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文献考察：脾膿瘍splenic abscess，治療は脾摘がスタンダードであった（１）が，最近は脾臓の免疫機能が重視されるようになり，経皮的ドレナージ療法も行われるようになってきた（２）．
１）Dig Surg. 2000;17(4):354-7.
Splenic abscess. An old disease with new interest.
Smyrniotis V, Kehagias D, Voros D, Fotopoulos A, Lambrou A, Kostopanagiotou G, Kostopanagiotou E, Papadimitriou J.
BACKGROUND/AIMS: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. METHOD: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. RESULTS: The mean age of patients was 43 years (range 7-79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. CONCLUSION: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available. PMID: 11053942
２）AJR Am J Roentgenol. 2002 Sep;179(3):629-32.
Percutaneous CT-guided drainage of splenic abscess.
Thanos L, Dailiana T, Papaioannou G, Nikita A, Koutrouvelis H, Kelekis DA.
OBJECTIVE: The objective of our study was to determine the current role of percutaneous CT-guided drainage as an alternative to surgical treatment of splenic abscesses. CONCLUSION: Splenic abscess is an uncommon entity that can be treated percutaneously. CT-guided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen. PMID: 12185032
追記：11例中7例に経皮的ドレナージが行われ，平均9.3日で治癒した．脾摘を行った4例は，凝固機能低下:2例，3個以上の多発膿瘍:1例，大きさ3cm以下の脾門部の膿瘍:1例であった．
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