Modalities:
(1) antibiotics
(2) aspiration or catheter drainage
(3) splenectomy
Antibiotic selection:
(1) If the causative organisms are not known, then a broad-spectrum regimenshould be used since many abscesses are polymicrobic.
(2) An attempt to be made to perform antibiotic susceptibility testing on the causative organism to guide selection of antibiotics.
Indications for splenectomy:
(1) a large abscess
(2) multiple abscesses
(3) one or more abscesses inaccessible to needle drainage
(4) splenic rupture
(5) recurrent abscesses from an uncontrollable source
(6) failure or complications of aspiration or catheter drainage
Needle aspiration or catheter drainage:
(1) Placement should be guided by ultrasonography or CT scan.
(2) A smaller abscess (some use < 3 cm while others < 5 cm) can undergo simple aspiration with a small gauge needle.
(3) A pigtail catheter with drainage can be used if:
(3a) the abscess is larger
(3b) the abscess is bilocular
