Early Surgical Drainage Research Articles

Bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient: a case report

BackgroundWorldwide, there is an increase in the frequency of reports of psoas abscesses due to advances in imaging technology, which has led to early diagnosis and treatment. A bilateral psoas abscess is rare and, when it occurs, is usually secondary and in immunocompromised patients. We present a case of a bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient.Case presentationA 21-year-old Ugandan female undergraduate who contracted human immunodeficiency virus through vertical transmission and has been on highly active antiretroviral drugs presented with bilateral lower abdominal pain with associated fever and headache. Clinical examination revealed abdominal tenderness in both iliac fossae with palpable masses. Ultrasonography revealed fluid collection in both psoas muscles confirming bilateral abscesses. The aspirate was acid-fast bacilli positive. A diagnosis of bilateral tuberculosis psoas abscess was made. Open drainage was performed and antituberculosis drugs were commenced.ConclusionsBilateral tuberculosis psoas abscesses occurring in human immunodeficiency virus-positive patients, although uncommon, is not unexpected. It is a form of secondary psoas abscess in immunocompromised patients. Here, the outcome was successful with a combination of early surgical drainage and appropriate medical therapy.

A case of multidrug-resistant intractable pylephlebitis and intra-abdominal abscess due to perforated appendicitis successfully treated with open abdominal management

BackgroundPylephlebitis, a rare and lethal form of portal venous septic thrombophlebitis, often arises from infections in regions drained by the portal vein. Herein, we report a case of peritonitis with portal vein thrombosis due to acute severe appendicitis, managed with intensive intraperitoneal drainage via open abdominal management (OAM).Case presentationA 19-year-old male with severe appendicitis, liver abscesses, and portal vein thrombosis developed septic shock and multi-organ failure. After emergency interventions, the patient was admitted to the intensive care unit. Antibiotic treatment based on cultures revealing multidrug-resistant Escherichia coli and Bacteroides fragilis and anticoagulation therapy (using heparin and edoxaban) was initiated. Despite continuous antibiotic therapy, the laboratory results consistently showed elevated levels of inflammatory markers. On the 13th day, open abdominal irrigation was performed for infection control. Extensive intestinal edema precluded wound closure, necessitating open-abdominal management in the intensive care unit. Anticoagulation therapy was continued, and intra-abdominal washouts were performed every 5 days. On the 34th day, wound closure was achieved using the anterior rectus abdominis sheath turnover method. The patient recovered successfully and was discharged on the 81st day.ConclusionsAlongside appropriate antibiotic selection, early surgical drainage and OAM are invaluable. This case underscores the potential of anticoagulation therapy in facilitating safe surgical procedures.

Treatment of pleural space infections

Pleural space infections occur in approximately 10% of patients hospitalized for pneumonia and their incidence is increasing with an aging population. Pulmonary ultrasound is a good bedside diagnostic tool able to reduce complications associated with thoracocentesis and drainage. The RAPID score is being increasingly validated as a predictor for mortality but has not yet been proven useful to guide the treatment strategy and needs incorporation into prospective studies. Awaiting studies on outcome prediction and the comparison of an early surgical strategy versus drainage with intrapleural enzyme therapy, this article presents a summary of current knowledge of this complication.

Management of Deep Neck Infection with Descending Mediastinitis using Video-Assisted Thoracoscopic Surgery

Descending mediastinitis is defined as the spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and has a high mortality rate. Prompt commencement of broad-spectrum antibiotics combined with surgical drainage is crucial to limit further spread of infection. We report a case of extensive deep neck infection in a 66-year-old female which rapidly progressed to the contralateral neck complicated by descending anterior mediastinitis. She underwent a combined transcervical and video-assisted thoracoscopic surgery (VATS) for drainage of abscess and was put on 3 weeks of intravenous antibiotics coupled with another 3 weeks of oral antibiotics. Deep neck infection with descending mediastinitis can be successfully treated with antibiotics and early surgical drainage via a combined transcervical and VATS approach.

Subscapular abscesses: A literature review and evidence-based treatment guidelines.

An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction. A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case. Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach. From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.

Cryptogenic subdural empyema mimicking subacute-subdural hematoma on CT imaging in the pediatric group: a clinical case series

Introduction: Subdural empyema (SDE) is a rare but potentially life-threatening intracranial infection that is invariably fatal if left untreated. As clinical and radiologic features may be subtle or uncertain, early diagnosis may be a challenge but is crucial in reducing morbidity and mortality. SDE should always be suspected especially in a paediatric group with a history of fever, focal seizures, meningism and neurological deficit. The management of SDE has been debated in the literature for decades. Being one of the most serious neurosurgical emergencies, goals include surgical evacuation where both burr-hole drainage and craniotomy are primary surgical options, treatment of pus, and establishing the etiologic agent which subsequently guides antibiotic therapy for a favourable outcome.
 Case presentation: We present three cases of immunocompetent patients, 4 and 6-month-old infants with a 14-year-old adolescent presenting with SDE without underlying risk factors. Non-contrast computed tomography imaging was equivocal for SDE. All of them required surgery. The two infants underwent burr holes and subsequently a wide craniotomy with intravenous antibiotics therapy while the adolescent required craniectomy because of swollen brain. They all had a favourable outcome on long term follow up.
 
 Conclusion: Paediatric supratentorial SDE, although rapidly fatal if not identified promptly, can be effectively managed with early surgical drainage preferably craniotomy, eradication of the source, and sensitive IV broad-spectrum antibiotics. In this article, we discuss the clinical presentation, diagnostic tools, treatment options and outcomes for SDE with an emphasis on the challenges.

Novel techniques in the treatment of skin and soft tissue infection.

Global antibiotic resistance is compromising the management of soft tissue infection and Acute Bacterial Skin and Skin Structure Infection (ABSSI). This review describes a novel topical treatment Reactive Oxygen (RO) gel which could compliment and in some situations replace systemic antibiotics. A novel topical treatment RO gel could have an important role in treatment, infection prevention and antimicrobial stewardship. RO is highly antimicrobial against Gram positive and negative bacteria, by slow release of oxygen radicals over a prolonged period of up to 72 h. It prevents and breaks down biofilm and may support healing by cellular signalling. Much clinical investigation remains to be delivered on RO therapy but there seem few disadvantages in its use and early clinical evaluations are extremely promising. Managing complicated skin and soft tissue infections require more than just antibiotic treatment. Soft tissue infection healing is often compromised by underlying comorbidities and pathology and increasingly the presence of highly antimicrobial-resistant bacteria. This has been highlighted particularly in war and trauma soft tissue infection. The fundamentals of soft tissue infection repair require early surgical drainage and debridement, correction of compromised physiology and treatment of underlying conditions and appropriate antimicrobial treatment. RO therapy could be an important advance.

Early Surgical Drainage for Pyogenic Liver Abscess in the Western World – A New Paradigm

Introduction: Pyogenic liver abscess (PLA) is not common in the Western world. Most patients are treated with image guided drainage (IGD). However, it is not successful in multiloculated abscess needing a later surgical drainage. We pursued a policy of best drainage as the first treatment even if it included liver resection and report our results. Methods: All patients treated for liver abscess at the University Hospital of Wales, Cardiff, UK, were identified from the Radiology and liver unit database from December 2010 to December 2020. We excluded patients who had gallbladder perforation into liver causing abscess. We collected data on demographics, mode of presentation, comorbidities, cause if known, organism, treatment, hospital stay and deaths. Results: There were 82 patients with a median age 68 (16-91) and male:female ratio of 2:1. The main presenting symptom was abdominal pain and fever in 62%. E.Coli and K.Pneumonia were the most common organisms. Treatment was surgical, IGD and antibiotics in 49%,21% and 30% respectively. Hospital stay was 13 days with no difference between the different treatment groups. Overall mortality was 5/82 (6%). Mortality in operative, IGD and antibiotic groups were 5%, 12% and 4% respectively. Two patients who died following surgery were elderly and had severe sepsis at presentation. Conclusion: Our results show that offering the best treatment including surgical drainage/resection as the first treatment leads to lower mortality and avoids prolonged hospital stay. Early referral to a liver unit for opinion or transfer is essential to achieve these results.

Alar cartilage hematoma of the nose secondary to facial trauma.

<p>A 27 years old male patient victim of road traffic accident presented to emergency department by ambulance team with ankle swelling and decrease range of motion, seen by orthopedic team and admitted as case of right ankle fracture for surgical intervention. Patient then referred to otolaryngology regarding on and off nasal bleeding and right nasal swelling arising from inner surface of right lower lateral cartilage of the nose 6 hour after the facial trauma, we present this case of hematoma of lower lateral cartilage which consider as one of the unique and rare condition following nasal and facial trauma. Early recognition of this condition is important, also differentiation between alar hematoma and septal cartilage hematoma is not easy for non-otolaryngology doctor, so increase awareness of this condition as one of possible sequel of fecal trauma and early referral to otolaryngology services is crucial. We present here a case of right sided alar cartilage hematoma, including the approach, management and follow up of the patient. We recommend early surgical drainage to optimize aesthetic out come after trauma.</p>

Diagnostic Key Points and Surgical Management of Necrotizing Fasciitis: A Retrospective Study.

Necrotizing fasciitis (NF) is a fatal disease with a high mortality rate that can be easily misdiagnosed. The aim of this study was to improve the diagnostic rate of NF and overall survival. We conducted a single-center, retrospective, noncontrolled study involving 36 patients who were admitted to our department between December 2017 and October 2019, and summarized the diagnostic key points and timing of surgical treatment. All patients were diagnosed at our department and underwent multiple courses of treatment. The records included information regarding underlying diseases, bacterial culture results, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of procedures, and type of antibiotics. All 36 cases of NF were cured and showed good patient condition on follow-up; the mean number of surgeries was three, and the mean duration of hospitalization was 37 days (range, 21-83 days). The LRINEC scores of 16 patients were ≥8 points. Seventeen patients with underlying diabetic disease had higher inflammatory index scores than those without diabetes. The LRINEC scores of patients with (n = 17) and without (n = 19) DM were 7.40 ± 2.99 and 3.80 ± 2.39, respectively (P < .01). Cases of NF that were treated with early incision and surgical abscess drainage required fewer surgeries and a shorter length of hospitalization. Thus, surgeons should be more aware of NF and aim to make an early and accurate diagnosis using various approaches. Complete surgical debridement plays an essential role in NF treatment, and diabetes mellitus is a significant adverse factor that exacerbates the severity of NF. Negative-pressure techniques are useful in cases involving nonanaerobic infections and cause minimal complications.

Primary pyomyositis of the forearm in a non-immunocompromised boy

We present a previously healthy 5-year-old boy with primary pyomyositis of the right forearm due to methicillin-susceptible Staphylococcus aureus. He had no apparent portal of entry. He was cured after surgical drainage of the affected forearm along with a three-week course of sequential intravenous and oral antibiotics. Pyomyositis is a rare but serious bacterial infection of striated muscle that should be part of the differential diagnosis of any child with fever, localized extremity pain, and edema. It can advance to abscess formation in the affected muscle and have serious short- and long-term consequences. The vast majority of cases in both tropical and temperate regions are caused by S. aureus. Hence, empirical anti-staphylococcal therapy pending culture results is appropriate. MRI is the best imaging modality for diagnosis, while common laboratory tests like hemogram, ESR and CRP are useful for monitoring response to therapy. Early diagnosis, surgical drainage and lengthy treatment with appropriate antibiotics lead to clinical cure in most cases.

Primary Infective Pyomyositis of the Hip Abductors Presenting as Trochanteric Bursitis

Introduction: Pyomyositis is an uncommon suppurative infection of skeletal muscle. In recent times, it is becoming more prevalent in the context of immunosuppression and diabetes and it is known to show a preponderance for pelvic girdle muscles. We present a case of a primary infective pyomyositis of the gluteal musculature in a diabetic patient which presented initially as a typical greater trochanteric bursitis. Case Report: A 52 year old female presented with sudden onset left lateral thigh pain localized to the greater trochanteric region. Relevant comorbidities included a BMI of 35, uncontrolled non insulindependent diabetes mellitus and hypertension. Her HbA1c on presentation was 97mmol/mol. She had a raised CRP of 92 with a normal white cell count. MRI confirmed an ill-defined collection overlying the gluteal tendon insertions with extensive surrounding oedema. The patient was surgically managed and underwent incision and drainage through a direct lateral incision. Samples sent were positive for staphylococcus aureus and the patient was commenced on IV flucloxacillin. They progressed to a full recovery. Conclusion: We recommend that consideration be given to infective pyomyositis in the differential for patients presenting acutely with trochanteric hip pain. Pyrexia, raised inflammatory markers and a history of diabetes mellitus or other immunosuppressive conditions should raise clinical suspicion for occult infection even in the setting of a common clinical complaint such as trochanteric hip pain. MRI is essential in achieving early diagnosis and surgical drainage and medical management can lead to a good clinical recovery.

Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis

BackgroundTreatment of anorectal abscesses continues to revolve around early surgical drainage and control of perianal sepsis. Yet even with prompt drainage, abscess recurrence and postoperative fistula formation rates are as high as 40% within 12 months. These complications are thought to be associated with inadequate drainage, elevated bacterial load, or a noncryptoglandular etiology of disease. Postoperative antibiotics have been used to account for these limitations, but their use is controversial and only weakly supported by current guidelines due to low-quality evidences. The aim of the present study was to perform a systematic review and meta-analysis of the current literature to determine the role of antibiotics in prevention of anal fistula following incision and drainage of anorectal abscesses. MethodsLiterature search was conducted using Medline, EMBASE, Scopus, the Cochrane Library, and Web of Science databases from 1946 to April 2018. Search terms were “perianal OR anal OR fistula-in-ano OR ischiorectal OR anorectal AND abscess AND antibiotics” and was limited to human studies in the English language. Literature review and data extraction were completed using PRISMA guidelines. A total of six studies with 817 patients were included for systematic review. The weighted mean age was 37.8 years, 20.4% of patients were female, and the follow up ranged from one to 30 months. Antibiotic courses varied by study, and duration ranged from five to 10 days. Of included patients, 358 (43.8%) underwent management without antibiotics while 459 (56.2%) patients were treated with antibiotics. Fistula rate in subjects receiving antibiotics was 16% versus 24% in those not receiving postoperative antibiotics. Meta-analysis revealed a statistically significant protective effect for antibiotic treatment (3 studies, OR 0.64; CI 0.43–0.96; P = 0.03). ConclusionsAntibiotic therapy following incision and drainage of anorectal abscesses is associated with a 36% lower odds of fistula formation. An empiric 5–10-day course of antibiotics following operative drainage may avoid the morbidity of fistula formation in otherwise healthy patients, although quality of evidence is low. Further randomized trials are needed to fully clarify the role, duration, and type of antibiotics best suited for postoperative prevention of fistula following drainage of anorectal abscesses.

Septic cerebral thrombosis in neonates: A case report and review of the literature

Introduction: Septic dural-sinus thrombosis is rare; it is one of the most misdiagnosed conditions of our time. It is often associated with a high level of mortality. Especially in neonates who have an underdeveloped immune system and haphazard clinical manifestation. Septic sinus thrombosis frequently involves cavernous sinuses. The superior sagittal sinuses’ involvement is exceptional as it is often associated with a fatal outcome. Studies demonstrate that heparin therapy in sagittal sinus septic thrombosis is unnecessary and that the focus of treatment shall be intravenous antibiotics and early surgical drainage of purulent collections who can be a source of widespread infections. Case Report: We report the case of a three months old boy, without pathological history, admitted in the intensive care unit (ICU) for febrile convulsion resistant to first line therapy. Cerebrospinal fluid analysis results were in favor of pneumococcus pathogens. Cerebral computed tomography (CT) has shown a superior longitudinal sinus thrombophlebitis complicating an encephalitis, with multiple venous infarcts. After which antibiotherapy was changed and anticoagulation added. Six days later, the sedation was stopped to evaluate the neurological state. The patient has shown a persistence of the coma state. After a multidisciplinary discussion, a transcranial Doppler was realized only to confirm the brain death state. The evolution was marked by the death of the patient after three days. Conclusion: In general, cerebral venous thrombosis (CVT) is a disease with complex clinical manifestations, atypical in many patients. If an alteration of consciousness is the main symptom in a CVT patient, the prognosis can be bleak. Most patients with CVT have a good prognosis after early anticoagulant and antibiotherapy. Since cerebral hernia is the most common cause of death in CVT, intensive care should be given special attention to the detection and treatment of focal lesions occupying space.

2316. The Frequency of Multifocal Disease and Pyogenic Hip Arthritis in Neonates With Osteomyelitis

BackgroundOsteomyelitis and septic arthritis are important infections in neonates in intensive care units. The literature on neonatal osteoarticular infections during the past twenty years, a period during which there was an emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), is limited. The purpose of this study was to describe a case series of neonatal osteoarticular infections during recent decades. In particular, we sought to describe the current microbiology, prevalence of multi-bone and contiguous joint involvement, and proportion of cases with pyogenic arthritis of the hip.MethodsMulti-center retrospective chart review. Cases were identified through NICU registries at 2 tertiary/quaternary children hospitals between 1993 and 2017. The diagnosis required suggestive clinical findings plus radiological findings or positive blood, joint fluid, or bone culture.ResultsThirty cases were identified. The median gestational age was 28 weeks, with 24 (80%) cases occurring in premature babies. The median age at time of diagnosis was 33.5 days (range, 11–175) days.The most common localized clinical findings were erythema (66%) and swelling (60%); the most common systemic finding was apnea (53%). Seventy percent had osteomyelitis, 27% had both bone and joint involvement, and one had septic arthritis only. Eight babies (27%) had an infection in more than one noncontiguous site. The most commonly identified bone was the femur (41%) and joint was the knee (20%) followed by hip (17%). Of the 5 babies with hip infection, two were recognized more than 48 hours after initial presentation. An ultrasound of the hip was performed on 12 babies (40%), including 4 out of the 5 who had surgical drainage of the hip.Cultures of blood, joint fluid, and bone were positive in 23, 6, and 2 babies, respectively. Methicillin-susceptible S. aureus (71%) was the most common pathogen followed by MRSA (21%).ConclusionNeonates in a NICU with osteoarticular infection frequently have multiple sites of involvement. The hip joint is infected in a sizeable minority of babies with osteoarticular infection. In view of the importance of early diagnosis and surgical drainage of pyogenic hip arthritis, ultrasound of the hips should be considered in neonates in a NICU with osteoarticular infection at any body site.Disclosures All authors: No reported disclosures.

Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era.

We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum β-lactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post-antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.

Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre.

This study is intended to analyze the clinical profile and outcomes of deep neck space infection in diabetic patients in our tertiary care centre. A prospective study of 1year duration from 30th September 2015 to 30th September 2016 at department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati. A total of 45 diabetic patients who presented with DNSI are included in this study. Their demographic profile, etiology, bacteriology, treatment, duration of hospital stay, complicationsand outcomes have been analyzed. 45 patients were recorded; 32 (71.11%) were men, and 13 (45%) were women, with a mean age of 63.27±7.55years. There were 30 patients (66.67%) who had associated systemic diseases apart from diabetes mellitus. The parapharyngeal space in 13 patients (28.89%) was the most commonly involved space. Odontogenic infections in 18 patients (40%) and upper airway infections 9 patients (20%) were the two most common causes. Klebsiella pneumonia in 29 patients (64.44%), was the commonest organism isolated through pus cultures. All the patients except one (97.78%) came with abscess and underwent surgical drainage. One patient (2.22%) with carbuncle underwent regular dressing. Six patients (13.33%) had major complications. Those patients with other underlying systemic diseases or complications tended to have a longer hospital stay and were older. No cases of death has been reported. (mortality rate, 0%). DNSI patients with diabetes have a more severe clinical course. They are likely to have complications more frequently and a longer duration of hospital stay. In clinical practices while dealing with these patients more vigilance is required. On admission empirical antibiotics should cover K. pneumonia. Early surgical drainage remains the main method of treatment. Primary prevention can be achieved by orodental hygiene, regular dental check ups and in this part of the country by avoidance of substance abuse like tobacco chewing.

Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child

Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases.

A study of deep space infections of neck

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to analyse the signs and symptoms, etiology, site and outcome of deep space infections of neck.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was retrospective study and included 50 patients admitted with deep neck space infections to Government Mc Gann teaching hospital SIMS, Shimoga, Karnataka, India between January 2009 – January 2015. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The extreme age group, high virulence of organism, underlying clinical conditions, low socioeconomic groups are vulnerable for above infections. Mortality in 3 cases was due to mediastinitis and extended space infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Deep neck space infection is still a challenging disease in otorhinolaryngology. Early surgical drainage remains the main method of treating deep neck abscesses and conservative medical treatment are effective in selective cases that have minimal cellulitis.&lt;/p&gt;

Spinal Epidural Hematoma Related to Vertebral Fracture in an Atypical Rigid Diffuse Idiopathic Skeletal Hyperostosis: A Case Report.

Introduction:Spinal epidural hematoma (SEH) is a rare disease that causes cord compression and neurologic deficit. Spontaneous SEH is related to minor trauma, bleeding disorders, and anticoagulant medications. Posttraumatic SEH has been associated with low-energy spine hyperextension injuries in patients with ankylosing spinal disorders such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH). A variant named atypical DISH-like with SEH is reported.Objective:To describe the management, diagnosis, and treatment of an unusual SEH case in a patient causing delayed neurologic deficit with rigid atypical DISH-like spine.Case Description:An elderly woman with prior antiplatelet therapy presented with delayed neurological deficit suffering trauma after falling. Computed tomography (CT) imaging studies reveal hyperextension fracture pattern and signs mimic DISH missed on standard X-ray images. Magnetic resonance (MR) study demonstrates posterior epidural mass compatible with SEH in thoracic spine with cord compression. Using a midline posterior approach, an urgent intervention and a left multiple partial unilateral decompressive laminectomy at T4-T7 and a long instrumented fusion at T3-T9 were performed for achieving spinal stability and neurological improvement, both of which were observed.Conclusion:Patients with rigid spine who sustain low-energy injuries may be prone to have a fracture and epidural hematoma, especially if they take anticoagulant medications. Imaging studies including MR and CT scans should be reviewed carefully to rule out any occult fracture. Urgent or early surgical hematoma drainage and instrumented fusion must be performed to achieve stability and functional recovery.