脾膿瘍－左上腹痛的重要鑑別診斷

Splenic Abscess, an Important Differential Diagnosis of Left Upper Quadrant Abdominal Pain

脾膿瘍是很少見的疾病，但若延誤診斷則有高致死率，好發於免疫功能不全患者譬如有糖尿病或肝硬化等疾病。由於糖尿病及癌症盛行率的增加及免疫抑制劑的使用，使得脾膿瘍盛行率有逐漸增加的趨勢。

本篇個案報告為一位56歲男性，過去有高血壓及酒精性肝硬化病史，此次因畏寒、倦怠及左上腹痛至門診就醫。理學檢查發現肝脾腫大，超音波顯示肝臟腫大且邊緣不規則，脾臟有一個低迴音性病灶，經腹部電腦斷層證實為多葉型脾膿瘍。病人住院後，接受超音波導引之膿瘍引流及使用抗生素治療，順利出院。希望藉此個案報告，讓基層醫師在鑑別診斷左上腹痛時，能想到可能是少見但有致命危險的脾膿瘍，尤其是遇到肝硬化、糖尿病或免疫不全病史的病人。

 

Splenic abscess is an uncommon but complicated disease whose risk of mortality increases with delayed diagnosis and treatment. Splenic abscess occurs mainly in patients with immunocompromised conditions like diabetes mellitus and liver cirrhosis. Due to increased prevalence of diabetes mellitus and cancer, and increased immunosuppressant agent use as well, the risk of splenic abscess has been rising recently.

A 56-year-old male patient, who had hypertension and alcoholic liver cirrhosis visited our outpatient department with complaints of chillness, fatigue, and left upper quadrant abdominal pain. Physical examination revealed hepatomegaly and splenomegaly. Abdominal sonography showed hepatomegaly with an irregular surface and hypoechoic lesions in spleen. Abdominal computed tomography showed multiloculated splenic abscess. After admission, sonography-guided splenic abscess drainage was performed smoothly and antibiotic treatment was also given. The patient was discharged after successful treatment, In conclusion, when physicians encounter patients with left upper abdominal pain, splenic abscess, though uncommon, can be excluded only after careful and thorough examination; this is especially the case with patients with liver cirrhosis, diabetes mellitus, or immunocompromised condition.