Unusual abscess masquerading as poorly differentiated adenocarcinoma of the colon showing characteristics of choriocarcinoma.

Seventy-seven cases of pyogenic abdominal wall abscess and 33 cases of psoas abscess admitted to the Red Cross Children's Hospital are reviewed separately. The difficulty encountered in diagnosis, particularly in deep-seated abdominal wall abscesses, is emphasised as resulting in delays in treatment. Ultrasound accurately delineated the abscess in 80% of cases submitted for this investigation. Surgical drainage proved effective therapy, and Staphylococcus aureus was the causative organism in more than 80%. No long-term sequelae were encountered.

Abdominal Wall Abscesses in Patients With Crohn's Disease: Clinical Outcome

BACKGROUND Acute appendicitis is a common surgical emergency, and perforated appendix is one potential complication. Acute appendicitis can be complicated by perforation and peritonitis, but chronic abscess formation is less common. This report presents the case of a 45-year-old woman with a 7-day history of right lower-abdominal pain and swelling due to perforated acute appendicitis and abdominal wall abscess that required laparotomy and drainage. The presentation of this particular case is unique in that a fistulous tract formed subsequent to perforation of the appendix, with the resultant abscess forming in the abdominal wall. The current case study serves to showcase the diagnostic challenges associated with such a presentation. CASE REPORT A 45-year-old woman presented to the emergency department with a 7-day history of right lower-quadrant and midline lower-abdominal pain and swelling. Computed tomography (CT) scans with intravenous (IV) and rectal contrast showed an abdominal wall abscess with no signs of obstruction, perforation, or appendicitis. Incision and drainage of the abdominal wall abscess with debridement of the abdominal wall was complicated by peritoneal adhesions, and open laparotomy was thus performed. Upon entry into the abdominal cavity, the appendix was found to be adherent to the abdominal wall. It was noted that the appendix had perforated, allowing for fistula formation with the abdominal wall. CONCLUSIONS Clinicians should maintain a high index of suspicion for perforated appendicitis in cases of abdominal wall abscesses with leukocytosis and right lower-quadrant pain, even when initial imaging does not show obvious appendicitis.

BackgroundA small percentage of patients with foreign body ingestion develop complications, which have a variety of clinical presentations. Less than 1% of cases require surgical intervention. We present a patient with an abdominal wall abscess resulting from a fish bone that pierced the cecum. The patient was treated laparoscopically.Case presentationA 55-year-old Japanese man presented to our hospital with a complaint of right lower abdominal pain. A physical examination revealed tenderness, swelling, and redness at the right iliac fossa. Computed tomography showed a low-density area with rim enhancement in his right internal oblique muscle and a hyperdense 20 mm-long pointed object in the wall of the adjacent cecum. Based on the findings we suspected an abdominal wall abscess resulting from a migrating ingested fish bone. He was administered antibiotics as conservative treatment, and the abscess was not seen on subsequent computed tomography.Two months after the initial treatment, he presented with the same symptoms, and a computed tomography scan showed the foreign body in the same location as before with the same low-density area. We diagnosed the low-density area as recurrence of the abdominal wall abscess. He underwent laparoscopic surgery to remove the foreign body. His appendix, and part of his cecum and the parietal peritoneum that included the foreign body, were resected. He had an uneventful postoperative course, and at 1 year after the surgery, the abdominal wall abscess had not recurred.ConclusionsAn abdominal wall abscess developed in association with the migration of an ingested fish bone. We suggest that a laparoscopic surgical resection of the portion of the bowel that includes the foreign body is a useful option for selected cases.

Introduction: Colonic carcinoma has a variety of clinical presentations, however, invasion of the abdominal wall arising from the transverse colon is a rare one, as seen in this case report. Case report: 62-year-old patient with diffuse high intensity abdominal pain, fever, nausea, vomiting and an epigastric abscessed heterogeneous mass (8 x 7 x 7cm). A water-soluble contrast enema was performed, showing diverticula, absence of distal colon contrast transition and the apple core sign, compatible with transverse colon obstruction. A transverse colectomy was performed, with primary colo-colonic end-to-end anastomosis, including omentectomy and complete en-bloc resection of the affected abdominal wall area. The histopathological findings showed a transverse colon adenocarcinoma with abdominal wall invasion; all surgical margins were free of disease (R0), and 24 lymph nodes were retrieved. Patients’ recovery was successful. Discussion: Locally advanced colorectal cancers invade adjacent organs without distant metastases. They may result in abscess formation even in unusual locations like the abdominal wall, which is a rare complication (0.3 to 4%). Colon cancer diagnosis before surgery may not always be possible; and a flawed diagnosis can determine an incomplete treatment because the intraoperative macroscopic malignancy recognition is not always achievable. En-bloc resection is the gold standard treatment to accomplish a complete resection, with histologically negative margins and no residual tumor (R0). Conclusion: Colon adenocarcinoma may rarely present as an abdominal wall abscess. Image studies may include CT, radiography, etc. but the patient’s clinical status should always be prioritized; those who present abdominal obstruction with a high risk of sepsis and mortality should be offered immediate surgical treatment. En-bloc resection is the gold standard to accomplish histologically negative margins and no residual tumor.

Colorectal cancer usually presents with intestinal symptoms, but rare extraintestinal manifestations may occur from tumuor invasion. These include abdominal wall abscess, rupture, subcutaneous thigh or retroperitoneal abscess, and emphysema, often leading to misdiagnosis and treatment delays. We report a 30-year-old male with progressive, painless right upper abdominal swelling for four months and a discharging anterior abdominal wound for two months. Initially treated as soft tissue infection, further evaluation revealed a transverse colon tumuor with abdominal wall abscess. He underwent extended right hemicolectomy with ileotransverse anastomosis. Histopathology confirmed adenocarcinoma. A postoperative complication of surgical site infection was successfully managed with antibiotics and wound dressing with povidone iodine. This case highlights considering colonic cancer in atypical abdominal wall presentations.

Actinomycetoma of the colon presenting as abdominal wall abscess. Case report and review of the literature

Toothpick ingestion is a rare but potentially fatal condition which may cause bowel perforation and rare complications if it migrates out of the gastrointestinal tract. This case report describes a...

Rectal adenocarcinoma with choriocarcinomatous differentiation: Clinical and genetic aspects

Introduction Abdominal wall invasion by cancerous cells arising from the colon with an overlying secondary infection that presents as an abdominal wall abscess has been encountered previously, but such a symptom is rarely the first presentation of colon cancer. There are very few cases reported in the literature. Case Presentation In this case report, we present a case of a 66-year-old male presenting with abdominal wall abscess that was refractory to treatment. The patient later was found to have an abdominal wall invasion by an underlying colonic carcinoma. Conclusion The purpose of this review is to set forth the proper approach when encountering such cases and emphasize on the significance of keeping a high index of suspicion. We also highlight the need for utilizing proper diagnostic imaging modalities prior to invasive intervention.

Spilled gallstones left in the abdominal cavity or trapped at trocar sites may cause considerable morbidity. We saw a patient with an abdominal wall abscess 2 years after laparoscopic cholecystectomy secondary to spilled stones. After we reviewed the operative procedure in addition to the accumulated experience in laparoscopic surgery, we believe that retrieval of specimens and their contents is of paramount importance, especially when the gallbladder is infected, contains several stones, or may harbor malignancy. Therefore, we made use of a simple surgical glove with a long pursestring suture surrounding the opening to collect the specimen. This method proved to be simple and quite convenient, with the needed materials readily available. It can collect the spilled stones within the abdominal cavity as well as the gallbladder and can transport these stones out of the abdominal cavity with ease and safety. It also protects the specimen in contact with the wound and cuts short the operating time. The technique and advantages are described.

Locally invasive colon carcinoma comprises a small fraction of the incidence of colon carcinoma. Complications, such as perforation and obstruction, can occur in less than 0.5% of cases and often present differently based on location. We present a case of an 85-year-old woman who presented with an acute abdominal wall abscess which was caused by perforation of transverse colon carcinoma. En-bloc resection increases 5-year survival, and adjuvant chemotherapy reduces the risk of recurrence in patients with stage II resectable colon carcinoma.

Crohn's disease is a chronic, non-specific transmural colonic inflammatory disease of unknown etiology which can affect the whole gastrointestinal tract. According to recent literature, tumor necrosis factor alpha (TNF-alpha) plays an important role in the development of mucosal inflammation. Infliximab, a monoclonal TNF-alpha antibody which by binding to soluble and transmembrane TNF as well can block its effects in vivo and in vitro. The authors present the case of a young Crohn's patient in whom abdominal wall abscesses and fistula developed besides pancolitis. The disease developed fulminantly so there was no possibility to initiate classical therapy regimens. After surgical consultation decided to administer infliximab therapy (5mg/body weight on the 0.-2. and 6.th weeks). For objectification of the disease course we used the Crohn's disease activity index (CDAI or Best score). After treatment the fistula closed and the radical surgical intervention could be avoided. Gluten sensitive enteropathy (GSE) also could be proven in this patient (based on histology and antibodies) but the symptomatology of this disease did not change despite infliximab therapy without diet. After it the recommended gluten free diet made the patient symptom free. Coexistence of these two diseases is rarity in the literature so attention should be paid to Crohn's patients who are not symptom free after specific treatment. On the other hand, infliximab therapy may not useful for the treatment of celiac disease.

This case report describes an intra-abdominal and abdominal wall abscess formation in a 53-year male. The abscess developed 20 years after an uncomplicated laparoscopic cholecystectomy. He presented to multiple clinics with complaints of abdominal swelling and pain and had been prescribed multiple courses of antibiotics in the preceding six months before a definitive diagnosis was made. Subsequent ultrasound and computed tomography scans confirmed intra-abdominal abscess infiltrating the liver and the abdominal wall abscess. Incision and drainage were performed and multiple gallstones in the abscess cavity were visualised. Early postoperative complications including abscess formation usually come to attention; however, the importance of late complications should not be undervalued, especially when an abscess develops in a patient with a history of recent or remote cholecystectomy. Thorough investigation, consideration of possible diagnosis related to abscess formation post-cholecystectomy, and timely action is the key to management. Key Words: Abdominal wall abscess, Laparoscopic cholecystectomy, Complications, Retained gallstones.

Dear Editor, Spigelian hernia can be described as a protrusion of a peritoneal sac, organ, or preperitoneal fat through a congenital or acquired defect in the Spigelian fascia, which is the part transeversus abdominis aponeurosis that lies between the semilunar (Spigelian) line and the lateral edge of the rectus muscle, often above the inferior epigastric vessels, at the level of the arcuate line where the fascia is widest and weakest.[1] Some authors have suggested that perforating vessels can weaken the fascia, permitting the entrance of a lipoma and leading to hernia formation.[2] Because of their small neck size, approximately one third of Spigelian hernias in adults appear incarcerated during surgery. Spigelian hernia is in itself very rare and is difficult to diagnose clinically. It has been estimated that it constitutes 0.12% of abdominal wall hernias.[3] Despite the fact that cases of Spigelian hernia have also been reported in children or even infants, it is a relatively rare hernia that occurs usually in females between 40 and 70 years of age, while the etiologic factors classically associated with this defect are claimed to be obesity, chronic obstructive pulmonary disease, prior surgery, and abdominal trauma.[4] Patients with Spigelian hernia usually complain of pain or lump or both at the site of herniation.[5] The pain is sharp and constant or intermittent, or there is a dragging and uncomfortable feeling.[5] It has been estimated that Spigelian hernias are approximately 2% of the abdominal wall hernias that require emergency operation due to incarceration.[6] When strangulation or incarceration of the herniated contents is present, the pain at the hernia site will be severe and constant. A correct preoperative diagnosis is made in only 53 to 75% of patients, and a significant percentage of incarcerated Spigelian hernias are diagnosed during an emergency laparotomy.[4][7] Spangen reported that 24.1% of Spigelian hernias reach the surgeon incarcerated and that the hernial sac contents are usually found to be small bowel, colon, or omentum.[5] This is supported by our patient in whom hernia sac content was omentum. This report emphasizes possibility of a hernia while a surgeon is dealing with an abdominal wall abscess and the surgeon has to be totally sure about the appropriate treatment to prevent devastating complications. A 60-year old obese female presented to our hospital with history of constant pain and lump in the right lower abdominal wall for the last three days. She also gave history of fever for the last two days. Her bowel habits were normal and did not have any other complaint. On examination, a soft lump of about 4x4x1.5 cm was found on right lower abdomen at the margin of the right semilunar line with inflamed overlying skin (Figure 1 and Figure 2). Fig. 1 Spigelian hernia as abdominal wall abscess. Fig. 2 CT scan showing abdominal wall abscess and adjacent bowel walls. There was no cough impulse and lump would not decrease on lying down position. Bowel sounds were normal. Aspiration of swelling revealed purulent materials. Digital rectal examination was normal and x-ray of abdomen revealed nothing significant. Ultrasound (USG) abdomen showed parietal wall abscess with gut loop adherent to it. Computed tomography (CT) scan was advised which confirmed Spigelian hernia with strangulation or incarceration of the omentum and abscess formation in abdominal wall. The patient was taken up for exploratory laparotomy. On exploration, about 25 ml of pus was drained. The defect was seen in peritoneum and gangrenous omentum was seen herniating (Figure 3). Fig. 3 Gangrenous omentum. The strangulated omentum was excised and the defect was closed with herniorrhaphy. Pus culture sent grew Klebsiella sensitive to imipenam. The post-operative course of the patient was uneventful. The patient was followed up for over six months without any local recurrence.