ISOLATED ENTERIC SPLENIC LESION IN AN IMMUNOCOMPETENT HOST: AN INTERESTING CASE REPORT

Splenic abscess is often an unrecognized complication of enteric fever. Diagnosis is difficult because of its rarity, insidious onset, and non-specific presentation. We report an interesting case of splenic lesion in an immunocompetent adolescent with no other comorbidities, who presented with history and clinical presentation more suggestive of tubercular etiology. However, culture from the CT-guided fine-needle aspirate grew Gram-negative bacilli, identified as Salmonella Typhi which was sensitive to ampicillin, cotrimoxazole, azithromycin, and ceftriaxone. He responded favorably with oral antibiotics without any further surgical intervention. High degree of clinical awareness with timely and appropriate microbiological evaluation helped into an early definitive diagnosis of enteric splenic abscess. This case highlights that in this era of emerging infections, we should not miss the atypical presentations of the endemic diseases. Safe and minimally invasive radiological intervention with good microbiological correlation is a successful spleen conserving treatment alternative to surgery in suitable patients of splenic abscess

Endovascular aneurysm repair:Is imaging surveillance robust, and does it influence long-term mortality?

Purpose: Endovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.<p></p> Methods: A retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.<p></p> Results: Data were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).<p></p> Conclusion: Only half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance