la importancia inmunológica del bazo y la morbimortalidad del tratamiento quirúrgico, hay una tendencia al tratamiento médico y de menor invasión. En este artículo se presenta una revisión narrativa del problema con base en la literatura médica con mayor ‘evidencia’, se discuten las diferentes alternativas de tratamiento y se concluye que el tratamiento debe individualizarse a cada paciente. El drenaje percutáneo es la primera línea de tratamiento; si este fracasa, debe considerarse la esplenectomía. Aunque con tiempos quirúrgicos más prolongados, la esplenectomía laparoscópica se asocia con una reducción significativa de la morbilidad posquirúrgica.
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Referencias bibliográficas
Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA. Percutaneous CT-guided drainage of splenic abscess. Am J Roentgenol. 2002;179:629-32.
https://doi.org/10.2214/ajr.179.3.1790629
Wang CC, Lee CH, Chan CY, Chen HW. Splenic infarction and abscess complicating infective endocarditis. Am J Emerg Med. 2009;27:1021.e3-5.
https://doi.org/10.1016/j.ajem.2008.12.028
Cohen MAA, Galera MJ, Ruiz M, La Calle JP, Rius X, Artigas V, et al. Splenic abscess. World J Surg. 1990;14:513-6.
https://doi.org/10.1007/BF01658678
Chun CH, Raff MJ, Contreras L, Varghese R, Waterman N, Daffner R, et al. Splenic abscess. Medicine. 1980;59:50-65.
https://doi.org/10.1097/00005792-198001000-00003
Tartaglia D, Galatioto C, Lippolis PV, Modesti M, Gianardi D, Bertolucci A, et al. Splenic abscess after splenic blunt injury angioembolization. Ann Ital Chir. 2014;85:57(ePub). Fecha de consulta: 27 de junio de 2015 . Disponible en: http://www.ncbi. nlm.nih.gov/pubmed/25362884.
Sakran N, Ilivitzki A, Zeina AR, Assalia A. Splenic abscess after sleeve gastrectomy: A report of two cases. Obes Facts. 2012;5:635-9.
https://doi.org/10.1159/000342805
Stamou KM, Menenakos E, Gomatos IP, Panousopoulos SG, Smparounis S, Leandros E, et al. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia. Obes Surg. 2011;21:1490-3.
https://doi.org/10.1007/s11695-010-0302-0
Martínez DG, Sánchez AW, García AP. Splenic abscess after laparoscopic Nissen fundoplication: A consequence of short gastric vessel division. Surg Laparosc Endosc Percutan Tech. 2008;18:82-5.
https://doi.org/10.1097/SLE.0b013e318159e837
Ooi LL, Leong SS. Splenic abscesses from 1987 to 1995. Am J Surg. 1997;174:87-93.
https://doi.org/10.1016/S0002-9610(97)00030-5
Phillips GS, Radosevich MD, Lipsett PA. Splenic Abscess: Another look at an old disease. Arch Surg. 1997;132:1331-6.
https://doi.org/10.1001/archsurg.1997.01430360077014
Fonseca EM, Nuño FJ, Menéndez MJ, Arias IM, Rodríguez B. Abscesos esplénicos: revisión de 7 casos. An Med Interna. 2007;24:511-2.
https://doi.org/10.4321/S0212-71992007001000012
Narra RK, Jehendran MV. Ruptured splenic abscess causing pneumoperitoneum: A rare cause revisited. BMJ Case Rep. 2015. doi:10.1136/bcr-2014-209055.
https://doi.org/10.1136/bcr-2014-209055
Ishigami K, Decker GT, Bolton-Smith JA, Samuel I, Wilson SR, Brown BP. Ruptured splenic abscess: A cause of pneumoperitoneum in a patient with AIDS. Emerg Radiol. 2003;10:163-5.
https://doi.org/10.1007/s10140-003-0302-7
Gómez CC, Zúñiga E. Abscesos esplénicos por Salmonella.Acta Méd Colomb. 2005;30:123-5.
Villamil-Cajoto I, Lado FL, van den Eynde-Collado A, DíazPeromingo JA. Abscesos esplénicos: presentación de nueve casos. Rev Chil Infectol. 2006;23:150-4.
https://doi.org/10.4067/S0716-10182006000200008
Gil LF, Soler C, Crespo L, Villa M, Alfonso L, Contreras IC. Absceso esplénico amebiano. Revi Cubana Cir. 2011;50:560-9. 17. Bernabeu-Wittel M, Villanueva JL, Pachón J, Alarcón A, López-Cortés LF, Viciana P, et al. Etiology, clinical features and outcome of splenic microabscesses in HIV-infected patients with prolonged fever. Eur J Clin Microbiol Infect Dis. 1999;18:324-9.
https://doi.org/10.1007/PL00015013
Warshauer DM, Hall HL. Solitary splenic lesions. Semin Ultrasound CT MR. 2006;27:370-88.
https://doi.org/10.1053/j.sult.2006.06.003
Chiang IS, Lin TJ, Chiang IC, Tsai MS. Splenic abscesses: Review of 29 cases. Kaohsiung J Med Sci. 2003;19:510-5.
https://doi.org/10.1016/S1607-551X(09)70499-1
Semelka RC, Kelekis NL, Sallah S, Worawattanakul S, Ascher SM. Hepatosplenic fungal disease: Diagnostic accuracy and spectrum of appearances on MR imaging. Am J Roentgenol. 1997;169:1311-6.
https://doi.org/10.2214/ajr.169.5.9353448
Kamaya A, Weinstein S, Desser TS. Multiple lesions of the spleen: Differential diagnosis of cystic and solid lesions. Semin Ultrasound CT MR. 2006;27:389-403.
https://doi.org/10.1053/j.sult.2006.06.004
Elsayes KM, Narra VR, Mukundan G, Lewis JS Jr, Menias CO, Heiken JP. MR imaging of the spleen: Spectrum of abnormalities. Radiographics. 2005;25:967-82.
https://doi.org/10.1148/rg.254045154
Meshikhes AW, Al-Momen SA. Laparoscopic diagnosis of splenic tuberculosis. Surg Laparosc Endosc Percutan Tech. 2006;16:355-6.
https://doi.org/10.1097/01.sle.0000213723.26967.c6
Tung CC, Chen FC, Lo CJ. Splenic Abscess: An Easily Overlooked Disease? Am Surg. 2006;72:322-5.
Llenas-García J, Fernández-Ruiz M, Caurcel L, Enguita-Valls A, Vila-Santos J, Guerra-Vales J-M. Splenic abscess: A review of 22 cases in a single institution. Eur J Intern Med. 2009;20:537-9.
https://doi.org/10.1016/j.ejim.2009.04.009
Tomar LR, Rajendran R, Pandey SK, Aggarwal A. Splenic abscess: Plasmodium vivax with secondary Escherichia coli infection. Trop Doct. 2015;45:143-5.
https://doi.org/10.1177/0049475514561507
Choudhury SR, Debnath PR, Jain P, Kushwaha AS, Puri A, Chadha R, et al. Conservative management of isolated splenic abscess in children. J Pediatr Surg. 2010;45:372-5.
https://doi.org/10.1016/j.jpedsurg.2009.10.074
Choudhury SR, Rajiv C, Pitamber S, Akshay S, Dharmendra S. Management of splenic abscess in children by percutaneous drainage. J Pediatr Surg. 2006;41:e53-6.
https://doi.org/10.1016/j.jpedsurg.2005.10.085
Kombo BB, Okoh PD. Drainage of splenic abscess: A case report. Niger J Med. 2014;23:89-90.
Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: The significance in treatment of critically ill patients. World J Gastroenterol. 2006;12:7341-5.
https://doi.org/10.3748/wjg.v12.i45.7341
Iniguez A, Butte JM, Zúñiga JM, Torres J, Llanos O. Splenic abscesses. Report of seven cases. Rev Med Chil. 2008;136:38-43.
https://doi.org/10.4067/S0034-98872008000100005
Tikkakoski T, Siniluoto T, Paivansalo M, Taavitsainen M, Leppanen M, Dean K, et al. Splenic abscess. Imaging and intervention. Acta Radiol. 1992;33:561-5.
https://doi.org/10.1177/028418519203300613
Ferraioli G, Brunetti E, Gulizia R, Mariani G, Marone P, Filice C. Management of splenic abscess: Report on 16 cases from a single center. Int J Infect Dis. 2009;13:524-30.
https://doi.org/10.1016/j.ijid.2008.08.024
Kang M, Kalra N, Gulati M, Lal A, Kochhar R, Rajwanshi A. Image guided percutaneous splenic interventions. Eur J Radiol. 2007;64:140-6.
https://doi.org/10.1016/j.ejrad.2007.02.011
Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA. Percutaneous CT-guided drainage of splenic abscess. Am J Roentgenol. 2002;179:629-32.
https://doi.org/10.2214/ajr.179.3.1790629
Conzo G, Docimo G, Palazzo A, Della Pietra C, Stanzione F, Sciascia V, et al. The role of percutaneous US-guided drainage in the treatment of splenic abscess. Case report and review of the literature. Ann Ital Chir. 2012;83:433-6.
Alvi AR, Kulsoom S, Shamsi G. Splenic abscess: Outcome and prognostic factors. J Coll Physicians Surg Pak. 2008;18:740-3.
Sreekar H, Saraf V, Pangi AC, Sreeharsha H, Reddy R, Kamat G. A retrospective study of 75 cases of splenic abscess. Indian J Surg. 2011;73:398-402.
https://doi.org/10.1007/s12262-011-0370-y
Al-Salem AH, Qaisaruddin S, Jam'a AA, Al-Kalaf J, El-Bashier AM. Splenic abscess and sickle cell disease. Am J Hematol. 1998;58:100-4.
https://doi.org/10.1002/(SICI)1096-8652(199806)58:2<100::AID-AJH2>3.0.CO;2-W
Sharma D, Shukla VK. Laparoscopic splenectomy: 16 years since Delaitre with review of current literature. Surg Laparosc Endosc Percutan Tech. 2009;19:190-4.
https://doi.org/10.1097/SLE.0b013e3181a5a911
Winslow ER, Brunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: A meta-analysis with an emphasis on complications. Surgery. 2003;134:647-55.
https://doi.org/10.1016/S0039-6060(03)00312-X
Musallam KM, Khalife M, Sfeir PM, Faraj W, Safadi B, Abi Saad GS, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257:1116-23.
https://doi.org/10.1097/SLA.0b013e318275496a
Maluenda F, Burdiles P, Bragetto I, Csendes A. Esplenectomía laparoscópica en enfermedades hematológicas. Rev Méd Chil. 2004;132:189-94.
https://doi.org/10.4067/S0034-98872004000200008
Rosen M, Brody F, Walsh RM, Tarnoff M, Malm J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc. 2002;16:272-9.
https://doi.org/10.1007/s00464-001-8150-6
Targarona EM, Espert JJ, Bombuy E, Vidal O, Cerdan G, Artigas V, et al. Complications of laparoscopic splenectomy. Arch Surg. 2000;135:1137-40.
https://doi.org/10.1001/archsurg.135.10.1137
Corcione F, Pirozzi F, Aragiusto G, Galante F, Sciuto A. Laparoscopic splenectomy: Experience of a single center in a series of 300 cases. Surg Endosc. 2012;26:2870-6.
https://doi.org/10.1007/s00464-012-2272-x
Carbonell AM, Kercher KW, Matthews BD, Joels CS, Sing RF, Heniford BT. Laparoscopic splenectomy for splenic abscess. Surg Laparosc Endosc Percutan Tech. 2004;14:289-91.
https://doi.org/10.1097/00129689-200410000-00013
Uranues S, Alimoglu O. Laparoscopic surgery of the spleen. Surg Clin North Am. 2005;85:75-90.
https://doi.org/10.1016/j.suc.2004.09.003
Bhandarkar D, Katara A, Shankar M, Mittal G, Udwadia TE. Laparoscopic splenectomy for tuberculous abscess of the spleen. J Minim Access Surg. 2010;6:83-5.
https://doi.org/10.4103/0972-9941.68582
Nagem RG, Petroianu A. Subtotal splenectomy for splenic abscess. Can J Surg. 2009;52:E91-2.
https://doi.org/10.1590/S0102-67202008000200011
De Greef E, Hoffman I, Topal B, Broers C, Miserez M. Partial laparoscopic splenectomy for splenic abscess because of Salmonella infection: A case report. J Pediatr Surg. 2008;43:E35-8.
https://doi.org/10.1016/j.jpedsurg.2008.01.066
Lee SH, Lee JS, Yoon YC, Hong TH. Role of laparoscopic partial splenectomy for tumorous lesions of the spleen. J Gastrointest Surg. 2015;19:1052-8.
https://doi.org/10.1007/s11605-015-2812-5
Wang WD, Lin J, Wu ZQ, Liu QB, Ma J, Chen XW. Partial splenectomy using a laparoscopic bipolar radiofrequency device: A case report. World J Gastroenterol. 2015;21:3420-4.
https://doi.org/10.3748/wjg.v21.i11.3420
Balaphas A, Buchs NC, Meyer J, Hagen ME, Morel P. Partial splenectomy in the era of minimally invasive surgery: The current laparoscopic and robotic experiences. Surg Endosc. 2015;29:3618-27.
https://doi.org/10.1007/s00464-015-4118-9
Feldman LS, Demyttenaere SV, Polyhronopoulos GN, Fried GM. Refining the selection criteria for laparoscopic versus open splenectomy for splenomegaly. J Laparoendosc Adv Surg Tech A. 2008;18:13-9.
https://doi.org/10.1089/lap.2007.0050
Vergnaud J, Lopera C, Matallana R. Esplenectomía laparoscópica mano asistida. Técnica quirúrgica en esplenomegalia masiva. Rev Colomb Cir. 2005;20:166-71.
Comarmond C, Jaureguiberry S, Vaillant JC, Lecso M, Bricaire F, Caumes E. Giant splenic abscess due to Salmonella enteritidis in a returning traveler. J Travel Med. 2010;17:271-3.
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