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Sat Jun 9 16:02:29 BST 2007

In a message dated 6/9/2007 8:52:11 A.M. Eastern Standard Time,  
cmursic at gmail.com writes:

options  as I see them:

1. Repeat the CT scan.  What if the  scan shows no obvious abscess -
just a busted-up spleen with  perisplenic hematoma?  What would you see on
the scan  that would compel you to operate versus continue to watch?
2.  Start antibiotics and watch?
3. Remove the spleen and be done  with it?

I surmise that the midpole infarct is now infected. A CT is unlikely to  
differentiate a bland from an infected infarct. If you saw air in the infarct,  it 
might suggest infection but air after infarct is rather nonspecific. Unlikely 
 to be a missed injury but CT might identify it.

Antibiotics might win the day and you might ride this out but i am leaning  
toward splenectomy for this unusual case in an unhappy patient

sal sclafani

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