Abdominal Abscess Research Articles

Risk factors for abdominal surgical infectious complications after distal gastrectomy for gastric cancer: A post-hoc analysis of a randomized controlled trial (JCOG0912)

BackgroundAbdominal surgical infectious complications (ASIC) after gastrectomy for gastric cancer impair patients' survival and quality of life. JCOG0912 was conducted to compare laparoscopy-assisted distal gastrectomy with open distal gastrectomy for clinical stage IA or IB gastric cancer. The present study aimed to identify risk factors for ASIC using prospectively collected data. MethodsWe performed a post-hoc analysis of the risk factors for ASIC using the dataset from JCOG0912. All complications were evaluated according to the Clavien–Dindo classification (CD). ASIC was defined as CD grade I or higher anastomotic leakage, pancreatic fistula, abdominal abscess, and wound infection. Analyses were performed using the logistic regression model for univariable and multivariable analyses. ResultsA total of 910 patients were included (median age, 63 years; male sex, 61 %). Among them, ASIC occurred in 5.8 % of patients. In the univariable analysis, male sex (odds ratio [OR] 2.855, P = 0.003), diabetes (OR 2.565, P = 0.029), and Roux-en-Y (R–Y) reconstruction (vs. Billroth Ⅰ, OR 2.707, P = 0.002) were significant risk factors for ASIC. In the multivariable analysis, male sex (OR 2.364, P = 0.028) and R–Y reconstruction (vs. Billroth Ⅰ, OR 2.310, P = 0.015) were independent risk factors for ASIC. ConclusionsMale sex and R–Y reconstruction were risk factors for ASIC after distal gastrectomy. Therefore, when performing surgery on male patients or when R–Y reconstruction is selected after gastrectomy for gastric cancer, surgeons should pay special attention to prevent ASIC.

P214 Effects of rectal stump proctitis on short-term postoperative complications after proctectomy and ileal pouch-anal anastomosis for Ulcerative Colitis

Abstract Background Inflammation of the rectal stump (proctitis) after subtotal colectomy with ileostomy for ulcerative colitis (UC) is common. Proctitis may affect the postoperative outcomes of ileal pouch-anal anastomosis (IPAA). This study aims to explore associations between rectal stump proctitis and short-term postoperative complications (POCs) after proctectomy and IPAA for UC. Methods This retrospective single-centre study included patients who underwent proctectomy, IPAA and protective ileostomy for UC from 2000-2023. Data were retrieved from our prospectively-maintained database. Exclusion criteria were dysplasia or cancer (103 pts), missing pathology results (50 pts), undetermined colitis or Crohn’s Disease features at proctectomy (18 pts). All patients underwent three-staged IPAA and were divided into four groups according to the rectal stump proctitis status at pathology: remission, mild, moderate, and severe proctitis. A stepwise binary logistic regression analysis was performed for each short-term outcome. Models included variables with a different distribution according to the outcome (p-value ≤0.1). Results We included 785 patients who underwent proctectomy and IPAA. At pathology, remission was achieved by 162 (20.6%) patients, while proctitis of the rectal stump was mild in 211 (26.9%), moderate in 246 (31.3%), and severe in 166 (21.1%) patients, respectively. Table 1 details population characteristics and outcomes according to the proctitis status. Patients with moderate and severe proctitis received more preoperative biologics and ongoing systemic steroids at surgery. While they underwent previous abdominal surgery less frequently, the laparoscopy rate was lower with a longer postoperative length of stay. At multivariate (Table 2), Medical POCs were independently associated with ongoing antibiotics (OR 2.29 [1.01-5.20] p=0.047) and ASA score≥3 (OR 1.93 [1.11-3.35] p=0.019). Surgical POCs were independently associated with ongoing systemic steroids (OR 2.09 [1.19-3.68] p=0.011, while ongoing antibiotics (OR 0.2 [0.04-0.86] p=0.031) and laparoscopy (OR 0.53 [0.28-1.00] p=0.049) were protective. Intra-abdominal septic complications (IASCs) and abdominal/pelvic abscesses were independently associated with the proctitis status (OR 1.1 [1.06-2] p=0.018 and OR 1.56 [1.08-2.25] p=0.017, respectively). Conclusion Rectal stump proctitis was independently associated with postoperative abdominal and pelvic abscesses and IASCs after proctectomy and IPAA for UC. The association between proctitis and IPAA’s long-term outcomes and pouch failure need to be further explored.

Cholecystocutaneous Fistula Associated with Edwardsiella tarda as a Result of Aggressive Lymphoma Development.

A cholecystocutaneous fistula is a type of external biliary fistula that occurs when there is an abnormal connection between the gallbladder and skin. We report the first case of a cholecystocutaneous fistula that occurred in association with the development of lymphoma in the gallbladder. A 76-year-old woman who was under observation for follicular lymphoma with a low tumor burden presented with fatigue and abdominal pain. Imaging studies revealed cholecystitis associated with an abdominal subcutaneous abscess, and lymphoma transformation was confirmed by a lymph node biopsy. Edwardsiella tarda was cultured from both the abdominal subcutaneous abscess and percutaneous transhepatic gallbladder drainage, demonstrating cholecystocutaneous fistula, and open cholecystectomy revealed lymphoma cell infiltration into the gallbladder. Our case showed unique complications, and its successful management was associated with aggressive lymphoma development.

Effectiveness and safety of CT-guided drainage of abdominal abscesses with small and extra-small-bore drains: a single-centre observational study.

Computed tomography (CT)-guided percutaneous drainage is an established method for the treatment of abdominal abscesses. The purpose of this study is to evaluate the effectiveness and safety of drainage of abdominal abscesses with small-bore (6F and 9F) drains. The analysis of a prospectively maintained database included 135 consecutive patients from a single centre with abdominal or pelvic abscesses, who underwent CT-guided drainage. Procedures were performed using a one-step trocar technique with 6F (40 procedures) or 9F (95 procedures) catheters. Technical success was defined as insertion of the drain into the abscess cavity and aspiration of the fluid sample. Clinical success was defined as resolution of infection without surgical intervention or upsizing of the drain. The mean size of abscesses was 77.0 ± 28.8 mm (32-220 mm). Thick fluid was aspirated from 129 collections; 6 collections contained thin fluid. Technical success was achieved in 100% of procedures. Clinical success was achieved in 94.8% of patients. Surgical drainage was necessary in 3.7% of patients and upsizing in 1.5% of patients. Complications of Clavien-Dindo grade III were noted in 2.2% of patients without grade IV or V adverse events. The mean radiation dose in terms of Dose Length Product was 617 ± 467 mGy x cm. The mean procedure time was 28.0 ± 11.3 min. CT-guided drainage of abdominal abscesses with small- and very small-bore drains is usually sufficient to obtain clinical success with a low complication rate in the case of thick fluid collections.

Encasement of Ventral Hernia Mesh within Small Bowel: A Case Report

Ventral hernia repairs are one of the most commonly performed surgical interventions, with low overall complication rate of 15 percent of cases. Complications with wound healing account for over half of all complications associated with ventral hernia repairs. There is a risk, albeit low, of other such complications, including enterectomy, intra-abdominal infections, and mesh erosion into surrounding structures. We present a case of a 73-year-old male who presented to the hospital with a history of abdominal pain of one week duration. The patient was originally diagnosed with an abdominal wall abscess and recurrent hernia. Upon exploration of the abdominal cavity, it was noted that the mesh from previous ventral hernia repair had eroded into the lumen of the small bowel, requiring small bowel resection for removal of the mesh and repair of the hernia. Ventral hernia repairs are relatively safe, and complications of mesh erosion into the lumen of the small bowel are extremely rare, with minimal cases reported. This case highlights a rare complication associated with ventral hernia repairs and the importance of early recognition and appropriate repair when complications are found.

Minimally invasive interventions for complications associated with intra-abdominal calculi after laparoscopic cholecystectomy

To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.

Pericardial Effusion and Superficial Abdominal Abscess as Complications of Malposed PICC Line in a Preterm Neonate: A Case Report

In neonatal critical care units, peripherally inserted central catheter lines are frequently used to provide venous access for continuous parenteral nutrition and medications in newborns. In this case report, a male neonate weighing 1270 grams was on Continuous Positive Airway Pressure (CPAP) for hyaline membrane disease and initially received Total Parenteral Nutrition (TPN) through a Peripherally Inserted Central Catheter (PICC) in the left long saphenous vein on the second day. The baby developed tachycardia, respiratory distress requiring mechanical ventilation, and erythematous swelling over the paraumbilical region. A diagnosis of pericardial effusion and superficial abdominal abscess secondary to a malposed PICC line in a preterm, very low birth weight neonate was made. Suspecting a misplaced line, it was immediately removed, and the patient showed improvement over the next 24 hours. Within the next 48 hours, the patient was extubated to CPAP. Therefore, daily inspection by an expert, as well as confirmation of the central line tip, will aid in preventing delays in detecting complications.

Role of cellular indices in predicting post-appendectomy abscess in children.

Up to 20% of advanced appendicitis cases can be complicated by postoperative abscesses, adding morbidity and mortality and prolonging hospital stays. This study examines the utility of two cellular indices as predictors of post-appendectomy abscess compared to cell counts. A diagnostic study was conducted on patients <15 years old who underwent appendectomy at a pediatric hospital between 2021 and 2022 (Reg. 2023/390894). Preoperative values of leukocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR= neutrophils/lymphocytes), and platelet-to-lymphocyte ratio (PLR= platelets/lymphocytes) were compared between patients with post-appendectomy abdominal abscess (PAA) and those without this complication (NPAA). The area under the ROC curve (AUC) was used to establish the predictive capacity of each parameter for PAA. A total of 89 patients with PAA and 93 NPAA children were included.

Abscess formation of abdominal wall mimicking lymphoma due to Morganella morganii infection in a prepubescent children

Introduction: Morganella morganii infection mainly occurred in elderly people and immunocompromised patients.However, the abdominal wall abscess due to Morganella morganii infection in prepubertal children hasn't been documented.Our presented case is a 4-year-old male patient with a 1 month history of left lower quadrant abdominal mass. Preoperative ultrasonography showed a hypoechoic, heterogeneous mass and the mass wasn't just confined to the abdominal wall, mimicking lymphoma. On CDFI, an image of highly vascularized mass was demonstrated. The patient underwent lump resection of abdominal wall.Postoperative process was uneventful except intermittent haematuria, and bladder sludge and urethral calculus on ultrasonography.By symptomatic treatment, haematuria disappeared and urethral calculus and bladder sludge decreased. Then the patient discharged home. Postoperative histopathology and immunohistochemistry were suggestive of abscess formation and Morganella morganii was isolated finally from the aspirated pus. Conclusion: Therefore, although the abdominal wall abscess due to Morganella morganii infection is rare, it should not be absent in the differential diagnosis of abdominal wall masses in children. Imaging features of abdominal wall masses should closely integrate the pertinent clinical history.

Impact of surgical site infection after open and laparoscopic surgery among paediatric appendicitis patients: A meta-analysis.

Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post-operative wound infection among the paediatric appendectomy and the open-access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34-1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open-access treatment groups (OR, 1.64; 95% CI, 0.90-3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, -4.36; 95% CI, -17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open-approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection.

Abdominal Abscesses Caused by Nocardia farcinica in an Immunocompromised Patient: A Case Report and Literature Review

Abdominal Abscesses Caused by Nocardia farcinica in an Immunocompromised Patient: A Case Report and Literature Review

Stereotactic body radiotherapy with or without selective dismutase mimetic in pancreatic adenocarcinoma: an adaptive, randomised, double-blind, placebo-controlled, phase 1b/2 trial

Stereotactic body radiotherapy (SBRT) has the potential to ablate localised pancreatic ductal adenocarcinoma. Selective dismutase mimetics sensitise tumours while reducing normal tissue toxicity. This trial was designed to establish the efficacy and toxicity afforded by the selective dismutase mimetic avasopasem manganese when combined with ablative SBRT for localised pancreatic ductal adenocarcinoma. In this adaptive, randomised, double-blind, placebo-controlled, phase 1b/2 trial, patients aged 18 years or older with borderline resectable or locally advanced pancreatic cancer who had received at least 3 months of chemotherapy and had an Eastern Cooperative Oncology Group performance status of 0-2 were enrolled at six academic sites in the USA. Eligible patients were randomly assigned (1:1), with block randomisation (block sizes of 6-12) with a maximum of 24 patients per group, to receive daily avasopasem (90 mg) or placebo intravenously directly before (ie, within 180 min) SBRT (50, 55, or 60 Gy in five fractions, adaptively assigned in real time by Bayesian estimates of 90-day safety and efficacy). Patients and physicians were masked to treatment group allocation, but not to SBRT dose. The primary objective was to find the optimal dose of SBRT with avasopasem or placebo as determined by the late onset EffTox method. All analyses were done on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, NCT03340974, and is complete. Between Jan 25, 2018, and April 29, 2020, 47 patients were screened, of whom 42 were enrolled (median age was 71 years [IQR 63-75], 23 [55%] were male, 19 [45%] were female, 37 [88%] were White, three [7%] were Black, and one [2%] each were unknown or other races) and randomly assigned to avasopasem (n=24) or placebo (n=18); the placebo group was terminated early after failing to meet prespecified efficacy parameters. At data cutoff (June 28, 2021), the avasopasem group satisfied boundaries for both efficacy and toxicity. Late onset EffTox efficacy response was observed in 16 (89%) of 18 patients at 50 Gy and six (100%) of six patients at 55 Gy in the avasopasem group, and was observed in three (50%) of six patients at 50 Gy and nine (75%) of 12 patients at 55 Gy in the placebo group, and the Bayesian model recommended 50 Gy or 55 Gy in five fractions with avasopasem for further study. Serious adverse events of any cause were reported in three (17%) of 18 patients in the placebo group and six (25%) of 24 in the avasopasem group. In the placebo group, grade 3 adverse events within 90 days of SBRT were abdominal pain, acute cholangitis, pyrexia, increased blood lactic acid, and increased lipase (one [6%] each); no grade 4 events occurred. In the avasopasem group, grade 3-4 adverse events within 90 days of SBRT were acute kidney injury, increased blood alkaline phosphatase, haematoma, colitis, gastric obstruction, lung infection, abdominal abscess, post-surgical atrial fibrillation, and pneumonia leading to respiratory failure (one [4%] each).There were no treatment-related deaths but one late death in the avasopasem group due to sepsis in the setting of duodenal obstruction after off-study treatment was reported as potentially related to SBRT. SBRT that uses 50 or 55 Gy in five fractions can be considered for patients with localised pancreatic ductal adenocarcinoma. The addition of avasopasem might further enhance disease outcomes. A larger phase 2 trial (GRECO-2, NCT04698915) is underway to validate these results. Galera Therapeutics.

A case report of surgical complications in a patient with ulcerative colitis

Rapidly rising prevalence of ulcerative colitis in developed countries among young population compels the medical community to pay attention not only to the problems of early diagnosis and therapy of this disease, but also to preventing the development of complications, that may lead to disability. This article reviews a clinical case of the development of surgical complications in a patient with a long-term active course of ulcerative colitis, who has been also suffering from autoimmune hepatitis and primary sclerosing cholangitis for 20 years. The prolonged active course of the disease and total damage to the colon, association with primary sclerosing cholangitis, as well as the patient’s low adherence to therapy were risk factors for the development of adenocarcinoma of the ascending colon, which required radical surgical treatment. The formation of adhesive disease and multiple abdominal abscesses can be noted as long-term complications, which led to the repeated use of invasive methods of treatment. Over the next few months, the patient experienced 2 more episodes of local purulent complications that required surgical treatment due to the ineffectiveness of antibiotic therapy. All episodes of purulent complications were accompanied by progressive leukopenia due to prolonged use of immunosuppressive drugs. In our opinion, in patients with ulcerative colitis who take cytostatic agents for a long time, special attention should be paid to monitoring and correcting leukopenia, as well as preventing the development of purulent complications.

Impact of preoperative endoscopic procedures on adverse event rates after surgical resection for main-duct and mixed-type intraductal papillary mucinous neoplasms (IPMNs)

BackgroundMain-duct (MD-) and mixed-type (MT-) IPMNs harbor an increased risk of pancreatic cancer and warrant surgical resection. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are important in the diagnosis of IPMNs. The aim of this study was to investigate whether endoscopic procedures manipulating the MD impact postoperative adverse events in patients with MD- and MT-IPMNs. MethodsWe performed a retrospective study of 369 patients who underwent resections for MD- or MT-IPMN at two tertiary centers (2000–2019). Multivariable logistic regression analyses were performed for postoperative adverse events to compare the risks between intervention (ERCP, EUS-FNA with branch duct (BD) aspirated, EUS-FNA with MD aspirated from the duct directly or cyst/mass arising from MD) versus no-intervention group. Results33.1 % of patients had a preoperative ERCP and 69.4 % had EUS-FNA. Postoperative adverse events included: 30-day readmission (12.7 %), delayed gastric emptying (13.8 %), pancreatic fistula (10.3 %), abdominal abscess (5.7 %), cardiopulmonary adverse events (11.4 %), and mortality (1.4 %). The model was adjusted for potential confounders. There were no significant differences between the ERCP and no-ERCP groups for specific adverse events. Compared to no-EUS-FNA groups, groups of EUS-FNA with BD aspiration and EUS-FNA with MD aspiration from the main pancreatic duct directly or cyst/mass arising from MD did not show a significant increase in specific adverse events. ConclusionsPostoperative adverse events were not significantly increased among patients who had ERCP or EUS-FNA before surgical resection for MD- or MT-IPMNs. Endoscopic procedures directly sampling the MD can be safely pursued for diagnostic purposes in selected cases.

The role of the multidisciplinary team in surgical management of intractable tubo-ovarian abscess as a late sequelae of challenging Crohn's disease in the modern era: A case report and review of current literature.

Chronic, severe Crohn's disease in a young female patient can result in surgical complexity. The rarity of the presentation of intractable pelvic abscesses within this etiology with additional considerations given to fertility concerns and hence requirement for input from a multi-disciplinary team makes this a vital case in building a consensus for evidence-based surgical management. A 29-year-old nulliparous woman was referred to our tertiary centre for surgical management of Crohn's disease with known tubo-ovarian abscess and abdominoperineal and abdominal wall sinuses. Her previous surgical history included 4 midline laparotomies, subtotal colectomy and proctectomy with stoma formation. The patient underwent egg collection to preserve fertility. This was followed by midline laparotomy and abdominoperineal resection, which involved a retrograde radical modified hysterectomy using the Hudson technique, alongside excision of the perineal sinus, with reconstruction of the perineal defect using an internal pudendal artery perforator gluteal fold flap, and in addition to excision and drainage of the abdominal wall abscess. Involvement was sought from gynecological oncology, colorectal, urology, plastics, stoma, fertility, microbiology, and gastroenterology teams, which enabled successful preservation of end organ function and improvement in patient psychological well-being. This case is a paradigm of surgical challenge, requiring expert gynecological oncology techniques including a retroperitoneal approach, nerve and vessel sparing considerations alongside colorectal and urological procedures. Moreover, we believe that our blueprint for effective multi-disciplinary practice will inform the future management of gynecological surgery. Therefore this report aims to contribute towards the optimum management of the gynecological sequelae of Crohn's disease.

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

Tuberculous psoas abscess usually results from tuberculous spondylitis but may also develop from direct spread or via hematogenous route [1]. Our case involves direct spread from an adjacent perinephric abscess with associated thoracic extension from suspected direct erosion or a diaphragmatic defect. We present a case of pleural empyema arising from abdominal tuberculous abscesses. This is an 11-year-old male who initially presented with a three-week history of cough, intermittent fever, and dyspnea. Congenital diaphragmatic hernia was first suspected at the emergency department when an opacified left hemithorax with cystic lucencies was noted. Further imaging of the chest and upper abdomen was done in our institution revealing large left perinephric and psoas abscesses with intra-thoracic extension resulting in empyema thoracis and necessitans. Culture of the abscess fluid yielded no growth but GenExpert tested positive for M. tuberculosis. Tuberculosis remains a major illness in developing countries and has a multitude of infection sites and clinical presentation. Our case presented as an ascending thoracic extension of a perinephric and psoas abscess, likely from a diaphragmatic defect. The absence of spinal involvement proves its renal origin. The importance of CT scan is highlighted in medically-confounding cases such as this one.

S2650 Endoscopic Drainage of a Large Abdominal Abscess in the Setting of a Ventriculo-Peritoneal Shunt

S2650 Endoscopic Drainage of a Large Abdominal Abscess in the Setting of a Ventriculo-Peritoneal Shunt

Minimally Invasive Treatment of Abdominal Abscesses in Children Using Ultrasound Navigation

The article provides a brief review of the literature on the diagnosis and management tactics of children with abdominal abscesses. A study of the literature has shown that open methods of treating abdominal abscesses are still the most common in children’s practice, although puncturedrainage techniques have obvious advantages. This publication presents an analysis of the results of five years of experience in the treatment of children with abdominal abscesses using minimally invasive technologies. A unique clinical case of multiple abdominal abscesses in a 10-year-old child undergoing outpatient treatment for gastroduodenitis without an effect is described in detail. During hospitalization, an ultrasound examination (ultrasound) was performed, multiple abscesses of the abdominal cavity of various localization and sizes were found. The method of percutaneous minimally invasive surgical intervention under ultrasound control was chosen as the treatment tactic. The above observation shows the wide possibilities of ultrasound in the diagnosis and treatment of abdominal abscesses in children.

Abdominal Wall Abscess: An Infrequent Presentation of Colon Adenocarcinoma

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.

Azithromycin to Prevent Sepsis of Death in Women Planning a Vaginal Birth

ABSTRACT A high proportion of peripartum maternal deaths are caused by infection and sepsis, and this proportion continues to rise. In addition, neonatal sepsis is the third most common cause of neonatal death; the 2 conditions are connected in that maternal infection causes an increased risk of neonatal sepsis. Recent studies have shown azithromycin to be effective in reducing instances of maternal infection after an unplanned cesarean delivery, but its effectiveness for infections related to vaginal delivery has not yet been examined. This study, A-PLUS (Azithromycin Prevention in Labor Use Study), was designed to investigate the effectiveness of azithromycin in women planning a vaginal delivery. This study was conducted as a multicountry, double-blind, placebo-controlled, randomized trial over 8 sites in 7 countries. Primary outcomes included maternal sepsis or death within 6 weeks of delivery, as well as stillbirth, neonatal death, or sepsis within 4 weeks of delivery. Secondary maternal outcomes included related components, such as specific infections of chorioamnionitis, endometritis, perineal wound infection, abdominal or pelvic abscess, mastitis or breast abscess, pneumonia, or pyelonephritis, as well as therapeutic use of antibiotics, duration of hospital stay, readmission, admission to a special care unit, and unscheduled health care visits. Secondary outcomes relating to neonates included similar components, specific infection, the duration of hospital stay, readmission, admission to a special care unit, unscheduled health care visits, and safety outcomes (adverse events related to medication). Final analysis included 29,278 women, with 14,590 women (and 14,687 neonates or stillbirths) in the azithromycin group and 14,688 women (and 14,782 neonates or stillbirths) in the placebo group. Maternal sepsis or death was observed in 227 patients in the azithromycin group and 344 patients in the placebo group (adjusted relative risk, 0.67; 95% confidence interval [CI], 0.56–0.79; P &lt; 0.001). Sepsis was the case in 219 in the azithromycin group and 339 in the placebo group (relative risk, 0.65; 95% CI, 0.55–0.77), and death from sepsis was rare. For neonates, stillbirth, death, or sepsis was observed in 1540 in the azithromycin group and 1526 in the placebo group (relative risk, 1.02; 95% CI, 0.95–1.09), with sepsis accounting for 1433 and 1407 cases in the azithromycin and placebo groups, respectively. Both the outcomes of stillbirth and neonatal death were relatively uncommon. Maternal adverse effects experienced from the medication were not significantly different between groups, and the azithromycin group had noticeably reduced risk of endometritis, wound infections, and several others when compared with the placebo group. These results indicate that azithromycin is consistently effective in lowering the risk of infection and sepsis in mothers and infants during vaginal delivery. The number treated to prevent 1 case of maternal death or sepsis was 125; this is consistent with previous research in individuals undergoing cesarean delivery. Although azithromycin was effective at preventing maternal infection and sepsis, there were no significant effects on neonatal outcomes. This is consistent with most previous research; reasons for discrepancies could be inclusion of different types of infections and differences in antibiotic treatment between countries. Further research could improve the generalizability of these findings by focusing on factors that influence the effectiveness of azithromycin and that impact its clinical use.