The Surgical Management of Splenic Abscess

Abstract

Splenic abscess is a rare but potentially fatal intra-abdominal infection that requires prompt antimicrobial therapy and effective source control. Historically, total splenectomy was considered the standard treatment because it provided definitive eradication of infected splenic tissue. Contemporary management has shifted toward individualized, spleen-preserving strategies, particularly image-guided percutaneous drainage in patients with accessible, unilocular, and predominantly fluid collections. Splenectomy remains the most reliable option for multiloculated or multiple abscesses, splenic rupture, fistulization, severe sepsis, failed drainage, inaccessible collections, or extensive parenchymal destruction. Laparoscopic splenectomy may be feasible in hemodynamically stable patients, whereas open surgery remains appropriate for unstable or anatomically complex disease. Partial splenectomy and operative drainage without splenectomy have been reported in selected patients, especially children, but evidence is limited. Antibiotics are required in all patients and should be tailored to cultures whenever possible. Available comparative evidence suggests that percutaneous drainage may be associated with lower morbidity and mortality than splenectomy in appropriately selected patients, although current studies are predominantly retrospective and affected by selection bias. This review summarizes the diagnosis, indications, operative options, percutaneous treatment, special populations, complications, and proposed decision-making algorithm for splenic abscess.