What causes splenomegaly due to abdominal infection?

From the Guidelines

Splenomegaly due to abdominal infection is typically caused by bacterial infections, and the primary approach is to identify and treat the specific abdominal infection causing the splenomegaly. For bacterial abdominal infections, broad-spectrum antibiotics should be initiated immediately. Common regimens include:

• Piperacillin-tazobactam 3.375g IV every 6 hours
• Ceftriaxone 2g IV daily plus metronidazole 500mg IV every 8 hours
• Ciprofloxacin 400mg IV every 12 hours plus metronidazole 500mg IV every 8 hours Antibiotic therapy should be tailored based on culture results and continued for 7-14 days, depending on the severity and type of infection, as recommended by the 2017 WSES guidelines for management of intra-abdominal infections 1. In addition to antibiotics, supportive care is crucial:
• Ensure adequate hydration with IV fluids
• Provide pain management as needed
• Monitor for potential complications like splenic rupture The spleen should be regularly assessed through physical examination and imaging (ultrasound or CT scan) to track its size and ensure resolution. Splenomegaly occurs due to the spleen's role in filtering blood and trapping pathogens. As it combats the infection, it enlarges. Once the infection is controlled, the spleen typically returns to its normal size over several weeks to months. If splenomegaly persists after treating the underlying infection, further investigation may be necessary to rule out other causes such as hematological disorders or malignancies. The most recent and highest quality study, published in 2023, emphasizes the importance of source control in emergency general surgery, including the management of intra-abdominal infections 1. It is essential to note that the choice of empiric antibiotic regimens should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology, as recommended by the 2017 WSES guidelines 1.

From the Research

Causes of Splenomegaly due to Abdominal Infection

• Splenomegaly, or the enlargement of the spleen, can be caused by various factors, including abdominal infections 2
• Abdominal infections, such as intra-abdominal infections (IAIs), can lead to splenomegaly due to the spread of infection to the spleen 3, 4, 5, 6
• The most common causes of IAIs include:
  • Bacterial infections, such as those caused by Enterobacteriaceae, Gram-positive cocci, and anaerobes 4, 2, 5, 6
  • Fungal infections, although less common, can also cause IAIs 4
• The diagnosis of splenic abscesses, a type of abdominal infection that can cause splenomegaly, is typically made using computed tomography (CT) scans and blood cultures 2
• The treatment of IAIs, including those that cause splenomegaly, typically involves broad-spectrum antibiotic therapy, with the goal of covering all potential pathogens 3, 4, 5, 6

Risk Factors for Splenomegaly due to Abdominal Infection

• Certain patient populations are at increased risk for developing splenomegaly due to abdominal infection, including:
  • Immunocompromised patients 2
  • Patients with a history of invasive procedures or surgery 5
  • Patients with underlying medical conditions, such as liver disease 5
• The presence of certain microorganisms, such as resistant bacteria, can also increase the risk of treatment failure and complications, including splenomegaly 3, 4, 5, 6

Treatment and Management

• The treatment of IAIs, including those that cause splenomegaly, typically involves empiric antibiotic therapy, with the goal of covering all potential pathogens 3, 4, 5, 6
• The choice of antibiotic therapy should be guided by the results of cultures and susceptibility testing, as well as the patient's individual characteristics and medical history 5
• In some cases, surgical or percutaneous drainage may be necessary to manage the infection and prevent complications, including splenomegaly 2, 6