Anterior Abdominal Wall Abscess Research Articles

Study of Clinico- Epidemiological Profile of Patients with Gallbladder Perforation

Background: Gallbladder perforation (GBP) is rare but a potentially fatal disease; its presentation can vary and hence is difficult to diagnose early. It is usually a complication of acute cholecystitis with or without gallstones. Most perforations are subacute, producing a pericholecystic collection. Acute free perforation with biliary peritonitis and chronic perforation with an internal biliary fistula are rare. The fundus of the gallbladder is the most common site of perforation because of its poor blood supply. Material & Methods: This retrospective observational study included all cases of gallbladder perforation that presented to general surgery ward from January 2019 to January 2022. Cases of traumatic gallbladder perforation and gangrenous gall bladder were excluded. The patients were assessed for epidemiological and clinical parameters like age, gender, socio economic status, presenting complaints, history of substance abuse, co- morbidity, hemoglobin, total leucocyte count, renal function tests, liver function tests, history of fever, fever on presentation, pulse, blood pressure and respiratory rate on presentation, type and site of perforation, method of management, diagnostic procedures(ultrasound and contrast CT abdomen findings), duration of hospital stay, and post-operative complications if any were evaluated. Results: This study included 14 patients ( 4 males and 10 females). The mean age of patients was 63.7 years. Gallbladder perforation was most common in the 5th and 6th decade of life. Two Patients had type l perforation and 12 patients had type ll perforation(Neimer’s classification) . Cases were diagnosed on the basis of contrast enhanced CT scan. Patients were managed with carbapenems, intravenous fluids and analgesics . 11(79%) patients were managed conservatively. One patient presented with impending rupture of anterior abdominal wall abscess that was communicating with pericholecystic abscess. Patients on conservative management were managed empirically with Carbapenem antibiotics and recovered well. Two patients underwent cholecystostomy. The mean hospital stay was 11.5 days for conservatively managed group and 18 days for patients who underwent upfront surgery. There was no reported mortality. All patients underwent interval open cholecystectomy after 06 weeks.Mean post operative hospital stay was 4 days in these patients. Each patient was followed up for 06 months in outpatient department and through telecommunication. Conclusion: Gallbladder perforation represents a special diagnostic and surgical challenge. Careful selection and management of patients with broad spectrum antibiotics can help us manage patients conservatively.

827 Unusual Presentation of Missed Appendicitis

Abstract I present the case of old age man, who presented with pain right side of the abdomen with huge anterior abdominal wall swelling, along with loose motion in one of the hospitals in an Asian country. His inflammatory markers were unremarkable, and his ultrasound showed fluid-filled bowel loops, with no ascitic fluid. The appendix could not be visualised. On examination, he had tender and distended abdomen and bowel sounds were exaggerated. Laparotomy was performed and it came out to be missed appendicitis which buried into the abdominal wall and caused the pus track down anteriorly to appear as anterior abdominal wall abscess as one of its rare complications. Appendectomy was done alongside abdominal wall exploration. Pus was drained. The patient improved and went home in the second post-operative week.

Acute calculous cholecystitis complicated by a large anterior abdominal wall abscess

We present a 74-year-old male patient with a rare case of acute calculous cholecystitis that was complicated by formation of a large anterior abdominal wall abscess due to neglection. The primary management consisted of antibiotic therapy and two consequent procedures of abscess drainage. Cholecystectomy was postponed due to the massive volume of the abscess which posed a great risk for complications if the patient were to be operated on at that point, therefore an elective open cholecystectomy was performed 3 months later. This case is a good example for the management of such a rare and interesting complication.

A rare case report of an appendiceal abscess with a pneumatocele and direct extension into an anterior abdominal wall abscess

A rare case report of an appendiceal abscess with a pneumatocele and direct extension into an anterior abdominal wall abscess

Spontaneous rupture of pyonephrosis presenting as anterior abdominal wall abscess: a rare case report

BackgroundA pyonephrosis caused by an obstructing calculus is typically accompanied by fever, loin pain, and other signs of urinary tract infection. Occasionally, severe thinning of the renal parenchyma in pyonephrosis allows direct forniceal rupture into the retroperitoneum and very rarely into the anterior abdominal wall, misconstruing it as an isolated abdominal wall abscess.Case presentationDiabetes-related 55-year-old diabetic male presented with abscess in his periumbilical region extending into right lumbar region. He did not exhibit any urinary symptoms, and contrast enhanced computed tomography [CECT] abdominal and pelvic examinations revealed right pelvic calculus with pyonephrosis. There is a 7.5 mm defect in the lower pole of the right kidney with 171 cc of collection adjacent to the kidney communicating with 150 cc of superficial abdominal wall collection through a 15 mm defect. Incision and drainage of abdominal and retroperitoneal abscesses were done at first. Right DJ stenting was performed. Right lateral decubitus was placed for dependent drainage. Resolution of residual collections was confirmed by subsequent ultrasonography KUB, and drain was then removed. Right DJ stenting done, and patient was discharged. Two months later, DTPA scan done and revealed GFR of 30 ml/min of right kidney. Patient underwent right percutaneous nephrolithotomy.ConclusionThe sudden rupture of pyonephrosis is a rare event. Even rarer is the presentation of pyonephrosis as an abscess on the anterior abdominal wall. The correct diagnosis and search for the source of the abscess must be undertaken before intervention. An aggressive and prompt management is needed to prevent further complications from occurring. This case is being presented to add to the literature with regard to abnormal presentations of ruptured pyonephrosis and its management.

Anterior abdominal wall abscess secondary to spontaneous rupture of liver abscess in a resource-limited, rural, surgical setting: A case report

Liver abscess continues to be a major surgical burden in low-and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic female presented with acute pain in the right, upper quadrant of the abdomen. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with an ultrasound-guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited, rural, surgical centers.

Anterior abdominal wall abscess: A rare presentation of advanced carcinoma of the stomach

Surgeons often encounter patients with advanced carcinoma of the stomach that necessitate urgent operative interventions. The presentations include perforation-peritonitis, bleeding, and gastric outlet obstruction. Carcinoma of the stomach is known to invade surrounding organs such as the transverse colon, pancreas, spleen, liver, and rarely, the anterior abdominal wall. In this case report, we describe an elderly diabetic male patient who presented with a large anterior abdominal wall abscess. The contrast-enhanced computed tomography scan of the abdomen showed a communication from the pylorus of the stomach to the abscess cavity. He underwent drainage of the abscess, and the wound was transiently managed with a vacuum-assisted closure. On gastroscopy, a fistulous opening was noted in the pylorus with surrounding erythema. The biopsy from the lesion was reported as a poorly differentiated adenocarcinoma with signet-ring cells. Anterior abdominal wall abscess is a rare presentation of carcinoma stomach and when identified, the primary aim of the treatment should be the sepsis control and wound healing followed by definitive management.

A rare case of tubercular collarstud abscess of anterior abdominal wall

Tuberculosis (TB) is considered as a ubiquitous disease, as it can involve any organ or a part of the body. Commonly, it involves the lungs and the abdomen. Muscle involvement is rare. In most cases, it is secondary to tubercular costochondritis or TB of the spine. Autopsy studies have revealed the abdominal wall involvement in <1% of patients who died of TB. A high index of suspicion is necessary to diagnose tubercular lesions in unusual anatomical locations. Antitubercular therapy is the main form of treatment; however, some patients may require surgical intervention. We are hereby presenting a case of tubercular anterior abdominal wall abscess secondary to wet peritonitis in a 40-year-old apparently healthy male with no past history of TB. The objective is to alert the clinicians and radiologists to the possibility of TB when considering such cystic lesions of the anterior abdominal wall.

CASE OF TREATMENT OF AN ANTERIOR ABDOMINAL WALL ABSCESS CAUSED BY LARGE BOWEL FISTULA

This article presents a clinical case of treatment of an anterior abdominal wall abscess,which arose due to the formation of an external fistula of the sigmoid colon duringperforation of the diverticulum of the latter.The patient underwent laparotomy, a combined left hemicolectomy with small bowelresection, excision of the large intestinal fistula of the anterior abdominal wall,rehabilitation, and drainage of the abdominal cavity. The postoperative period was withoutcomplications, the wound healed with primary tension. The patient was discharged fromthe hospital in a satisfactory condition on the 17th day.Сonclusion. The treatment of purulent-inflammatory diseases of the anterior abdominalwall it is necessary to pay attention to the cause of their occurrence, as well as to excludesurgical diseases of the abdominal cavity.

A rare case of anterior abdominal wall abscess due to transmigrated fish bone from transverse colon

A rare case of anterior abdominal wall abscess due to transmigrated fish bone from transverse colon

Anterior Abdominal Wall Abscess: An unusual presentation of Carcinoma of the Colon

Anterior Abdominal Wall Abscess: An unusual presentation of Carcinoma of the Colon

The Occurrence of Postoperative Complications in Patients Undergoing Surgery due to Complications from Crohn's Disease: A Case Report

Summary Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum or anus. Less commonly, it affects the stomach, esophagus and mouth. Often, the disease affects multiple areas of the gastrointestinal tract. The cause of CD is not known and there is no curative treatment. The current medical and surgical treatment is effective in controlling the disease, but even with optimal treatment, recurrences and relapses are frequent. Various risk factors specific for the patients with conditions related to the CD can influence the outcome of the surgical treatment in the postoperative period. Those risk factors can be preoperative laboratory inflammatory markers such as WBC and CRP values, phlegmona of the anterior abdominal wall and preoperative interintestinal abscess, positive resection margins. Here we present a case of a patient who was surgically treated as an emergent case because of the complication due to Crohn's disease. At presentation, the patient had leukocytosis, elevated CRP, anemia, low levels of total proteins, and albumin.

Anterior Abdominal Wall Abscess in a patient with Acute Suppurative Appendicitis

Anterior Abdominal Wall Abscess in a patient with Acute Suppurative Appendicitis

External biliary fistula presenting as anterior abdominal wall abscess – a rare presentation in modern surgical practice

Cholecystocutaneous fistula is a rare complication of cholecystitis. We report a case of a 75-year man who presented with features of anterior abdominal abscess, which on further exploration was diagnosed to be an external biliary fistula. This case illustrates that any cutaneous abscess in the right hypochondrium should be viewed with caution and investigated thoroughly.

Role of Ultrasonography and Multi-detector CT in Imaging of Anterior Abdominal Wall Lesions

This study aim to evaluate the role of US and CT when needed in diagnosis of anterior abdominal wall lesions. Ultrasound and Multi-detector computed tomography are currently the study of choice to diagnose abdominal wall lesions; mostly hernia it also allows accurate identification of abdominal wall hernias and their content, and it allows to assess the possible complications, differentiate from other abdominal masses like: tumors, hematoma, abscess and it helps in the detection of pre- or postoperative complications. This prospective study included 50 patients suffering from abdominal wall swelling, US examination of abdomen was performed for all patients and only 10 patients had under gone US and CT examination the abdomen. The ratio of females to males was 28 to 22. Their ages ranged from 22-60 years with mean age of 40 years. Ventral hernia was the most common cause of anterior abdominal wall lesions 26 cases (52%), anterior abdominal lump 14 cases (28%), 10 cases were needed to CT evaluation. Ventral hernia was the most common lesions (30%) 3 cases out of 10 cases, strangulated hernias (20%) 2 cases, spegilan hernia, anterior abdominal wall abscess and desmoid tumor (10%) 1 case for each. US is the prime investigation for patients suspected of having abdominal wall swellings and was the first step in the diagnosis while CT scan was a sensitive tool for imaging and we recommend it as a confirmative imaging method

Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location.

Trauminio skrandžio plyšimo sepsinių komplikacijų gydymas minimaliai invaziniais metodais: klinikinis atvejis

ĮžangaIzoliuotas trauminis skrandžio plyšimas pasitaiko labai retai. Apie 95 % atvejų diagnozuojami gretutinių organų sužalojimai. Dėl santykinai palankios skrandžio anatomijos, jo mobilumo bei storos sienos skrandžio plyšimai sudaro 0,02–1,7 % visų bukų pilvo sužalojimų. Mūsų tikslas – aprašyti neįprastą trauminį skrandžio plyšimą, gydytą minimaliai invazinės chirurgijosmetodais.Atvejis62 metų vyras skubos tvarka hospitalizuotas į chirurgijos skyrių dėl skausmo epigastriumo srityje ir kraujavimo iš viršutinės virškinimo trakto dalies klinikinių požymių. Ligonis teigė, kad prieš 2 savaites patyrė buką pilvo traumą. Iš anamnezės žinoma apie skrandžio opaligę. Atlikus endoskopinį tyrimą rastas visą mažąją kreivę apimantis skrandžio išopėjimas be aktyvaus kraujavimo požymių. Pilvo organų echoskopijos duomenimis, konstatuota bursa omentalis skysčio sankaupa, priekinės pilvo sienos hematoma ir laisvas skystis pilvo ertmėje (apie 500–700 ml). Įtarta pridengta skrandžio kūno mažosios kreivės perforacija ir hemoperitoneumas. Ligoniui siūlytas skubus operacinis gydymas, bet jis tokio gydymo kategoriškai atsisakė. Konservatyvaus gydymo metu, atsiradus infekcijos požymių, atliktas pilvo organų ultragarsinis ir kompiuterinės tomografijos tyrimai, kuriais nustatyta bursa omentalis skysčio sankaupos ir priekinės pilvo sienos hematomos supūliavimas. Atliktas ultragarsu kontroliuojamas pilvo sienos hematomos dravimas 12 Fr drenu. Endoskopinės procedūros metu per užpakalinę skrandžio sieną drenuotas bursa omentalis pūlinys, į jo ertmę įkišus du 7 Fr drenus. Normalizavosi temperatūra, kraujo tyrimų rodikliai, pacientas pradėjo normaliai valgyti. Geros būklės išrašytas į namus 35 parą nuo hospitalizacijos pradžios. Stebėtas ambulatoriškai. Komplikacijų nekonstatuota. Po 2 mėnesių endoskopiškai pašalinti skrandžio drenai.IšvadaSkrandžio trauminio sužalojimo sepsinės komplikacijos gali būti efektyviai gydomos minimaliai invazinės chirurgijos priemonėmis – perkutaniniu ir endoskopiniu transgastriniu pūlinių drenavimu.

Gallbladder Perforation Presenting as Abdominal and Chest Wall Abscess

Gall bladder perforation is itself a rare entity and its presentation as cellulitis of anterior chest wall is unique. We present a case of 80 year old lady who presented to us as abscess of anterior abdominal wall. Though cholecystectomy was performed but the patient expired two days later due to multiple organ dysfunction syndrome. Thus gallbladder perforation is a rare but life threatening complication of cholecystitis and must be dealt aggressively.

English

A 60 years old women presented with non healing wound in right groin since last 8 months. She had a history of incision and drainage of anterior abdominal wall abscess in right groin 1 year back, CT Scan demonstrated a mass in right iliac fossa and para renal space with possibility of ruptured appendix with periappendiceal abscess in retroperitoneum. In view a palpable lump a sinogram was performed suggestive of enterocutaneous colonic fistula. Right Hemicolectomy with fistulous tract excision was performed and Histopathology report was suggestive of Mucinous adenocarcinoma of appendix and caecum infiltrating through whole thickness of wall into pericaecal tissue. Stage- T3NxMx, with clear resection margins.

Anterior Abdominal Wall Abscess as a Complication of Appendicular Mass in Elderly

Appendicitis in the elderly continues to be a challenging surgical problem. Patients usually present late with atypical presentations. The diagnosis of appendicitis is often difficult to establish and there are increased rate of perforation and mortality. Abscess formation with extension to anterior abdominal wall as reported in this case is rather rare. Older patients also tend to undergo more complicated operative procedures and higher rate of postoperative morbidity and mortality. We reported a case of atypical presentation of appendicitis as anterior abdominal abscess and postoperative challenges in geriatric surgery.