Clinical Brief Indian J Pediatr 1995; 62 : 623-625 Splenic Abscess Following Blunt Abdominal Trauma Ashok Kumar, Anand Kumar*, Deepika Chaudhary** and V. Bhargava Departments of Pediatrics, *Surgery and **Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi Abstract. A rare case of splenic absces~ occurring after blunt abdominal trauma in a previously healthy boy is reported. The diagnosis was made by ultrasonography. The patient recovered after splenectomy and drainage of subphrenic and intraperitoneal pus. (Indian J Pediatr 1995; 62 9 623-625) Key words : Abdominal trauma; Splenectomy; Splenic abscess. Splenic abscess is a rare clinical entity in children. We report a case of splenic ab- scess presenting as a late complication of blunt abdominal trauma. CASE REPORT A fifteen year old boy was admitted with a high grade fever and severe pain in left hypochondrium for 6 days. There was no history of vomiting, diarrhea, constipation;. cough, or respiratory distress. On exami- nation, he::was febrile (102-104~ and toxic. Vital ~igns were stable. Examination of abdomen revealecl slight distension, ten- derness, and guarding on left side. The spleen was not palpable at the time of ad- mission but during the course of illness it measured 3 cm below the costal margin. Bowel sounds were sluggish. There was no fluid in abdomen. He also had tenderness Of left hemithorax anterolaterally below the 6th intercos~l space. Hemogram revealed a leucocyte count of 18000/cu mm with 78% neutrophils and 22% lymphocytes, Fib 11 g/dl, and ESR 60 mm/hour. Radiographs of the abdomen and chest were unremarkable. The results of widal test and blood culture were nega- tive. Sonography of abdomen demon- strated a large hypoechoic area on the anteromedial aspect of the spleen (Fig. 1) and fluid collection in the left subdiaphragrnatic space and peritoneum. Retrospective interr.ogation of the child re- vealed a history of falling off a bicycle about a week before the onset of this ill- ness. The diagnosis of traumatic splenic abscess with left subphrenic abscess and localized peritonitis was made. He Was 'given cefotaxime, gentamicin and metronidazole and was subjected to laparatomy. On laparatomy; the spleen ap- peared grossly corigested and edematous, with a large subcapsular tear and an in- fected hematoma surrouncled by necrotic tissue. Thick pus was also found in left subphrenic area and intraperitoneally. The child made rapid recovery following splenectomy, drainage of subphrenic ab- scess and peritoneal lavage. Histopathology of the spleen revealed fea- tures of acute inflammation and hemor- rhagic necrosis. Pus culture was sterile. There was no laboratory evidence of he- molytic anemia in our patient.