Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature

Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature

Hiang Jin Tan, Adrian Kah Heng Chiow, Nita Thiruchelvam, Siong San Tan, Lip Seng Lee

Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore 529889.

Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.

Keywords: laparoscopic surgery, melioidosis, spleen, pancreas

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Hiang Jin Tan, Adrian Kah Heng Chiow, Nita Thiruchelvam, Siong San Tan, Lip Seng Lee.Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature. International Journal of Case Reports, 2021, 5:241. DOI: 10.28933/ijcr-2021-08-1505


1. Currie BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respir Crit Care Med 2015;36:111–25. doi: 10.1055/s-0034-1398389. Epub 2015 Feb 2.
2. Churuangsuk C, Chusri S, Hortiwakul T, et al. Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in southern Thailand: a 10-year retrospective study. Asian Pac J Trop Med 2016;9:256–60. doi: 10.1016/j.apjtm.2016.01.034. Epub 2016 Jan 11.
3. Bhengsri S, Baggett HC, Jorakate P, et al. Incidence of bacteremic melioidosis in eastern and northeastern Thailand. Am J Trop Med Hyg 2011;85:117–20. doi: 10.4269/ajtmh.2011.11-0070
4. Lee YL, Lee SJ, Tsai HC, et al. Pyogenic liver abscess caused by Burkholderia pseudomal-lei in Taiwan. J Formos Med Assoc 2006;105:689–93. doi: 10.1016/s0929-6646[09]60171-6.
5. Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management.Clin Microbiol Rev. 2005 Apr; 18[2]:383-416. doi: 10.1128/CMR.18.2.383-416.2005
6. Reactivation of latent melioidosis presenting with acute pyelonephritis and bacteremia. Shaaban H, Hallit R, Slim J, Sree A, Sensakovic JW. Avicenna J Med. 2014 Jan; 4[1]:20-1. doi: 10.4103/2231-0770.127418
7. Lumbiganon P, Viengnondha S. Clinical manifestations of melioidosis in children. Pediatr Infect Dis J 1995;14:136–40. doi: 10.1097/00006454-199502000-00010.
8. Singh M, Mahmood M. Melioidosis: the great mimicker. J Community Hosp Intern Med Perspect. 2017 Oct; 7[4]:245-247. doi: 10.1080/20009666.2017.1348875.
9. Huang, W., Wu, G., Chen, F. et al. Multi-systemic melioidosis: a clinical, neurological, and radiological case study from Hainan Province, China. BMC Infect Dis 18, 649 [2018].
10. Joazlina ZY, Wastie ML, Ariffin N. Computed tomography of focal splenic lesions in pa-tients presenting with fever. Singapore Med J 2006;47:37–41. PMID: 16397719
11. Ng CY, Leong EC, Chng HC. Ten-year series of splenic abscesses in a general hospital in Singapore. Ann Acad. Med Singapore 2008; 37:749–752. PMID: 18989490
12. White NJ, Dance DA, Chaowagul W, Wattanagoon Y, Wuthiekanun V, Pitakwatchara N. Halving of mortality of severe melioidosis by ceftazidime. Lancet 1989;23:697–701. doi: 10.1016/j.ijantimicag.2014.01.005
13. Bulus H, Mahmoud H, Altun H, Tas A, Karayalcin K. Outcomes of laparoscopic versus open splenectomy. J Korean Surg Soc. 2013 Jan;84[1]:38-42. doi: 10.4174/jkss.2013.84.1.38.
14. Lee, L., Wong, J., Chiow, A., Lee, S., Chan, C., Tan, S., Teo, J., Goh, B.. The develop-ment of robotic hepatopancreatobiliary surgery in Singapore: a multi-institutional experi-ence. Annals of Laparoscopic and Endoscopic Surgery, North America, 3, jul. 2018. doi: 10.21037/ales.2018.07.03
15. Targarona EM, Cerdán G, Gracia E, Rodríguez M, Trias M. Results of laparoscopic sple-nectomy for treatment of malignant conditions. HPB [Oxford]. 2001;3[4]:251-5. doi: 10.1080/136518201753335746.
16. Hai Chen, Zhi-qiang Hu, Yao Fang, Xiao-xue Lu, Li-da Li, Yuan-li Li et al. Splenic abscess caused by Burkholderia pseudomallei. Medicine [2018] 97:26. doi: 10.1097/MD.0000000000011208.
17. Deng-Wei Chou and Yie-Wen Lin. Splenic Infarction and Rupture Due to Melioidosis. Am J Med Sci. 2017 Dec;354[6]:633-634. doi: 10.1016/j.amjms.2016.12.009. Epub 2016 Dec 14
18. Ninan F, Mishra AK, John AO, Iyadurai R. Splenic granuloma: Melioidosis or Tuberculo-sis?. J Family Med Prim Care 2018;7:271-3. DOI: 10.4103/jfmpc.jfmpc_171_17
19. Liv Hesstvedt, Marianne Wilhelmsen, Anne Torunn Mengshoel, Anne Ma Dyrhol‐Riise. Two Norwegian Patients With Melioidosis Presenting With Bacteraemia and Splenic and Prostatic Abscesses, Journal of Travel Medicine, Volume 18, Issue 6, 1 November 2011, Pages 418–421,
20. Miraclin AT, Mani SS, Suresh S, Iyyadurai R. Septicemic melioidosis with ruptured splenic abscess in a patient with thalassemia intermedia. J Global Infect Dis 2017;9:32-3. DOI: 10.4103/0974-777X.194372
21. Jitendranath A, Bhargavi L, Ramani Bai J T, Radhika R. A case of melioidosis from splen-ic abscess. J Acad Clin Microbiol 2016;18:40-3. DOI: 10.4103/0972-1282.184765
22. Tak Kuan Chow, Lin Chuan Eu, Kin Fah Chin, Kien Chai Ong, Jayalakshmi Pailoor, Jamu-narami Vadivelu et al. Case Report: Incidental Splenic Granuloma due to Burkholderia pseu-domallei: A Case of Asymptomatic Latent Melioidosis?Am. J. Trop. Med. Hyg., 94[3], 2016, pp. 522–524. doi:10.4269/ajtmh.15-0774
23. Seymour Levine, Thomas J. Whelan. Melioidosis of the spleen. Am J Surg. 1968 Jun;115[6]:849-53. Doi:[68]90533-3
24. Maytapa, J., Thanapirom, K., Kullavanijaya, P., and Komolmit, P. [2018] Gastrointestinal: Splenic abscesses‐related gastrosplenic fistula: Unusual complication of melioidosis. Jour-nal of Gastroenterology and Hepatology, 33: 1163. doi: 10.1111/jgh.14095.
25. Wu YC, Hsu JW, Chang TH, & Kung WC. Melioidosis in an urban-dwelling Taiwanese man with splenic abscesses. Trop Doct. 2010 Oct;40[4]:240-1. doi: 10.1258/td.2010.090472. Epub 2010 Aug 13.

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