Case history/examination
A 26-year- old African male farmer presented with a 3-month history of a
rapidly progressing left hypochondrial mass. This was associated with
abdominal pain and intermittent fever. He had no history of trauma,
infective endocarditis nor tuberculosis. He was neither human
immunodeficiency virus (HIV) positive nor diabetic. A full blood count
revealed a low haemoglobin level (Hb 6.1 g/dl), a leucocytosis of 16.5 x
109/l , and, a normal platelet count
of 307 x 109/l . Physical examination demonstrated a
tender splenomegaly extending to the umbilicus (Hackett’s 4). There was
no associated lymphadenopathy and cardiovascular examination was normal.
The differential diagnosis would include space-occupying lesions or
splenic masses due to trauma leading to haematoma or rupture, splenic
abscess, tumours and cysts. An abdominal ultrasound scan suggested a
splenic abscess. Following the transfusion of 2 units of whole blood, he
underwent a difficult resection of a large necrotic fluid- filled spleen
which was densely adherent to the tail of the pancreas, inferior surface
of the liver and greater curve of the stomach (Fig 1). Macroscopically,
the resected spleen was large, multiloculated with total parenchymal
destruction (Fig 2). He made good recovery and was discharged a week
later after receiving vaccines against the encapsulated bacterial
organisms, streptocococcus pneumonia, haemophilus influenza andneissieria meningitides that may cause an overwhelming post
splenectomy infection (OPSI).