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2012, Number 4

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Rev Mex Cir Endoscop 2012; 13 (4)

Laparoscopic management of splenic abscess subsequent to non Hodkin lymphoma: a case report

Muñoz JD, Vidal VM, Quirarte C, Álvarez SZ, Cruz O, Flores AM

Language: Spanish
References: 32
Page: 211-215
PDF size: 399.17 Kb.


ABSTRACT

Introduction: The most common splenic neoplasia is the non Hodgkin lymphoma (50 to 80%), it involves 1% of the general total of non Hodgkin lymphomas. In patients with radiologic evidence of splenic disease, multiple or focal, associated with fever and a positive history of neoplasia, the splenic abscess and difusse large cells lymphoma should be suspected. The splenic abscess is a weird condition which occurs between 0.14 to 0.7% and is associated to splenic neoplasias in 30% of the cases. Objective: To present a clinical case where the management of splenic abscess due to non Hodgkin lymphoma is done by laparoscopic technique. Case presentation: A 66 year old female is presented white abdominal pain in the left upper quadrant which is increased with physical efforts and by food intake. She presents with anemia and elevated with and red blood cells levels. She had the background of non Hodgkin lymphoma in remission. Abdominal tomography is performed which shows an image compatible with splenic abscess. Diagnostic laparoscopy, drainage of splenic abscess, splenectomy and hepatic biopsy are done. Biopsy results reported difusse large cell lymphoma, with splenic anaplasia and central necrosis. Discussion: Splenic abscess is a weird disease. Early diagnosis requires a high suspicion in every case; usually tomography and ultrasonography are diagnostic. Treatment is based in antiobiotic therapy, percutaneous drainage and splenectomy, however, the drainage has a high failure rate from 14.3 to 75% and most of the series propose it as the previous treatment for surgery in patients with serious comorbidities. The laparoscopic drainage offers the advantage of being diagnostic and therapeutic in patients with splenomegaly and hipersplenism, for which it remains the procedure of choice. Conclusion: Laparoscopic approach facilitates in a single procedure the diagnosis and management of non Hodgkin lymphoma´s activity. In this case, it was considered the best choice for the treatment of the associated symptoms of the patient, and her prognosis was related to her previous health conditions.


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