無芽胞嫌気性菌による巨大腹壁膿瘍の1例

Abstract

A case of giant abdominal wall abscess due to Bacteroides fragilis and other five species of non-sporeforming anaerobes was reported.The patient, 26 years old housewife, experienced pollakisuria, left lumbago and fever (38-39°C) early in August, 1978. In near hospital she was treated with Ampicillin and Cephalexin under diagnosis of pyelonephritis, but did not improve. She noticed swelling of the left abdominal wall on August 10 Because she had had left hip joint tuberculosis, she was admitted on suspicion of tuberculous cold abscess on September 4. By the puncture of the abscess in the left lower part of the abdominal wall, foul pus was collected and the result of acid-fast stain and aerobic culture was negative. On the other hand, anaerobic culture showed a great number of B. fragilis with some anaerobic Gram-positive cocci. Abdominal wall abscess due to anaerobes was diagnosed and surgical drainage was performed at once; abundant foul grey-yellowish pus was drained. The chemotherapy of Lincomycin 2.4 g/day, i.v. andMinocycline 100mg/day, p.o. was started and from the next day fever fell down. After the chemotherapy for six weeks and irrigation of the abscess cavity by chlorhexidine (Hibitane) for two weeks, she improved completely.B. fragilis was abundantly isolated from all four cultures with Peptostreptococcus micros, Psc. anaerobius, Psc. sp., Peptococcus sacchrolyticus and anaerobic non-sporeforming Gram-positive bacilli. One colony of M. tuberculosis was cultured only one time, but it was considered to be not pathogenic.Abdominal wall abscess is generally known to follow surgical operations, infections or trauma of gastrointestinal tract and female genital organs. It was assumed that the abscess in this case had followed urinary tract infection.