laparoscopic sleeve gastrectomy ( lsg ) is currently one of the most commonly performed bariatric surgeries in the world
. known perioperative complications include haemorrhage , leak , small bowel obstruction and infections ( mostly wound and intra - abdominal abscess ) .
intra - abdominal abscess presents in < 1% of all procedures , and , to the best of our knowledge , only six cases of splenic abscess as a complication of lsg exist in the literature [ 26 ] .
a 45-year - old woman with a past medical history significant for essential hypertension , asthma and morbid obesity status post lsg 20 days before admission , presented with abdominal pain of 10 days duration .
the pain was localized to the left upper quadrant and was associated with fever , chills , nausea and infrequent vomiting . at the time of the lsg ,
her post - operative course was uneventful and she was discharged home 3 days after admission .
however , she had not attempted any solid food due to nausea . on admission ,
physical exam was significant for mild pain on palpation of the left upper abdominal quadrant .
a computed tomography ( ct ) of the abdomen was obtained and showed a well - circumscribed 7.1 by 5.4 cm air - fluid collection in the medial aspect of the spleen . of note , an upper gastrointestinal series with gastrografin showed no evidence of leak from her gastrectomy staple line .
the patient was started on empiric piperacillin / tazobactam and a ct - guided drainage of the abscess was performed .
the patient was treated with meropenem and linezolid for 4 days , and then switched to intravenous ceftriaxone once the microbiology results became available .
she was discharged home to complete 2 weeks of intravenous antibiotics . however , after 3 weeks the patient returned to the hospital with new left upper abdominal pain that referred to the left shoulder , poor oral intake , fever and shortness of breath .
a repeat ct of the abdomen showed an air - fluid collection in the medial spleen comparable in size to the one present at post drainage .
a ct - guided drainage of the splenic abscess was performed and the patient was discharged home to complete 2 weeks of intravenous ceftriaxone and oral metronidazol .
splenic abscess is a rare occurrence , with the vast majority of the available literature consisting of case reports and series from tertiary care centres .
splenic abscess as a complication of lsg appears to be an extremely rare entity with only six cases in the literature [ 26 ] .
these patients were ages 1946 , none had a reported immunosuppressive condition , presented in the late post - operative period , and only one had an intraoperative complication ( table 1 ) .
previous authors have pointed out that splenic abscess in the bariatric population could have a different aetiology from the classically described in the general population . among the proposed factors are extension from a gastric staple - line leak , splenic injury during surgery and inadvertent splenic ischaemia [ 3 , 6 ] . regarding the latter , in a recently published series of 565 lsg , 0.53% presented with splenic abscess in post - operative days 914 .
interestingly , the authors of this paper reviewed the video recordings of all cases and reported a rate of spleen infarcts of 7.79% .
all splenic abscesses in this series had evidence of infarct during the original procedure , leading them to suggest that they are both related .
a similar study with closer follow - up suggested this as well . in our case
, there was no evidence of intraoperative injury to the spleen , staple - line leak or splenic ischaemia .
the causative agent was s. anginosus , usually found as a commensal of the oral cavity and gastrointestinal tract , but capable of suppurative infections that are often associated with antecedent disruption of the gastrointestinal mucosa . in the present patient , without any obvious perforation or anastomotic leak , haematogenous spread caused by transient bacteraemia during the surgical procedure is certainly a possibility .
she responded well to the combination of intravenous antibiotics and percutaneous drainage , and there was no need for splenectomy . 

table 1characteristics of previous case reports of splenic abscess as a complication of lsg.case ( reference)age / seximmunosuppressionimmediate complicationspost - operative day of presentationtreatmentevidence of leakagecultured organismrojas et al . 46/fnohaemoperitoneum , splenic hilum and hepatic injury14iv antibiotics , percutaneous drainageyess .
no75iv antibiotics , percutaneous and laparoscopic drainagenostaphylococcusspp.,enterobacter cloacae , streptococcus mitis and oralisavulov et al .
44/mnono70iv antibiotics , percutaneous drainage , splenectomynoklebsiella pneumoniae , streptococcus pneumoniae , acinetobacterspp.current study , 201645/fnono20iv antibiotics , percutaneous drainagenos .
anginosus characteristics of previous case reports of splenic abscess as a complication of lsg . in conclusion ,
splenic abscess is an uncommon complication of lsg , albeit one that should be entertained in the patient with abdominal pain and fever given its high mortality .
a ct of the abdomen with contrast is the preferred diagnostic tool ; patients should be treated with a combination of intravenous antibiotics and either percutaneous drainage or splenectomy .
further studies with a larger sample of lsg patients should be conducted in order to elucidate the role of splenic ischaemia in abscess formation .
 abstractsplenic abscess as a complication of laparoscopic sleeve gastrectomy ( lsg ) is rare . 
 there have only been six cases in the literature . in most of these cases , 
 the classic predisposing factors for developing splenic abscess were absent , leading to the hypothesis that transient bacteraemia caused by mucosal disruption during the surgical procedure and splenic ischaemia may play a role . 
 these patients usually present in the late post - operative period with abdominal pain , fever and leucocytosis . 
 the preferred treatment is intravenous antibiotics and percutaneous drainage or splenectomy . 
 we report a case of splenic abscess caused by streptococcus anginosus that occurred 20 days after lsg in a 45-year - old woman without immunosuppressive conditions . 
 the patient was successfully treated with antibiotic therapy and percutaneous drainage . 