A CASE OF SPLENIC ABSCESS WITH CHOLECYSTITIS AND DIVERTICULOSIS OF THE COLON (GRASER'S DIVERTICULOSIS)

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The patient, a 54-year-old man, had received a fracture of the left rib two years previously, and subsequently suffered from upper abdominal pain in July 1983. In September of that year, he was admitted to our Department of Internal Medicine complaining of pyrexia, left abdominal pain and tarry stool. Cholelithiasis, splenic abscess and diverticulosis in the sigmoid colon were diagnosed by abdominal echoscope, CT, enema and so on. In October of the same year. cholecystectomy, splenectomy and sigmoidectomy were performed. The size of the spleen was equal to that of a child's head, from which approximately 300ml of pus flowed out, and colibacillus and anaerobes were isolated. The gall baldder showed strongly inflammatory, signs and c concretion was found trapped within Hartmann'spouch. Inflammatory findings of diverticulum in the colon were not strong. Splenic abscess is a relatively rare diease and only 25 cases have been reported in Japan. The causes of isolated splenic abscess are thought to be as follows; (1) hematogenous spread of bacteria from a focus of infection, (2) trauma, (3) inflammation occurring due to the influence of peripheral organs, (4) splenic infarction, (5) hemoglobin abnormality. The cause in our case was thought to be (1), and totalization of the cases reported in Japan revealed that the most common cause was also (1).
日本臨床外科学会の論文