Emergency Drainage Research Articles

ANTERIOR ABDOMINAL WALL ABSCESS A RARE PRESENTATION OF LEFT SIDED COLONIC CARCINOMA: A DIAGNOSTIC CHALLENGE FOR A GENERAL SURGEON

Background: The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial presentation is uncommon. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20 x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks. She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this differential because it is easily ignored pre-operatively.

Svær sjælden komplikation til epididymitis

Severe rare complication to epididymitisEpididymitis is a common disease in the emergency department, but an abscess as a complication is rare. This case report describes an 82-year-old man, who suffered from a rare and severe complication from epididymitis after prescription of antibiotics. Ultrasound was the key to diagnose the abscess easy and fast in the emergency department. The patients were scheduled for an emergency surgical incision and drainage. He was discharged 14 days later from the hospital without any complications. Epididymal abscesses are an uncommon complication of epididymitis seen in the emergency department. It is a very rare but potentially life-threatening complication to be aware of.

Epiglottic abscess as a rare cause of muffled voice

A 42-year-old male presented with fever and symptoms of impending upper airway obstruction on the day of presentation. He required immediate intubation due to swollen epiglottis. The condition responded to antibiotic and steroids, and he was able to be extubated after 3 days. Two days later, however, the epiglottis started to swell up again, this time with pus discharge. Emergency exploration and drainage of the epiglottic abscess were executed, and the patient was kept intubated for a few days afterwards for the swollen epiglottis to reduce in size. Daily flexible laryngoscopy was commenced to monitor the disease status. After completing the antibiotic therapy the patient was discharged in good general condition.

Macrosquare-wave Jerks Subsiding after Hydrocephalus Treatment in a Thalamic Hemorrhage Patient

A 54-year-old man suddenly developed impaired consciousness and left hemiplegia due to a right thalamic hematoma. Emergent ventricular drainage for acute hydrocephalus improved the level of consciousness, but macrosquare-wave jerks (MSWJ) consisting of a right-ward intrusive saccade and corrective saccade appeared. The MSWJ disappeared on day 2 when follow-up CT revealed improvement of hydrocephalus. However, on day 36, after ventricular drainage was clamped, the MSWJ reappeared. After ventriculoperitoneal shunt, MSWJ again subsided. In this patient, hydrocephalus may have stretched the superior colliculus, thereby decreasing activity of the fixation neurons and then omnipause neurons, and eventually resulting in the reversible MSWJ.

Minimal Incision Venectomy for Peripheral Septic Thrombophlebitis

Peripheral septic thrombophlebitis is an uncommon but potentially lethal condition fraught with systemic complications. Optimal treatment calls for surgical excision of the inflamed venous segment, followed by antimicrobial therapy. However, the extended skin incision and meticulous flap elevation of conventional venectomy leaves substantial residual scarring. Herein, we detail a minimal incision venectomy performed for peripheral septic thrombophlebitis in a 55-year-old man. The patient was initially admitted for conservative management of intracranial hemorrhage but subsequently developed high fever and hypotension. An abscessed intravenous catheter site of the left forearm was the apparent source. Following emergency drainage and serial irrigation, surgical venectomy was undertaken to radically remove the septic focus, excising a 10-cm segment of infected vein through a separate proximal incision. After the procedure, the patient’s recovery was complete and free of complications at postoperative 6-month visit. Under appropriate indications, minimal incision venectomy can be an effective therapeutic alternative with minimal scarring.

Management of urological trauma associated with pelvic fractures.

Urological trauma is frequently encountered in patients with high energy pelvic fractures and can have debilitating long-term sequelae for patients without appropriate multidisciplinary management. Anterior pelvic ring disruption causes a high incidence of bladder rupture and urethral injuries, and initial assessment requires urological tract imaging and emergent bladder drainage before subsequent surgical repair. Pelvic ring disruption requires urgent fixation and should be managed as an open fracture in the context of significant bladder and urethral injury with urinary leakage. Long-term outcomes are variable and genitourinary dysfunction is commonly reported among patients with pelvic fractures. Optimisation of patient outcomes relies heavily on collaborative management between orthopaedic and urological specialists and requires an appreciation of the anatomical intricacies of the pelvis. This article provides an overview of the British Orthopaedic Association Standards for Trauma and Orthopaedics management of urological trauma in the context of pelvic fractures.

A rare case of cervical abscess caused by Parvimonas micra

Cervical abscesses develop in the tissue spaces between the cervical fascia. The rapid expansion of these abscesses can lead to fatal outcomes. We describe a case of a deep cervical abscess caused by Parvimonas micra. He was referred to our department with complaints of sore throat and neck pain. Ultrasonography revealed a hypoechoic area in the cervical interfascicular space. An ultrasound-guided puncture was performed to collect pus for bacteriological examination. Subsequently, a contrast-enhanced computed tomography scan revealed a multi-focal abscess extending from the left mandible to the left side of the neck, without any mediastinal abscess. An emergency drainage and antibacterial therapies were performed, and the patient progressed well. Parvimonas micra, a gram-positive anaerobic bacterium, was detected in the pus collected before incision, and appropriate antibiotics were immediately administered. The collection of pus prior to incision and drainage aids accurate identification of the causative organism and appropriate treatment.

Percutaneous nephrostomy versus retrograde ureteral stent for acute upper urinary tract obstruction with urosepsis

PurposeWe aimed to compare the efficacy of percutaneous nephrostomy (PCN) versus retrograde ureteric stent (RUS) for acute upper urinary tract obstruction with urosepsis. Materials and methodsWe performed a random study, comparing PCN to RUS, for the treatment of patients requiring emergency drainage due to acute upper urinary tract obstruction with urosepsis between January 2019 to March 2020. Data collected included patient characteristics, stone material, microbiological characteristics, and laboratory data. Statistical analysis was performed by the student's t-test or Mann-Whitney U test or chi-squared test and Fisher exact test. ResultsAt first, a total of 75 patients were eligibly assessed for enrollment. Among them, 3 cases were excluded for declining to participate and 7 cases were failed treated with RUS. At last, 35 PCN (53.85%) and 30 RUS (46.15%) patients were analyzed. There were 24 (36.92%) men and 41 (63.08%) women. The median age was 65 years. Emergency decompression was achieved by PCN in 35 (53.85%) patients and by RUS in 30 (46.15%). Urine culture was positive in 32 (49.23%) patients, of which 17 (53.13%) had E. coli. Postoperative C-reactive protein value and normal temperature recovery time in the PCN group were significantly lower than in the RUS group(P < .05). ConclusionPCN had a better outcome than RUS in emergency drainage with urosepsis, especially for patients with severe inflammation and fever.

Outcome of acute septic dislocation of hip in children reduced at arthrotomy

BackgroundPathological dislocation of hip following episode of septic arthritis is a long recognized complication. We determined clinicoradiological outcome in 14 children presenting with acute septic dislocation of hip and reduced at the time of emergency arthrotomy and drainage. MethodsThe retrospective study was conducted at a tertiary care health centre located at suburb of a low income country. The study involved a 10 years chart review of children with confirmed septic arthritis of hip presenting with complication of acute joint dislocation and treated with open reduction at the time of arthrotomy and surgical drainage. All included patients were provided postoperative abduction splintage for minimum 3 months. The clinical evaluation at final follow up was done using modified Moon’s criteria for outcome assessment. The radiological outcome was analyzed in terms of containment (Severin class), sequelae (Choi radiological types) and effect on acetabular development (acetabular index, AI). The AI on normal and reduced sides was compared statistically. ResultsAverage patient age at the time of presentation was 7.2 months and follow up available was 32 months (range, 12–70 months). Functionally, 5 had excellent and 6 had good outcomes at the final follow up. Two patients had fair whereas 1 had poor outcome. Seven hips were Severin class II, 4 class III and 2 class IV and 1 was class VI. One patient had Choi type IA, 3 type IB, 8 type IIA, 1 type IIB and only 1 had type IVA at follow up. The mean AI of reduced hip was 23.4° and was significantly higher than that of unaffected side (mean 15.7°). ConclusionsThe complication of acute septic dislocation of hip in children may not have a sinister prognosis as commonly believed. These hips however were associated with significant acetabular dysplasia in the follow up period.

Catheter ablation in atrial fibrillation: comorbidities and mortality from high-volume centers

Abstract Background Catheter ablation (CA), has gained wider acceptance as an attractive option for treating symptomatic AF. Although traditionally seen as a safe procedure, there is limited and conflicting data on procedure-related early morbimortality, with new evidence suggesting early mortality may be as high as 0.5%-1%. Purpose We aimed to assess the rates of early and late morbimortality of post-atrial fibrillation (AF) ablation in high-volume centers. Methods Prospective registry of 2 high-volume ablation centers, comprising 3722 consecutive patients (mean age 61.1±11.2, 66.4% male, n=2471), who underwent AF ablation from 2005 to 2019. Early mortality was defined as death during initial admission or during the first 45 days after ablation. Median follow-up time was 5.4 years. Results Most patients were treated with radiofrequency (97%) while 3% were treated with cryoablation. Early mortality was 0.08% (n=3), with a median time from ablation to death of 22 days. Cumulative mortality at 3, 6 and 12 months was 0.08%, 0.16% and 0.19%, respectively. At 3 and 5 years, mortality remained low at 0.48% and 0.73%, respectively. Early mortality was higher among patients who had suffered procedural complications (fistula and stroke, p&amp;lt;0.001). Among the latter, pericardial effusion and tamponade were the most frequently found (0.6%, n=24), only 1 of which required emergent surgical drainage and myocardial repair. Early ischemic stroke occurred in 2 patients (0.1%). Other less frequent complications were atrio-esophageal fistula (0.1%, n=2), phrenic nerve palsy (0.1%, n=2), anoxic encephalopathy following cardiac arrest (0.03%, n=1) and pulmonary vein stenosis (0.03%, n=1). Conclusion Early mortality following ablation is very low (&amp;lt;0.1%), when performed by an experienced high-volume team. Severe complications are rare (&amp;lt;1%) and mostly amenable to treatment. Our findings reaffirm the overall safety of AF ablation. AF catheter ablation morbimort Funding Acknowledgement Type of funding source: None

Pseudo-polyarthrite rhizomélique satellite d’une leucémie myélomonocytaire chronique

IntroductionMyelodysplasia (MDS) can occur as systemic manifestations such as connective tissue diseases or vasculitis. Rheumatological manifestations are also described in such context. Herein, we report the observation of a patient with chronic myelomonocytic leukemia (CMML) who developed systemic manifestations: polymyalgia rheumatica and pericarditis. Case reportA 78-year-old patient was referred for the exploration of two months history of inflammatory shoulder pain associated with biological inflammatory syndrome. He presented with asthenia, anorexia and loss of 5kg in one month. He had a three years follow-up for a CMML without any specific treatment. All of the explorations carried out showed a typical polymyalgia rheumatica. A pericardial effusion requiring emergency drainage was synchronously diagnosed. All the symptoms occurred during a worsening of his hematological disease. The rheumatological manifestation was favorable after a short corticosteroid therapy and pericarditis did not recur after 2 years of follow-up. ConclusionIt should be necessary to screen patients for MDS in a context of systemic manifestation, especially in elderly patients with an abnormal blood count (cytopenia, macrocytosis and monocytosis).

RETROPHARYNGEAL ABSCESS WITH MEDIASTINITIS REQUIRING VIDEO-ASSISTED THORACOSCOPIC SURGERY

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Retropharyngeal abscesses are rare in adults. We present a case of anterior and posterior mediastinitis and empyema secondary to retropharyngeal abscess requiring video-assisted thoracoscopic surgery (VATS) and median sternotomy. CASE PRESENTATION: A 58-year-old male with chronic obstructive pulmonary disease presented to the ED with 2 days of right sided pleuritic chest pain with associated worsening dyspnea on exertion, odynophagia/dysphagia, hoarseness, and night sweats over the past two weeks. He had two prior ED visits with milder symptoms where he was cleared by ENT and sent home with oral corticosteroids. No history of immunosuppression, recent drug use, or odontogenic procedures. He was afebrile, tachycardic, and saturating 95% on 2 L nasal cannula. Exam was significant for neck swelling with tenderness of the submandibular region and right chest wall along with expiratory coarse prolonged wheezes. Labs were notable for leukocytosis with neutrophilia and bandemia. He was started on corticosteroids and broad spectrum antibiotics. Computed tomography (CT) of the neck showed a rim enhancing hypodensity around the post cricoid region of the hypopharynx with extension into the anterior mediastinum (Figure 1). He had emergent incision & drainage by ENT and thoracic surgery where a Jackson-Pratt drain was placed. Repeat imaging revealed progression with a loculated empyema and mediastinal tracking which required VATS with right pleural decortication (Figure 2 & 3). Two days later, the patient's clinical status did not improve despite broad spectrum antibiotics and drainage and he required a median sternotomy with washout of the anterior/posterior mediastinal fluid collections and three chest tubes. Abscess cultures were positive for Streptococcus parasanguinis, Rothia mucilaginosa, and Candida glabrata. All drains were removed after minimal drainage. On discharge, he was requiring oxygen with exertion and went to a long term acute care hospital to continue broad spectrum antibiotics. DISCUSSION: Retropharyngeal abscess can be associated with high mortality and morbidity (1). It may be secondary to accidental penetrating trauma, iatrogenic, or spread of oropharyngeal infection (2). This case is unique in that there was no clear etiology for the retropharyngeal abscess. Deep neck infections tend to follow the path of least resistance of the well-defined cervical fascial planes and can lead to pericardial and pleural effusions. High index of suspicion should be entertained for patients presenting with fevers, sore throat, and dysphagia. Contrast enhanced CT imaging is utilized to characterize the extent of the abscess. Management typically requires surgical intervention and intravenous antibiotics. CONCLUSIONS: Descending mediastinitis can be life-threatening if not diagnosed promptly. Early intervention with surgical management and antibiotics is vital to improved outcome. Reference #1: Jain H, Knorr TL, Sinha V. Retropharyngeal Abscess. In: StatPearls. StatPearls Publishing; 2020. Accessed May 30, 2020. http://www.ncbi.nlm.nih.gov/books/NBK441873/ Reference #2: Mark R, Song S, Mark P. Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection. Case Rep. 2018;2018:bcr-2018-225019. doi:10.1136/bcr-2018-225019 DISCLOSURES: no disclosure on file for Frank Ajatta; No relevant relationships by Venkata Bandi, source=Web Response No relevant relationships by Lorraine Cornwell, source=Web Response No relevant relationships by Kalpalatha Guntupalli, source=Web Response My spouse/partner as a Consultant relationship with Abbvie Please note: $1-$1000 Added 05/27/2020 by Ebtesam Islam, source=Web Response, value=Consulting fee No relevant relationships by Sarah Jaroudi, source=Web Response

Policy-Driven Sustainable Saline Drainage Disposal and Forage Production in the Western San Joaquin Valley of California

Environmental policies to address water quality impairments in the San Joaquin River of California have focused on the reduction of salinity and selenium-contaminated subsurface agricultural drainage loads from westside sources. On 31 December 2019, all of the agricultural drainage from a 44,000 ha subarea on the western side of the San Joaquin River basin was curtailed. This policy requires the on-site disposal of all of the agricultural drainage water in perpetuity, except during flooding events, when emergency drainage to the River is sanctioned. The reuse of this saline agricultural drainage water to irrigate forage crops, such as ‘Jose’ tall wheatgrass and alfalfa, in a 2428 ha reuse facility provides an economic return on this pollutant disposal option. Irrigation with brackish water requires careful management to prevent salt accumulation in the crop root zone, which can impact forage yields. The objective of this study was to optimize the sustainability of this reuse facility by maximizing the evaporation potential while achieving cost recovery. This was achieved by assessing the spatial and temporal distribution of the root zone salinity in selected fields of ‘Jose’ tall wheatgrass and alfalfa in the drainage reuse facility, some of which have been irrigated with brackish subsurface drainage water for over fifteen years. Electromagnetic soil surveys using an EM-38 instrument were used to measure the spatial variability of the salinity in the soil profile. The tall wheatgrass fields were irrigated with higher salinity water (1.2–9.3 dS m−1) compared to the fields of alfalfa (0.5–6.5 dS m−1). Correspondingly, the soil salinity in the tall wheatgrass fields was higher (12.5 dS m−1–19.3 dS m−1) compared to the alfalfa fields (8.97 dS m−1–14.4 dS m−1) for the years 2016 and 2017. Better leaching of salts was observed in the fields with a subsurface drainage system installed (13–1 and 13–2). The depth-averaged root zone salinity data sets are being used for the calibration of the transient hydro-salinity computer model CSUID-ID (a one-dimensional version of the Colorado State University Irrigation Drainage Model). This user-friendly decision support tool currently provides a useful framework for the data collection needed to make credible, field-scale salinity budgets. In time, it will provide guidance for appropriate leaching requirements and potential blending decisions for sustainable forage production. This paper shows the tie between environmental drainage policy and the role of local governance in the development of sustainable irrigation practices, and how well-directed collaborative field research can guide future resource management.

The Analysis of Urological Morbidity in HIV-Infected Patients of the Vladivostok City District

Introduction: HIV infection, the disease that develops as a result of infection with the human immunodeficiency virus, has moved from the category of fatal diseases to indolent manageable infections. Urologic diseases are a common complication observed already in the early stages of HIV infection, and the prevalence of kidney disease in HIV patients ranges from 5% to 30%. Our objective was to analyze urological morbidity in HIV-infected patients hospitalized for emergency and planned indications in the Urology Department of Vladivostok Clinical Hospital No. 2 (VCB No. 2) and to identify the main nosological forms of urological pathology in this cohort. Methods: For the analysis of epidemiological, immunological and virological characteristics of 91 HIV-infected patients admitted to the Urology Department from June 2016 to December 2019 we reviewed inpatient and outpatient medical histories, structured HIV-infected patients by urological nosologies, assessed stages of HIV infection and values of viral load and CD4+ T-lymphocytes, and established the presence of coinfections. Results: The analysis revealed the prevalence of acute infectious and inflammatory diseases of the urinary system (pyelonephritis, prostatitis, orchiepidymitis, kidney abscess) and urolithiasis, which in some cases required the immediate initiation of empirical antibiotic therapy and emergency drainage of the renal cavity system. Our findings are consistent with the results of studies previously conducted on a different population of HIV-infected patients. Conclusions: Since the Urology Department of Vladivostok Clinical Hospital No. 2 is the main hospital that provides both emergency and planned urology care, our data fully reflect urological morbidity of HIV-infected patients in the city district and can be used for optimization of medical care for this cohort of patients.

Floating Ice Transport Conditions at the Cross-Sections Between Pier Columns in Open Ice-Water Two-Phase Flow Canals

Floating ice is easy to jam at the cross-sections contracted by bridge pier, gate pier, etc., in ice-water two-phase flow canals. To solve the problem, the critical hydraulic conditions of floating ice transport at the cross-sections between pier columns were explored in this study. Based on the generalized physical model of the cross-sections between pier columns of water transfer canals, the movement and transport characteristics of floating ice in front of the pier columns were studied under different hydraulic conditions and ice conditions, and the critical hydraulic conditions necessary for floating ice to pass through the cross-sections between pier columns were analyzed. Moreover, dimensional analysis and regression analysis were carried out in order to establish an empirical equation for calculating the critical water flow Fr (Froude number) for the floating ice to be transported through the cross-sections between pier columns, thus providing a basis for the ice jam risk assessment and hydraulic regulation of ice-water two-phase flow canals, as well as control of the emergent ice drainage of canals during freezing periods.

Emergency Laparotomy in Denmark: A Nationwide Descriptive Study.

The term 'emergency open abdominal surgery' covers a range of common procedures with high complication and mortality risks; however, previous studies have not included descriptive analyses of the patients undergoing the procedures. The aim of this study is to present a nationwide description of all patients who undergo an emergency bowel resection, ostomy placement or drainage involving laparotomy at Danish hospitals and to report the 30- and 365-day mortality risks. We identified all of the patients in the Danish National Patient Register aged 18 + who underwent emergency open abdominal surgery in the form of a laparotomy during the period 2003-14. Using Poisson and logistic regression models, we analyzed incidence rates and mortality risk. The sample consisted of 15,680 patients, with an overall open abdominal surgery incidence rate of 30.4 cases per 100,000 person-years. The 30-day mortality risk was 19.3% for both sexes, and increased with age (at 80-89, mortality risk was 39.4% for males and 34.5% for females). The 30-day mortality risk fell by 5.4% during the study period, from 22.2% to 16.7%. Open abdominal surgery is a common, high-risk procedure with a high incidence rate and mortality risk, especially for elderly patients. The incidence rate and mortality risk fell during the period studied. In Denmark, there is no standard post-discharge care program for patients who undergo emergency laparotomies. Our results support the need to investigate standardized post-operative follow-up and rehabilitation plans to reduce mortality.

Presepsin and procalcitonin as predictors of sepsis based on the new Sepsis-3 definitions in obstructive acute pyelonephritis

BackgroundAcute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively evaluated patients who were admitted to our hospital for treatment of obstructive APN associated with upper urinary tract calculi. Blood and urine samples were collected before treatment of obstructive APN. Treatment included adequate antimicrobial therapy and emergency drainage to decompress the renal collecting system. We diagnosed sepsis using the new Sepsis-3 definition. We assessed predictors for sepsis by multivariate logistic regression analysis.ResultsSixty-one patients were included in this study. Overall, all patients underwent emergency drainage, and 11 (18.0%) patients showed sepsis. There were no significant differences in performance status or comorbidities between sepsis and non-sepsis groups. Platelet count and serum albumin level were significantly lower in the sepsis group than in the non-sepsis group (p = 0.001 and p = 0.016, respectively). Procalcitonin (PCT) and presepsin (PSEP) levels were significantly higher in the sepsis group than in the non-sepsis group (p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that PCT elevation (OR = 13.12, p = 0.024) and PSEP elevation (OR = 13.13, p = 0.044) were independent predictors for sepsis.ConclusionsElevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.

Percutaneous versus surgical drainage of non-iatrogenic pericardial effusion

Pericardial effusion can be a life-threatening condition when fluid accumulation is fast and large. Emergency drainage is then life saving but no consensus exists as to the preferential use of a percutaneous or surgical approach. To compare complications during follow-up and length of stay, one and six-months mortality and recurrences. All patients admitted for symptomatic pericardial effusion in 2017 in our tertiary Intensive Cardiac Care Center were prospectively included. Patients were analyzed depending on the type of drainage used: surgical of percutanous. A total of 129 patients were admitted for pericardial effusion and 92 were drained: 54 (58.7%) by a surgical and 38 (41.3%) by a percutanous way. At 6-months, no mortality or recurrences between groups were observed (12 (22.2%) versus 14 (36.9%) deaths; P = 0.12 and 6 (11.1%) versus 9 recurrences (23.7%); P = 0.11, respectively in the surgical and percutanous group). No in-hospital complications were found (4 (7.4%) for the surgical group, 1 (5.3%) for percutanous group; P = 0.39). length of in-hospital stay was shorter for patients treated by percutaneous drainage (5.9 days (±4.4) versus 8.2 days (±4.9); P = 0.02). Percutaneous drainage appears to be a reliable approach to treat symptomatic percicardial effusions without differences in terms of complications, recurrences or mortality compared to surgical drainage. Length of stay is shorter that may justify to use it at first line therapy.

Auditing the Routine Microbiological Examination of Pus Swabs From Uncomplicated Perianal Abscesses: Clinical Necessity or Old Habit?

BackgroundObtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management.MethodsWe reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano.ResultsA total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-in-ano.ConclusionsWe do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.

P1262 If anything can go wrong, it will: management of a pericardial effusion in a young patient

Abstract Case Report A 25 year-old male patient with an unremarkable past medical history presented to the Emergency Department due to a hemodynamically stable wide complex tachycardia at 260bpm with no response to adenosine, which was successfully treated with synchronized electrical cardioversion. Post cardioversion EKG revealed a pre excitation pattern and the transthoracic echocardiogram showed a large pericardial effusion with diastolic right atrial collapse. The patient was admitted in the Cardiology Department for emergent pericardiocentesis and further investigation. A total of 800 mL of bloody pericardial fluid was removed, compatible with an exudate, but fluid culture and cytology were inconclusive. Due to a rapid reaccumulation of pericardial fluid, the patient underwent a pericardial window, after which he developed an intractable pleuritic thoracalgia, refractory to the combination of ibuprofen, colchicine and oral steroid, despite the resolution of the pericardial effusion. He was also submitted to an electrophysiologic study with successful ablation of a right sided accessory pathway. Analysis of the pericardial fluid and biopsy were inconclusive once again, including a low level of adenosine deaminase and negative acid-fast bacilli test and nucleic acid amplification test for Mycobacterium tuberculosis. The patient was afebrile and denied any constitutional symptoms or relevant epidemiological context. The remainder etiological study was unremarkable, with the exception of fluctuating antibody titers for adenovirus, Borrelia burgdorferi and Mycoplasma pneumoniae, which were interpreted as a result of cross-reactivity. Nevertheless, a course of 21 days of doxycycline was tried without any significant improvement. Thoracic-abdominal-pelvic CT and PET scan were normal. Direct inoculation in guinea pig led to positive results for Mycobacterium tuberculosis and antituberculous therapy was started. Despite pathogen directed antibiotic treatment, there was no clinical improvement and the pericardial effusion gradually relapsed, evolving to cardiac tamponade requiring emergent drainage. Histologic examination of pericardial fragments finally revealed massive infiltration by an undifferentiated malignant tumor compatible with a malignant epithelioid hemangioendothelioma. Due to the patient’s poor performance status and rapidly deteriorating clinical course, it was decided not to start chemotherapy. The patient eventually died, 6 months after his admission to the ED and 2 weeks after the neoplasm’s diagnosis. Conclusion In regions with a high Tuberculosis incidence, there should be a high degree of suspicion for tuberculous pericarditis, especially in cases of recurrent pericardial effusion. Immunosuppressed individuals, such as oncologic patients, are at an increased risk for tuberculosis. The management of relapsing pericardial effusion remains a diagnostic challenge as described in this clinical case.