An 81-year-old male patient with a history of chronic obstructive pulmonary disease, hypertension and chronic renal failure was referred from his residential care facility due to abdominal pain and fever for 24 hours.
There is no clear traumatic antecedent, although the patient reports multiple extra dental caries, the last two occurring one week and 24 hours before the onset of symptoms.
Upon arrival to the emergency department, coughing and sputum were found.
Physical examination revealed a septic mouth, bilateral snoring and diffuse abdominal pain with no signs of peritoneal irritation.
The initial laboratory tests showed no leukocytosis or left shift, with hemoglobin of 11 g/dl and hematocrit of 36.5%.
A simple chest X-ray showed minimal bilateral pleural effusion without pulmonary infiltrates.
In 24 hours the patient experiences a generalized deterioration with greater abdominal pain, accompanied by voluntary defense in the left hemiabdomen, leukocytosis (11,600 with 91.1% neutrophils) and anemization (hemoglobin 8.9 g/dl).
Abdominal computed tomography (CT) was performed without contrast due to the deterioration of renal function (creatinine 2.1 mg/dl). The smallest density of the intra-abdominal cavity is normal size, heterogeneous density is suggestive of a lower peripheral density.
Contrast enhancement and previous recovery of renal function with intensive serum therapy, contrast-enhanced CT is repeated, confirming the presence of irregular splenic areas without contrast enhancement compatible with infarct areas ocer.
Conservative treatment with antibiotics and analgesia was established, with improvement of the respiratory symptoms but persistence of abdominal pain and leukocytosis with high acute phase reactants.
A control CT scan showed purulent collection suggestive of a plenic leakage in the upper pole of 9 x 11 x 9.5 cm with attenuation values of hematoma, so it was decided to perform an abundant percutaneous drainage collection
This material grows in cultures a multiresistant E. coli, only sensitive patient andmenes parameters, so the imipenem cycle begins and percutaneous drainage is maintained with progressive improvement of the general state.
Ten days after drainage and in the absence of debit, a new image control was performed with an abdominal ultrasound, proving the disappearance of the collection, so the catheter was removed and the patient was discharged.
After 7 months of follow-up, the patient remains asymptomatic, and a control CT scan shows normal characteristics and absence of intra-abdominal abscess.
