Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 7 , ISSUE 1 ( January-April, 2018 ) > List of Articles

RESEARCH ARTICLE

What comes First, the Spleen or the Valve? Management of Splenic Abscess complicating Infective Endocarditis: A Single-center Case Series

Amelia M Pasley, Natasha Hansraj, Jason D Pasley, Jose J Diaz, Brandon Bruns

Keywords : Infective endocarditis, Splenic abscess, Surgical timing

Citation Information : Pasley AM, Hansraj N, Pasley JD, Diaz JJ, Bruns B. What comes First, the Spleen or the Valve? Management of Splenic Abscess complicating Infective Endocarditis: A Single-center Case Series. Panam J Trauma Crit Care Emerg Surg 2018; 7 (1):77-81.

DOI: 10.5005/jp-journals-10030-1208

License: CC BY-NC 4.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Splenic abscess is a rare and highly morbid extracardiac manifestation of infective endocarditis (IE) and has only been described in small case series in the literature. Emergency surgeons are often consulted for splenectomy; however, the optimal timing (before or after valve) of this intervention remains unclear. We hypothesized that definitive valve intervention, prior to splenectomy, would lead to superior patient outcomes. Study design: A retrospective review of patients with IE and splenic abscess from June 2011 to June 2016 was performed at a quaternary referral center in the United States. Demographics, comorbid conditions, echocardiography results, intensive care unit (ICU)/hospital length of stay, operative interventions, splenectomy and valve replacement, and complications were collected. Patients were divided based on operation performed first: spleen first (SF) or valve first (VF). The primary outcome was mortality, with secondary outcomes including in-hospital morbidity. Results: Ten patients met criteria for inclusion (8 SF, 2 VF). Median age was 45 years. About 90% were male, 60% were active intravenous drug abusers, and 100% had bacteremia (most commonly Enterococcus), with 50% of the patients having single-valve disease and 50% of the patients multivalvular disease. Total 90% had preserved cardiac function [ejection fraction (EF) > 40%]. All patients had splenic abscess diagnosed on HD 1, with 40% undergoing preoperative angioembolization. There was no difference in mortality between the groups (SF 25% vs VF 0%). There was no difference in the splenectomy portion of the operation, regardless of preoperative angioembolization. Conclusions: Representing the largest modern case series on the topic, a 25% overall 6-month mortality rate was observed; however, there was no difference in the order of operation noted in our population. Splenic abscess in conjunction with IE is a highly mortal combination; therefore, a large-scale multi-institutional approach should be utilized to delineate this population and address the order of operation as well as the role of splenic angioembolization in this subset of patients.


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  1. Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, Woods CW, Reller LB, Ryan T, Fowler VG Jr. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002 Jan;162(1):90-94.
  2. Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, Casalta JP, Gouvernet J, Derumeaux G, Iarussi D, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005 Jul;112(1):69-75.
  3. Thuny F, Grisoli D, Collart F, Habib G, Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet 2012 Mar;379(9819):965-975.
  4. Gegouskov V, Petrov P, Simov D, Danov V, Blagov J, Petrov S. One-stage mitral valve replacement and splenectomy in splenic infarcts and infective endocarditis. Internet J Thorac Cardiovas Surg 2009;14(2).
  5. Kang DH. Timing of surgery in infective endocarditis. Heart 2015 Aug;101:1786-1791.
  6. Delahaye F, Cerlard M, Roth O, de Gevigney G. Indications and optimal timing for surgery in infective endocarditis. Heart 2004 Jun;90(6):618-620.
  7. Blasi S, De Martino A, Levantino M, Pratali S, Anastasio G, Bortolotti U. Splenectomy and valve replacement in patients with infective endocarditis and splenic abscesses. Ann Thorac Surg 2016 Sep;102(3):e253-e255.
  8. Elasfar A, AlBaradai A, AlHarfi Z, Alassal M, Ghoneim A, AlGhofaili F. Splenic abscess associated with infective endocarditis: case series. J Saudi Heart Assoc 2015 Jul;27(3): 210-215.
  9. Simsir SA, Cheeseman SH, Lancey RA, Vander Salm TJ, Gammie JS. Staged laparoscopic splenectomy and valve replacement in splenic abscess and infective endocarditis. Ann Thorac Surg 2003 May;75(5):1635-1637.
  10. Wu Z, Zhou J, Pankaj P, Peng B. Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy. Surg Endosc 2012 Oct;26(10):2758-2766.
  11. Naoum JJ, Siberfein EJ, Zhou W, Sweeney JF, Albo D, Brunicardi FC, Kougias P, El Sayed HF, Lin PH. Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome. Am J Surg 2007 Jun;193(6):713-718.
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