Abdominal Wall Abscess Research Articles

Abdominal wall actinomycosis simulating a malignant neoplasm: Case report and review of the literature

Abdominal wall actinomycosis is a rare disease frequently associated with the presence of an intra uterine device. We report on a case of a 47-year-old woman who had used an intrauterine device for many years and had removed it about a month prior to the identification of an abdominal wall abscess caused by Actinomyces israelii. The abscess mimicked a malignancy and the patient underwent a demolitive surgical treatment. The diagnosis was obtained only after histopathological examination. Postoperatively, the patient developed an infection of the wound which was treated with daily medication. The combination of long-term high dose antibiotic therapy with surgery led to successful treatment.

Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?

Recent studies have shown that closure of loop ileostomy can be performed in the day-case setting, reducing the length and cost of hospitalisation. By analysing our patients who have undergone reversal, we aimed to determine the length of hospital stay and potential factors behind stays beyond 24 h. A database of patients undergoing closure of loop ileostomy at one colorectal unit was examined. The times taken to discharge, morbidity and re-admission rates were recorded. Eighty patients underwent reversal of ileostomy between January 2001 and January 2006. Median age was 63 years (range, 22-81 years). The median length of stay was 4 days (range, 2-32 days). The median length of stay in patients without complications was 4 days. Many appeared able to be discharged earlier. Seventy-two patients (90%) were able to tolerate a solid diet within 48 h and 54 (67.5%) had bowel function within 3 days. Six patients went home before bowel function; none of these were re-admitted. Twenty patients (25%) developed complications, which included wound infection (8%), small bowel obstruction/ileus (6%), enterocutaneous fistula (1%), anastomotic leak (1%), and late abdominal wall abscess (1%). Of the patients, 16% stayed longer than 5 days despite having no postoperative complications. The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay.

Acute Buried Bumper Syndrome

Purpose: Introduction: Acute Buried Bumper Syndrome (BBS) is an unusual complication of percutaneous endoscopic gastrostomy (PEG) tube placement that can be lethal if not recognized early on. We present a case of BBS occurring in just six days. Case Report: An 85-year-old male underwent an uneventful Boston Scientific PEG tube placement for feeding purposes after he was diagnosed with stage 2A esophageal Adeno CA. Six days later he presented with worsening abdominal pain and inability to infuse feedings through the tube. Examination revealed erythema and induration at the PEG tube site with the tube in place at about 2 cm mark. Rest of the physical exam and routine laboratory testing was unremarkable. Abdominal CT-scan revealed that the button of gastrostomy tube had migrated up in the abdominal wall within the peritoneal cavity ventral to the stomach. A diagnosis of acute BBS was made, and the patient was treated with PEG tube removal and broad spectrum antibiotics. The PEG site improved and on day seven of admission, a replacement G-tube using a guide wire and the original tract, was placed by Interventional Radiology. The patient recovered uneventfully. Discussion: Buried bumper syndrome is an unusual complication of PEG tube that occurs when the internal bumper migrates and becomes lodged anywhere between the gastric wall and the skin along the PEG-tube track. Endoscopy is considered the most definite test. Although not always needed, ultrasound, computerized abdominal tomography, and magnetic resonance imaging can be helpful in the diagnosis. Excessive tension between the internal and external bumpers causing gastric ulceration at the bumper site is thought to be the initiating factor in BBS. It is usually considered to be a late complication, but cases occurring within one to two months have been reported. Treatment recommendations include removal of the buried bumper, even in the asymptomatic patients, to avoid further complications. In cases where a patient presents with an abdominal wall abscess, it may not be possible to place the replacement tube through the same tract.Figure: CT scan showing internal bumper in the abdominal wall within the peritoneal cavity.

W1096 Results from An Open-Label Extension of CHARM: Steroid-Free Remission in Patients with Crohn's Disease Who Received Adalimumab Therapy for At Least 3 Years

BACKGROUND: Natalizumab (NAT), a monoclonal antibody to α4-integrin, was recently approved by the FDA for use in the treatment of moderate to severe Crohn's disease (CD). AIM: To prospectively report the clinical outcomes and safety in patients (pts) treated with NAT at a tertiary care IBD center. METHODS: Eighteen pts with moderate to severe CD treated in clinical practice with intravenous NAT every 4 weeks were enrolled in a registry. Patients were assessed for clinical response to NAT (categorized as complete response [CR], partial response [PR], or no response [NR]), steroid reduction, and adverse events (AE). RESULTS: The median age of this group was 43.5 years (range 20-63) with median disease duration of 13 years (range 3-43). All patients had failed prior anti-TNF therapy (median of 2 agents). Twelve pts (67%) had ileocolonic CD at diagnosis and 5 (28%) had undergone colectomy prior to NAT. The median follow-up was 88 days (range 3-219). Two pts had screening brain MRI or CT prior to NAT. Pts received one to eight infusions of NAT for a total of 77 infusions. In total, 2 pts (11%) had CR, 13 (72%) had PR and 3 (17%) had NR. Two pts achieved complete mucosal healing as documented by radiography. There were 6 pts on corticosteroids; 4 prior to NAT and 2 initiated during treatment. One pt successfully completed prednisone taper and 2 pts are currently tapering (mean dose change 7.5 mg). Sixteen pts (89%) had a total of 55 AE. Clinically significant AE included 1 ileocolonic resection due to active CD with high-grade dysplasia found in surgical specimen, 1 abdominal wall abscess, 1 Epstein Barr virus febrile infection, 3 infusion reactions characterized by rash, pruritus or throat irritation and 4 hospitalizations secondary to volume depletion (2), abscess drainage (1) and fever work-up (1). Eight pts (44%) complained of headache following infusions and 1 of loss of balance and tinnitus. Two patients with neurologic symptoms underwent brain CT or MRI evaluations, which were negative. Minor infectious AE included 4 upper respiratory tract infections and 1 each of conjunctivitis, sinus infection, cystitis and otitis. Only 1 pt discontinued NAT due to an infusion reaction and acute infectious colitis. CONCLUSIONS: In this initial clinical practice experience, NAT was a clinically beneficial and well-tolerated option for patients with CD who had lost their response to, or who could not tolerate, anti-TNF agents.

W1097 Steroid-Free Remission and Fistula Closure in Adalimumab-Treated Patients with Moderate to Severe Crohn's Disease: the Access Trial

BACKGROUND: Natalizumab (NAT), a monoclonal antibody to α4-integrin, was recently approved by the FDA for use in the treatment of moderate to severe Crohn's disease (CD). AIM: To prospectively report the clinical outcomes and safety in patients (pts) treated with NAT at a tertiary care IBD center. METHODS: Eighteen pts with moderate to severe CD treated in clinical practice with intravenous NAT every 4 weeks were enrolled in a registry. Patients were assessed for clinical response to NAT (categorized as complete response [CR], partial response [PR], or no response [NR]), steroid reduction, and adverse events (AE). RESULTS: The median age of this group was 43.5 years (range 20-63) with median disease duration of 13 years (range 3-43). All patients had failed prior anti-TNF therapy (median of 2 agents). Twelve pts (67%) had ileocolonic CD at diagnosis and 5 (28%) had undergone colectomy prior to NAT. The median follow-up was 88 days (range 3-219). Two pts had screening brain MRI or CT prior to NAT. Pts received one to eight infusions of NAT for a total of 77 infusions. In total, 2 pts (11%) had CR, 13 (72%) had PR and 3 (17%) had NR. Two pts achieved complete mucosal healing as documented by radiography. There were 6 pts on corticosteroids; 4 prior to NAT and 2 initiated during treatment. One pt successfully completed prednisone taper and 2 pts are currently tapering (mean dose change 7.5 mg). Sixteen pts (89%) had a total of 55 AE. Clinically significant AE included 1 ileocolonic resection due to active CD with high-grade dysplasia found in surgical specimen, 1 abdominal wall abscess, 1 Epstein Barr virus febrile infection, 3 infusion reactions characterized by rash, pruritus or throat irritation and 4 hospitalizations secondary to volume depletion (2), abscess drainage (1) and fever work-up (1). Eight pts (44%) complained of headache following infusions and 1 of loss of balance and tinnitus. Two patients with neurologic symptoms underwent brain CT or MRI evaluations, which were negative. Minor infectious AE included 4 upper respiratory tract infections and 1 each of conjunctivitis, sinus infection, cystitis and otitis. Only 1 pt discontinued NAT due to an infusion reaction and acute infectious colitis. CONCLUSIONS: In this initial clinical practice experience, NAT was a clinically beneficial and well-tolerated option for patients with CD who had lost their response to, or who could not tolerate, anti-TNF agents.

W1095 Natalizumab Use in Clinical Practice in Patients with Moderate to Severe Crohn's Disease

BACKGROUND: Natalizumab (NAT), a monoclonal antibody to α4-integrin, was recently approved by the FDA for use in the treatment of moderate to severe Crohn's disease (CD). AIM: To prospectively report the clinical outcomes and safety in patients (pts) treated with NAT at a tertiary care IBD center. METHODS: Eighteen pts with moderate to severe CD treated in clinical practice with intravenous NAT every 4 weeks were enrolled in a registry. Patients were assessed for clinical response to NAT (categorized as complete response [CR], partial response [PR], or no response [NR]), steroid reduction, and adverse events (AE). RESULTS: The median age of this group was 43.5 years (range 20-63) with median disease duration of 13 years (range 3-43). All patients had failed prior anti-TNF therapy (median of 2 agents). Twelve pts (67%) had ileocolonic CD at diagnosis and 5 (28%) had undergone colectomy prior to NAT. The median follow-up was 88 days (range 3-219). Two pts had screening brain MRI or CT prior to NAT. Pts received one to eight infusions of NAT for a total of 77 infusions. In total, 2 pts (11%) had CR, 13 (72%) had PR and 3 (17%) had NR. Two pts achieved complete mucosal healing as documented by radiography. There were 6 pts on corticosteroids; 4 prior to NAT and 2 initiated during treatment. One pt successfully completed prednisone taper and 2 pts are currently tapering (mean dose change 7.5 mg). Sixteen pts (89%) had a total of 55 AE. Clinically significant AE included 1 ileocolonic resection due to active CD with high-grade dysplasia found in surgical specimen, 1 abdominal wall abscess, 1 Epstein Barr virus febrile infection, 3 infusion reactions characterized by rash, pruritus or throat irritation and 4 hospitalizations secondary to volume depletion (2), abscess drainage (1) and fever work-up (1). Eight pts (44%) complained of headache following infusions and 1 of loss of balance and tinnitus. Two patients with neurologic symptoms underwent brain CT or MRI evaluations, which were negative. Minor infectious AE included 4 upper respiratory tract infections and 1 each of conjunctivitis, sinus infection, cystitis and otitis. Only 1 pt discontinued NAT due to an infusion reaction and acute infectious colitis. CONCLUSIONS: In this initial clinical practice experience, NAT was a clinically beneficial and well-tolerated option for patients with CD who had lost their response to, or who could not tolerate, anti-TNF agents.

Abdominal Wall Abscess and Sepsis induced by Stercoral Penetration of a Sigmoid Colostomy-Report of a Case-

Abdominal Wall Abscess and Sepsis induced by Stercoral Penetration of a Sigmoid Colostomy-Report of a Case-

A Case of Exit-Site Infection and Abscess byMycobacterium Abscessusin a CAPD Patient

－Abstract－Nontuberculous mycobacterial infections are a rare, but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. This is typically suspected when a patient does not respond to treatment with the usual antibiotics. We describe here a case of Mycobacterium abscessus exit site infection with abdominal wall abscess formation that was associated with CAPD, which required peritoneal catheter removal, surgical debridement of the abscess and long term antibiotic therapy. KeyWords:Nontuberculous mycobacterium, Mycobacterium abscessus, Exit site infection, Continuous ambulatory peritoneal dialysis서 론복막투석 환자에서 복막투석 카테터와 관련된 감염은 흔한 합병증이며 대부분의 경우 그람양성이나 그람음성균이 원인이 된다. 비결핵성 미코박테륨(nontuberculousmycobacterium; NTM)에 의한 감염은 매우 드물며 출구 감염(exit-site infection)이나 복막염의 형태로 나

Small bowel necrosis and enterocutaneous fistulae resulting from iatrogenic spillage of dermoid cyst contents at the time of laparoscopic surgery

A 38-year-old lady with a 14 × 8 × 13-cm dermoid cyst underwent a laparoscopic left salpingo-oophrectomy. Intra-operatively, there was accidental spillage of the cyst contents into the peritoneal cavity. The spilled contents were completely sucked out and a thorough peritoneal lavage was done to decrease the risk of chemical peritonitis. The patient developed disseminated granulomatous chemical peritonitis, small bowel necrosis, multiple enterocutaneous fistulae, intra-abdominal, and anterior abdominal wall abscesses. Following four further surgeries, she finally made a recovery 6 months later. Chemical peritonitis and intra-abdominal abscesses are rare complications. Bowel necrosis and enterocutaneous fistulae have not been described. This case report will increase awareness of these rare complications and in their prevention and management. A literature review of strategies to prevent spillage of dermoid cyst contents at surgery is also presented.

Spontaneous Expulsion of a Biliary Stent via the abdominal wall: A rare complication: Case Report

We report a rare complication of a biliary stent inserted via endoscopic retrograde cholangio-pancreatography (ERCP) for benign biliary disease in a 60 years-old female presented with abdominal pain and a tender left iliac fossa (LIF) mass. She had change of the colour of the skin over the hypogastric region. Crepitus was felt in the subcutaneous tissue. Surgical drainage of the abscess was undertaken. A black, 14-cm biliary stent was found in the centre of the necrotic tissue. The patient, thereafter, made an uneventful recovery and the LIF mass disappeared. The wound was closed with secondary sutures about three weeks later, and complete healing was achieved thereafter. Here we discuss this rare complication. Keywords : Biliary stent migration, colonic perforation, abdominal mass, large bowel obstruction, abdominal wall abscess, ERCP complication. Sudan Journal of Medical Sciences Vol. 3 (3) 2008: pp. 255-258

Type II Gall Bladder Perforation with Abdominal Wall Abscess in a Cirrhotic Patient: Case Report and Review of the Literature

Gallbladder perforation is a rare condition even in patients affected by acute cholecystitis. Most patients who present with gallbladder perforations are diagnosed preoperatively by radiologic imaging. Morbidity and mortality for this condition has improved significantly over the last few decades. We encountered a cirrhotic patient who was affected by primary sclerosing cholangitis and who developed a type II gallbladder perforation before undergoing a cadaveric liver transplantation. In this article, we report her clinical course and our review of the current literature on this rare condition.

Abdominal Wall Abscess in a Diabetic Patient With Ruptured Appendicitis

Abdominal Wall Abscess in a Diabetic Patient With Ruptured Appendicitis

Improved intraperitoneal chemotherapeutic toxicity profile for ovarian cancer: A modification of the taxane-platinum protocol in GOG-172

5583 Background: GOG 172 demonstrated a significant survival advantage for intraperitoneal (IP) versus intravenous (IV) chemotherapy in optimally debulked ovarian cancer patients; however this treatment was also more toxic. Our objective is to describe the toxicity profile of a modified IP regimen. Methods: A chart review of all ovarian cancer patients who received IP chemotherapy from 12/2005 to 1/2008 was performed. All optimally debulked patients after primary surgery for ovarian cancer who underwent day 1 IV docetaxel 60–70 mg/m2, IP cisplatin 80–85 mg/m2 and day 8 IP paclitaxel 60–70 mg/m2 every 21 days were included. All patients received G-CSF support. Toxicities were recorded using CTCAEv3.0 criteria. Results: 37 patients met inclusion criteria, including 6 patients who previously received 3–4 cycles of neoadjuvant chemotherapy. 34 patients have completed chemotherapy and 3 patients are still undergoing treatment. 59% of patients (20/34) completed all planned cycles of IP chemotherapy and 85% (29/34) completed 50% or more of the planned cycles. 5 patients did not complete ≥ 50% of cycles. 3 of these 5 resulted from port failure, 1 patient developed an abdominal wall abscess requiring port removal, and a final patient had a vaginal vault evisceration during the first cycle of chemotherapy. Toxicity was evaluable for 37 patients and survival in 34 patients. The median number of completed cycles was 5 (range 0.5–7). Overall, 150.5 cycles were delivered with only 6 cycle delays. 9 patients required minor (10–15 %) dose reductions due to side effects. Grade 3 and 4 hematologic toxicities occurred in 12% of patients (4/34). 6 patients experienced grade 3 or 4 non-hematologic events. The overall response rate was 100% (CR=92%, PR=8%) with a median follow up time of 9 months (range 2–27 months). 7 patients have recurred (4 of these patients were platinum resistant). Conclusions: This modified IP regimen is well tolerated. In contrast to GOG 172, major toxicities were markedly reduced and most patients were able to complete > 50% of the planned cycles. These findings suggest that modification of the drugs, dose and schedule of IP chemotherapy should be further studied in future prospective chemotherapy trials in ovarian cancer. No significant financial relationships to disclose.

Two Cases of Recurrent Abdominal Wall and Perihepatic Abscesses Caused by Dropped Gall Stones During a Laparoscopic Cholecystectomy

While performing a laparoscopic cholecystectomy, a surgeon may occasionally drop a patient’s gall stones into the intraperitoneal cavity or perforate a patient’s gallbladder. However, most of the time, the dropped stones are spontaneously absorbed by the body. In some instances, the dropped gallstones may cause late complications in the patient, such as abscesses, the formation of fistulae, or adhesion in the intra-abdominal or extra-abdomial region. We report two cases of recurrent abdominal wall and perihepatic abscesses caused by dropped gall stones during a laparoscopic cholecystectomy with late diagnosis.

<i>Mycobacterium fortuitum</i> abdominal wall abscesses following liposuction

We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

Mycobacterium fortuitum abdominal wall abscesses following liposuction

ABSTRACTwe describe here a case of abdominal abscesses due to mycobacterium fortuitum following liposuction. the abscesses developed three months after the procedure and diagnosis was delayed for five months. the clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. this condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

Primary Cold Abscess Of The Anterior Abdominal Wall: An Unusual Site Of Presentation

Tuberculosis may involve any organ in the body but involvement of abdominal muscle is uncommon and, in most cases, is caused by spread of the infection by either hematogenous route or direct inoculation from a tuberculous abdominal lymph node or extension from underlying tubercular synovitis and osteomyelitis. Autopsy studies have shown abdominal wall involvement in less than 1% of patients who died of tuberculosis. Management of this entity is mainly in the form of anti-tubercular therapy. Surgical intervention in the form of either sonography or CT-guided aspiration or open drainage is usually reserved for patients in whom medical treatment fails. We are presenting a case of primary tuberculous abdominal wall abscess without any evidence of pulmonary, skeletal or gastrointestinal tuberculosis in an immunocompetent patient.

Acute appendicitis presenting with abdominal wall and right groin abscess: A case report

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

Spontaneous Gallbladder Perforation Presenting As Abdominal Wall Abscess

A rare and unusual case of spontaneous gall-bladder perforation presenting with anterior abdominal wall abscess is reported. Most of the times, such cases present with cholecystocutaneous fistula due to delay in diagnosis, thus adding to the morbidity. The present case could be picked up early with expert sonological examination leading to prompt surgical intervention.

What is the Optimal Time of Surgical Intervention After an Acute Attack of Sigmoid Diverticulitis: Early or Late Elective Laparoscopic Resection?

This prospective study was designed to check the ideal time of surgical intervention by comparing the results of early elective laparoscopic sigmoid resection after an inflammatory attack with those of late elective resection during the inflammation-free interval. A total of 210 patients (114 males) underwent laparoscopic resection for acute sigmoid diverticulitis between 1999 and 2005. They were prospectively divided into two groups: Group I with an early elective sigmoid resection (5-8 days after initial antibiotic treatment); Group II in the inflammation-free interval (4-6 weeks after initial hospitalization). There was no difference between the groups with regard to age (55.7 years), American Society of Anesthesiologists score (1.86), previous diseases, and extent of inflammation. After surgery, 156 patients (74.3 percent) were complication-free. There was a total of ten conversions (Group I, 9; Group II, 1; P<0.05). Minor complications developed in 42 patients (abdominal wall abscess=24, intestinal atony=6, hematoma=9, urinary tract infection=2). Eight patients in Group I (P<0.05) developed anastomotic leaks. None of the patients died. In the majority of patients, laparoscopic sigmoid resection in sigmoid diverticulitis can be performed without conversion. Patients who underwent surgery in the inflammation-free interval had a lower complication rate than those submitted to early elective resection. In our patient population, we were able to show that surgery in the inflammation-free interval significantly reduces postoperative morbidity. It is thus preferable for patients with sigmoid diverticulitis to receive initial antibiotic treatment and then undergo late elective laparoscopic sigmoid resection.