Infective endocarditis is a potentially life-threatening condition caused by a bacterial infection of the heart valves. The incidence of splenic abscess associated with infective endocarditis varies between 1-10% of cases, and its presence may indicate a severe form of the disease. We present a 24-year-old man diagnosed with infective endocarditis who was found to have a splenic abscess upon further evaluation. The patient was initially managed conservatively with targeted antibiotics, but after unsuccessful percutaneous drainage, a splenectomy was performed. The patient underwent mitral valve replacement surgery and made a good recovery. The patient's case highlights the importance of considering a secondary abscess in the management of infective endocarditis. This complication can easily be missed and cause significant morbidity. This case underscores the importance of early diagnosis and effective collaboration between various healthcare professionals to achieve the best possible outcome for patients with infective endocarditis and its associated complications.
Chest wall resection is defined as partial or full-thickness removal of the chest wall. Significant morbidity has been recorded, with documented respiratory failure as high as 27%. Medical records of all patients who had undergone chest wall resection and reconstruction were reviewed. Patients' demographics, length of surgery, reconstruction method, size of tumor and chest wall defect, histopathological result, complications, duration of post-operative antibiotics, and hospital stay were assessed. From 1 April 2017 to 30 April 2019, a total of 20 patients underwent chest wall reconstructive surgery. The median age was 57 years, with 12 females and 8 males. Fourteen patients (70%) had malignant disease and 6 patients (30%) had benign disease. Nine patients underwent rigid reconstruction (titanium mesh for sternum and titanium plates for ribs), 6 patients had non-rigid reconstruction (with polypropylene or composite mesh), and 5 patients had primary closure. Nine patients (45%) required closure with myocutaneous flap. Complications were noted in 70% of patients. Patients who underwent primary closure had minor complications. In total, 66.7% of patients who had closure with either fasciocutaneous or myocutaneous flaps had threatened flap necrosis. Two patients developed pneumonia and 3 patients (15%) had respiratory failure requiring tracheostomy and prolonged ventilation. There was 1 mortality (5%) in this series. In conclusion, chest wall resections involving large defects require prudent clinical judgment and multidisciplinary assessments in determining the choice of chest wall reconstruction to improve outcomes.