Splenic abscess secondary to pyelonephritis in a diabetic patient: A rare cause of acute abdomen requiring emergency surgery

Splenic abscess is a rare but life-threatening condition, often presenting with nonspecific symptoms and occurring more frequently in immunocompromised patients. We report the case of a 68-year-old male with poorly controlled type 2 diabetes mellitus who presented with persistent abdominal pain and fever. Initial imaging suggested a renal mass and urinary tract infection; however, his condition deteriorated, and repeat imaging revealed a large splenic abscess with peritonitis. Emergency open laparotomy was performed due to extensive splenic involvement and septic presentation. Intraoperatively, a ruptured splenic abscess with 80 % parenchymal lysis and 1000 cc of purulent fluid was found. Partial splenic preservation and surgical drainage were achieved. Postoperative imaging confirmed residual abscess cavities, but the patient improved clinically and was discharged for follow-up. This case illustrates the diagnostic and therapeutic challenges of splenic abscess, particularly in diabetic patients. It emphasizes the importance of maintaining suspicion for intra-abdominal infections in immunocompromised hosts, even when initial symptoms suggest a urinary source. Timely imaging, multidisciplinary management, and individualized surgical decisions are crucial for improving outcomes. Open surgery remains a valid treatment option when minimally invasive approaches present a significant risk. This report underscores the need for early recognition and aggressive intervention in complex intra-abdominal infections, especially in patients with multiple risk factors.