Dalak tüberkülozlu hastada splenektomi: Olgu sunumu

Yaklaşık 20 aylık halsizlik, iştahsızlık, öksürük, ateş, gece terlemesi ve kilo kaybı yakınmaları olan 4 yaşında erkek çocuk hastanemize getirilmiş, bir yıldan beri akciğer tüberkülozu tanısıyla antitüberküloz tedavi almasına karşın genel durumunda anlamlı düzelme olmadığı öğrenilmiştir. Ön-arka akciğer filiminde mikronodüler infiltrasyon, karın ultrasonografisi ve bilgisayarlı tomografisinde dalakta çok sayıda nodül ve/veya mikroapseler saptanmış ve splenektomi yapılmıştır. Ameliyatta dalak tamamen kalsifiye çok sayıda nodül ve mikroapselerle kaplanmış olarak bulunmuştur. Splenektomi sonrası, erken dönemde genel durumu düzelen ve yakınmaları gerileyen hastaya iki yıl boyunca antitüberküloz tedavi verilmiştir. Dört yıllık izlem sonrası son kontrolünde yakınması olmayıp genel durumu iyi ve gelişimi normaldir. Dalak tüberkülozu sıklığı son zamanlarda artmıştır. Özellikle tüberkülozun sık gö-rüldüğü bölgelerde tüberkülöz dalak apselerinden şüphenilmelidir. Erken tanı ve erken ilaç tedavisi önemlidir. Erken tedavi edilmeyen veya tedaviye dirençli dalak abseli olgular splenektomiden yarar görebilir.
Anahtar Kelimeler:

Dalak, Splenektomi, Tüberküloz

A case report of spleen tuberculosis treated by splenectomy

A 4-years-old boy who had weakness, anorexia, coughing, fever, night sweats, and weight loss that had persisted for 20 months admitted to our institution. Although he had received three antituberculous agents due to pulmonary tuberculosis for almost a year, there has been no significant improvement in his overall condition. Micronodular infiltration in chest x-ray, multiple nodules and/or small abscesses in the spleen in abdominal ultrasound and computerized tomography were found. Because of the failure of antituberculous therapy, splenectomy has been performed. Intraoperatively, the spleen was completely calcified and covered with multiple nodules and micro abscesses. Following the splenectomy, the patient's symptoms resolved and he began to gain weight. He received antituberculous therapy for two years concomitant with surgery. After 4 year-follow up, he still had no symptom and continued to do well with normal growth. The incidence of spleen tuberculosis has increased recently. The suspicion of tuberculous spleen abscess especially in endemic area and early diagnosis with early nonoperative management is important. The cases associated with severe drug resistant multiple tuberculous spleen abscesses that delayed in tuberculous treatment may benefit from splenectomy.

Kaynakça

1. Agarwala S, Bhatnagar V, Mitra DK, et al: Primary tubercular abscess of the spleen. J Pediatr Surg 27:1580, 1992

2. Chang MC, Lin SC, Jeng KS, et al: Tuberculous splenic abscess in a patient with acute myeloblastic leukemia. J Formosan (Taiwan) Med Assoc 84:1173, 1985

3. Gadacz TR, Lipsett P: Splenic abscess, in Gorbach SL, Bartlett JG, Blacklow NR (eds): Infectious Diseases. Phyladelphia, Pennsylvania. WB Saunders 1992, p:750

4. Gittes GK: Lesions of the pancreas and spleen, in Ashcraft KW, Murphy JP, Sharp RJ, Sigalet DL, Snyder CL (eds): Pediatric Surgery. Philadelphia, Pennsylvania. WB Saunders 2000, p:621

5. Hassan IS, Snow MH, Ong EL: Overhelming pneumococcal sepsis in two patients splenectomized more than ten years previously. Scott Med J 41:17, 1996

6. Henry K, Symmers WSC: Thymus, lymph nodes, spleen and lymphatic. Systemic Pathology 1992, p:576

7. Hopewell PC, Bloom BR: Tuberculosis and other mycobacterial diseases, in Murray JF, Nadel JA (eds): Philadelphia, Pennsylvania. WB Saunders 1994, p:1094

8. Lerner RM, Spataro RF: Splenic abscess: Percutaneous drainage. Radiology 153:643, 1984

9. Rossman MD, Oner-Eyüpoğlu AC: Clinical presentation and treatment of tuberculosis, in Fishman AP (ed): Fishman's pulmonary diseases and disorders. New York, Mc Graw-Hill 1988, p:2483

10. Schiller M: The spleen, in O'Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds): Pediatric Surgery. St Louis, Missouri. Mosby 1998, p:1545

11. Wu CC, Chow KS, Lu TN, et al: Tuberculous splenic abscess: Sonographic detection and follow-up. J Clin Ultrasound 18:205, 1990

12. Yelon JA, Green JD, Evans JT: Splenic abscess associated with osteomyelitis. Eur J Surg 162:913, 1996

Kaynak Göster

  • ISSN: 1016-5142
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

382 63