Case Of Abdominal Abscess Research Articles

Two Cases of Abdominal Abscess Caused by Retained Faecal Stone After Laparoscopic Appendectomy

Two Cases of Abdominal Abscess Caused by Retained Faecal Stone After Laparoscopic Appendectomy

S3503 A Rare Case of Abdominal Abscess in a Cirrhotic Patient Misdiagnosed as Spontaneous Bacterial Peritonitis

INTRODUCTION: Ascites is a major complication of cirrhosis with 50% mortality in 2 years. Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in the absence of an intra-abdominal surgically-treatable source. SBP is almost always monomicrobial and growth of more than 1 organism should raise suspicion for secondary bacterial peritonitis. We report a case of large intraabdominal abscess that was misdiagnosed and treated as SBP for several wks before the correct diagnosis was made. CASE DESCRIPTION/METHODS: A 56-year-old man with alcoholic cirrhosis presented with abdominal distention 6 months previously. Initial diagnostic tap yielded 36 PMNs/mm3 with negative culture. Ascites responded to medical management, but recurred 4 months later. Ascitic fluid on 2nd tap had 2648/mm3 PMNs with negative cultures. 11 days later, an ultrasound showed loculated ascites. A 3rd tap yielded fluid with 28,292 PMNs/mm3, cultures grew Klebsiella oxytoca and Streptococcus salivarius. IV cefotaxime was given for SBP. The 4th tap 3 days had >3 billion nucleated/mm3 (90% PMNs); cultures grew same organisms. He improved and was discharged on cefixime for 5 days, followed by trimethoprim/sulfamethoxazole for SBP prophylaxis. 2 weeks later, ascitic fluid on a fifth tap had nearly a million nucleated cells/mm3; cultures grew Streptococcus anginosus. Patient came to us 4 weeks later with abdominal distention and pain, had a mass-like firmness of the abdomen. Labs showed normal WBC count and liver enzymes. CT abdomen pelvis (Figure 1 A-B) showed intra-peritoneal fluid collection measuring 22 × 13 × 7.2 cm, with small ascites. Paracentesis yielded 5.6 L fluid growing Streptococcus anginosus and Lactobacillus fermentum. Patient underwent abdominal drain, was discharged on IV antibiotics. A repeat CT abdomen pelvis (Figure 2A–B) 4 weeks later showed near-complete resolution of abscess, was switched to oral amoxicillin for 3 weeks. He did well, with no recurrence of ascites. DISCUSSION: Ascitic fluid analysis can provide clues that differentiate SBP from secondary bacterial peritonitis. The cause of the abscess in this case is not clear, but the very high PMN counts and multiple organisms cultured from the ascites should have raised concern for secondary bacterial peritonitis. Because of failure to recognize these clues, definitive treatment was delayed. Not all cases of neutrophilic ascites in cirrhosis represent SBP.Figure 1.: A-B: CT abdomen pelvis cross sectional and coronal view showing a rim-enhancing fluid collection in the anterior peritoneal cavity measuring 22 × 13 × 7.2 cm, with small volume ascites and cirrhotic liver.Figure 2.: A-B: CT abdomen pelvis cross sectional and coronal view 4 weeks later showing near-complete resolution of the abscess with a small amount of air visible along the track of the drain catheter (solid white arrows).

A case of abdominal abscess and bacteremia caused by Mycoplasma hominis after laparoscopic-assisted uterine myomectomy

A case of abdominal abscess and bacteremia caused by Mycoplasma hominis after laparoscopic-assisted uterine myomectomy

Clinical observation of one-stage resection of left colon cancer with acute obstruction

Objective To explore the effect of surgical management of left colon cancer with acute obstruction. Methods A retrospective analysis was made on the clinical data of 85 cases with acute obstructive colorectal carcinoma treated by one-stage resection. Among the 85 cases, there were 48 cases of left colon obstruction(treatment group), and the control group included 37 cases of right colon cancer. To compare the occurrence of postoperative complications. Results 20 cases had postoperative complication in the treatment group, among which,2 cases had anastomosis fistula,4 cases of pulmonary infection,5 cases of abdominal abscess,6 cases of incision infection and 3 cases of intestinal adhesion. In control group, there were 15 cases had complication, among which,1 case had anastomosis fistula,3 cases of pulmonary infection,3 cases of abdominal abscess,5 cases of incision infection and 3 cases of intestinal adhesion. There was no significant difference in incidence rate of complication between two groups(P> 0.05). Conclusion One stage resection in the treatment of left colon cancer with acute obstruction is safe and feasible. Key words: Colonic neoplasms; Intestinal Obstruction; Anastomosis, Surgical

NASPGHAN Clinical Report on the Evaluation and Treatment of Pediatric Patients With Internal Penetrating Crohn Disease

Natural History of Pediatric Crohn Disease T he natural history of pediatric Crohn disease (CD) remains unpredictable, although some trends are observed that differentiate children from adults. Pediatric CD often presents with more severe disease and more frequent need for immunosuppressive therapy (1). Growth failure, present in 15% to 20% of patients, is a unique characteristic of pediatric CD not seen in adult-onset CD (2). Colonic disease distribution is common in patients younger than 10 years (1). The need for surgical intervention also varies, with 1 study reporting the actuarial risk of having undergone an extensive intestinal resection being 48.6% 5% in a childhood-onset group versus 14.6% 2% in the adult-onset group (P< 0.001) (1). More recently, long-term follow-up of patients enrolled in pediatric registries shows a cumulative surgical rate of 14% to 17% at 5 years and 28% at 10 years (3,4).

Efficacy of Different Therapeutic Options for Spontaneous Abdominal Abscesses in Crohnʼs Disease: Are Antibiotics Enough?

Management of abdominal abscesses (AA) in Crohn's disease (CD) always includes antibiotics, and some type of drainage is added according to the response and other considerations. Our aim was to assess the efficacy of different therapeutic approaches to spontaneous AA in CD. All cases of AA in CD were identified from the databases of five university hospitals. Postoperative cases were excluded. Therapeutic success was defined as abscess resolution and nonreappearance within 1 year of follow-up. We identified 128 cases in 2236 patients (cumulative incidence 5.7%). Initial therapy included medical therapy with antibiotics alone (42.2%), antibiotics plus percutaneous drainage (23.4%), and antibiotics plus surgical drainage (34.4%). The highest final efficacy corresponded to surgery (91%) as compared with antibiotic therapy alone (63%) or percutaneous drainage (30%). Failure of initial therapy was predicted by immunomodulators at diagnosis (odds ratio [OR] 8.45; 95% confidence interval [CI] 1.16-61.5; P = 0.03), fistula detectable in imaging techniques (OR 5.43; 95% CI 1.18-24.8; P = 0.02), and abscess size (OR 1.65; 95% CI 1.07-2.54; P = 0.02) only for patients treated with antibiotic therapy alone. Percutaneous drainage was associated with 19% of complications (enterocutaneous fistulas 13%); surgery was associated with 13% of postoperative complications (enterocutaneous fistulas 7.7%). Following abscess resolution, 60% of patients were started on thiopurines, 9% on biologics, and in 31% baseline therapy was not modified. Management of spontaneous AA in CD with antibiotics alone seems to be a good option for small abscesses, especially those without associated fistula and appearing in immunomodulator-naïve patients. Surgery offers better results in the remaining clinical settings, although percutaneous drainage can avoid operative treatment in some cases.

Ultrasonographic Characteristics of Abdominal and Thoracic Abscesses in Cattle and Buffaloes

Six cows and five buffaloes with abdominal and thoracic abscesses were examined clinically and ultrasonographically. There was a wide range of clinical signs and at least 50% of the animals exhibited dull demeanour, anorexia, abdominal pain, recurrent tympany and/or weight loss. Three cases of abdominal abscesses were imaged in the left ventral abdomen between the rumen and abdominal wall, two cases were imaged at the xiphoid cartilage near the reticular wall and one case was imaged on the right ventral abdomen between the jejunum and right abdominal wall. Four cases of thoracic abscesses were imaged in the third intercostal space on the left side; however, one case of abscess was imaged in the fourth intercostal space, also on the left side. The content of the abscess was echogenic in eight animals and anechoic in three. In three animals, the content of the abscess was partitioned by echogenic septae. In two cows, the echogenic content of the abscess was surrounded by a narrow rim of anechoic fluid. The diameters of the abscesses were 5-10 cm in three cows, 11-15 cm in seven cows and >15 cm in one cow. In every case, the diagnosis was confirmed by centesis and aspiration of the abscess, which yielded purulent material. There were biochemical data of hypoalbuminaemia and hyperglobulinaemia and 90% of tested animals had neutrophilia. Five cows were examined at slaughter, where the ultrasonographic diagnosis was confirmed.

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

Abdominal wall abscess due to Crohn's Disease used to be one of the definitive indications for operative treatment. The advent of interventional radiology, the accessibility to percutaneous drainage, and the availability of new medications raised the possibility of nonoperative treatment of this condition. The clinical presentation, treatment, and follow-up of 13 patients with abdominal wall abscesses secondary to Crohn's Disease were retrospectively reviewed. During a 10-year period (1993-2003), 13 patients with abdominal wall abscess were treated. Five patients had an anterolateral abdominal wall abscess and eight had a posterior abscess (psoas). In 11 patients, 17 drainage procedures were performed: 12 percutaneous and 5 operative. Despite initial adequate drainage and resolution of the abscess, all 13 patients eventually needed resection of the offending bowel segment, which was undertaken in 12 patients. The mean time between abscess presentation and definitive operation was 2 months. Percutaneous drainage is an attractive option in most cases of abdominal abscesses. However, in Crohn's Disease patients with an abdominal wall abscess, we found a high failure rate despite initial adequate drainage. We suggest that surgical resection of the diseased bowel segment should be the definitive therapy.

魚骨による消化管穿通, 腹腔内膿瘍の1例

魚骨による消化管穿通, 腹腔内膿瘍の1例

Abdominal Abscess Due to Cardiobacterium hominis and Clostridium bifermentans

A case of abdominal abscess and bacteremia due to Cardiobacterium hominis and Clostridium bifermentans was successfully treated with surgical drainage and ampicillin-penicillin. This case represents the rare occurrence of C. hominis infection without apparent endocarditis.

Comparative Accuracy and Complementary Use of 67Ga-Citrate Imaging and Ultrasound in the Diagnosis of Abdominal Abscesses

Ultrasound and 67Ga-citrate imaging were used simultaneously for the evaluation of 26 suspected cases of abdominal abscess. Scintiscanning and ultrasonography identified respectively 92% and 69% of the abscesses. Jointly, both modalities detected all 13 abscesses and we suggest an integrated approach in the evaluation of such cases.

BUCKINGHAMSHIRE GENERAL INFIRMARY, AYLESBURY.: A CASE OF ABDOMINAL ABSCESS, AND ONE OF RADICAL CURE OF HERNIA IN A CHILD

BUCKINGHAMSHIRE GENERAL INFIRMARY, AYLESBURY.: A CASE OF ABDOMINAL ABSCESS, AND ONE OF RADICAL CURE OF HERNIA IN A CHILD

A Case of Abdominal Abscess in Right Iliac and Inguinal Region

A Case of Abdominal Abscess in Right Iliac and Inguinal Region