Diagnosis Of Intra-abdominal Abscess Research Articles

Ileostomy reversal after subtotal colectomy in Crohn's disease: a single institutional experience at a high-volume center.

Our aim was to evaluate factors leading to ostomy reversal among a group of 44 patients with Crohn's disease (CD) who underwent subtotal colectomy (STC) between June 2011 and September 2018. Our study design was a retrospective chart review. Patients with CD who underwent STC were included. Logistic regression analysis was used to evaluate several risk factors for non-reversal including medications received prior to surgery and indication for STC. Of 44 STCs performed, 31 (70.5%) were completed laparoscopically and 13 required an open approach (29.5%). Nine patients (20.4%) underwent ostomy reversal, and the mean time to reversal was 8.4 months. Preoperative therapy with an immunomodulator or biologic was associated with ostomy reversal (OR and CI: 0.43, 0.09-0.93; 0.47, 0.10-0.96), as was a diagnosis of intraabdominal abscess (0.43, 0.09-0.93). Ileostomy reversal after STC in Crohn's disease is uncommon. Certain treatment regimens and diagnostic factors may impact the likelihood of ostomy reversal. Based on the available data, patients with CD whose disease is severe enough to require STC should be counseled that their ostomy will most likely be permanent. However, due to the low incidence of this procedure for CD, more data is needed.

Clinical study of intra-abdominal abscess and its management by percutaneous USG guided drainage

Background: Intra-abdominal abscesses continue to present therapeutic challenge to the surgeon. They are common complication of inflammatory bowel disease, malignancy and trauma. The objective of the present study is to manage the intra-abdominal abscesses by percutaneous aspiration under ultrasound guidance and placement of continuous catheter drainage wherever deemed necessary and to assess the efficiency, limitations and complications, if any of this method.Methods: A total of 120 cases of intra-abdominal abscesses were selected. The diagnosis of intra-abdominal abscess was confirmed by USG and/or CT. Patients were then subjected to ultrasound guided drainage/aspiration as a therapeutic measure. Post procedure patients were watched for signs of peritonitis. Systemic antibiotics were given, and analgesics were given on SOS basis. Follow up ultrasound after three days was done. Follow up was kept in all cases.Results: Most common occurring intra-abdominal abscesses were liver abscess (60.83%) and sub-diaphragmatic abscess (11.67%). The etiology was not known i.e. cryptogenic in 47.5% and occurring post-surgically were 28.33%. In 25% patients, single aspiration was sufficient. In 30.80% patients, 2 aspirations and in 29.12% patients, 3 aspirations were needed. 72.5% patients were successfully treated by aspiration only and in the remaining 27.5% patients drain was kept. The complication rate was 7.5%. [Bleeding-0.83%, recollection-1.67% and damage to viscera-0.83%, which were related to the procedure].Conclusions: The method is associated with good success rate, low morbidity and mortality, better patient compliance, low cost, can be performed under local anaesthesia and even in critically ill and high-risk patients and should be used as an initial procedure in the treatment of intra-abdominal abscesses.

Gist Gastric Perforated

We report the case of a 77 year old male who came to the emergency department with epigastric pain accompanied by fever and chills. After the diagnosis of intra-abdominal abscess and gastric tumor, emergency surgery was performed. Resection of the tumor and abscess drainage was performed. The patient had good post operative course. Keywords: GIST; Gastrectomy; Intra-Abdominal Abscess

Emergency Atypical Resection for Perforated Gastric Gist

We report the case of a 77-year-old male who came to the emergency department with epigastric pain accompanied by fever and chills. After the diagnosis of intra-abdominal abscess and gastric tumor, emergency surgery was performed with resection of the tumor and abscess drainage. The patient had a good postoperative course.

The diagnostics of postoperative abscesses of abdominal cavity in children

85 patients with abscesses of abdominal cavity (AAC) at the age from 5 to 15 years old were observed. 37 (43.5%) patients had unformed and 48 (56.5%) patients had formed intra-abdominal abscesses. Devised methods of complex investigation were used to diagnose postoperative abscesses of the abdominal cavity; they included the index of blood toxicity (IBT) and the index of spontaneous agglomeration leukocytes (ISAL) in combination with dynamic purposeful using of searching ultrasound sonography and clinical signs. The complex diagnostics including ultrasound sonography, indexes of blood toxicity, spontaneous agglomeration of leucocytes and clinical signs can allow us significantly improve the effectiveness of diagnosis of intra-abdominal abscesses in the early stages after surgical operation regarding to appendicular peritonitis (AP) in children and to choose the optimal method of surgical treatment.

Constituent analysis may permit improved diagnosis of intra-abdominal abscess

Intra-abdominal abscesses (IAA) often fail to resolve with intravenous antibiotics alone and frequently require drainage. Diagnosis of IAA in postoperative patients with other likely sources of infection is very difficult. In order to characterize IAA and identify parameters that might facilitate diagnosis, we prospectively examined peripheral blood and pus of 15 consecutive patients with IAA and compared them to samples from 34 consecutive patients with soft-tissue abscesses (STA). Serum interleukin (IL)-10 was elevated in IAA patients, while abnormally detectable serum IL-4 was demonstrated in the pus of both IAA and STA patients. IL-10 in IAA pus was more than 11-fold higher than in STA, whereas IL-4 in pus was similar in both types of abscesses. Both IL-4 and IL-10 were 4- to 10-fold higher in IAA and STA pus than in corresponding patient serum. Serum lysozyme was, however, significantly elevated in all abscess patients. The presence of IL-4 and IL-10 may indicate a T-helper 2 lymphocyte response in the etiology of abscess formation and persistence, although precise determination of T-helper 1-related cytokines is needed to verify this. Serum lysozyme and IL-10 may be reliable and relatively inexpensive diagnostic aids.

Improved clinical diagnosis of intra-abdominal abscess based on constituent analysis

Improved clinical diagnosis of intra-abdominal abscess based on constituent analysis

Noninvasive Imaging Tests in the Diagnosis and Treatment of Intraabdominal Abscesses in the Postoperative Patient

The postoperative surgical patient poses special problems in the diagnosis of intra-abdominal abscess. A natural evolution has occurred over the last 20 years from purely clinical impressions being used to initiate reoperations for abscess to the present scenario, in which sophisticated CT scans permit minimally invasive drainage methods. The CT scan has become the diagnostic imaging method of choice, with other techniques serving a very limited role at the present time.

The Diagnosis of Intra-abdominal Abscesses in Patients with Severe Crohn's Disease

A series of 24 patients with severe relapses of Crohn's disease responding poorly to conventional treatment with corticosteroids was studied to determine the incidence of intra-abdominal abscesses and the best means to detect them. Ultrasound scans proved to be difficult to interpret and unreliable. Computed tomography demonstrated abnormal bowel thickening in most cases, and showed seven of the eight intraabdominal abscesses. 111In leucocyte scintigraphy always demonstrated inflamed areas of bowel, but underestimated the extent of disease in three patients and overestimated it in five. All eight abdominal abscesses were detected, and there were no false-positive results. It was always possible to distinguish the abscess from inflamed bowel wall. Intra-abdominal abscess is not uncommon in patients with severe relapses of Crohn's disease which are not responsive to corticosteroid therapy, being present in about one-third of patients. 111In leucocyte scintigraphy is a simple and helpful test for differentiating between active inflammatory bowel disease and complicating abscesses, contributing significantly to the management of patients with severe Crohn's disease.

Ultrasonographic Features of Intra-abdominal Abscess

Intraabdommal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and It has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a non-invasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intra-abdominal abscesses and the results are as follows; 1. In total 48 cases, the intra-abdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intra-abdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the others (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8 %). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo-pattern of the lesions was cystic with or without internal echogenicity (69%).

Role of ultrasonography, gallium scanning, and computed tomography in the diagnosis of intraabdominal abscess

Ultrasonography is reasonable in cost and allows confirmatory needle aspiration. It is especially valuable when the clinical impression suggests a particular area where the abscess is probably located. Gallium scanning is useful to detect the abscess when examination suggests a septic process without clinical localization. Several false-positive findings were seen in postsplenectomy patients. Computed tomography should be reserved for patients in whom localization is by other means difficult. By correlating the results of these techniques with clinical findings, only one unnecessary operation resulted from false-positive studies, and no surgery was delayed due to improper reliance on negative findings.

Gallium 67 citrate scanning in the diagnosis of intraabdominal abscess

Fifty-one consecutive gallium scans in fifty patients with suspected intraabdominal abscess are reviewed. There were twelve true-positive, seven false-positive, twenty-nine true-negative, and two false-negative scans. Accumulation of gallium in the colon and in areas of healing and repair caused some interpretive difficulty. Despite a significant number of false-positive results, we believe that gallium scanning is a valuable diagnostic tool. Careful attention to technic and cautious interpretation should significantly reduce false-positive and false-negative scans.