When first-line percutaneous catheter drainage (PCD) combined with antibiotic therapy does not achieve confirmed healing of a splenic abscess on ultrasound follow-up, a surgical next step becomes necessary. This protocol addresses exactly that escalation scenario.
First-line management comprised hospitalisation with extended antibiotic therapy — initiated after blood and, where feasible, abscess cultures, and subsequently adjusted per antibiogram results — together with ultrasound-guided percutaneous catheter drainage. PCD involved aspiration of the splenic abscess via an 8–10 F catheter, cavity lavage with saline, daily aspiration, and eventual catheter withdrawal after healing confirmation on ultrasound.
Escalation to the current protocol is triggered when healing of the splenic abscess cannot be confirmed on ultrasound control despite this drainage approach.
In patients for whom percutaneous catheter drainage has proved insufficient, a definitive open surgical procedure targeting the spleen is the indicated next step. The complete procedural details, clinical criteria, and decision algorithm are available in the full structured regimen.
DOI: 10.1186/s12879-024-10122-8
After insufficient PCD on three (18.8%) patients, splenectomy was performed as a second-line procedure (Table 2).
In patients who underwent splenectomy, open total splenectomy was performed.
Splenectomy is required in patients for whom PCD is not effective.
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