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

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.