Extensive Abscess Formation Research Articles

Deep Neck Abscess: A case report

Background: Deep Neck Abscess is a severe neck infection characterized by abscess formation in the submandibular and sublingual spaces, typically originating from odontogenic infections. Despite declining incidence due to antibiotics, the condition remains a critical concern in developing countries. It can cause life-threatening complications like airway obstruction and mediastinitis if left untreated. Objective: To report a case of Deep Neck Abscess in a 32-year-old female with an odontogenic infection. Case Report: A 32-year-old female presented with progressive neck swelling, trismus, and pain originating from a lower molar infection. Examination revealed fluctuating masses in the submandibular and submental regions, with CT imaging confirming extensive abscess formation. Laboratory tests showed leukocytosis. Clinical question: What is the management of Deep Neck Abscess with an odontogenic infection? Methods: Evidence-based literature study of Deep Neck Abscess with an odontogenic infection. Result: Treatment for Deep Neck Abscess are surgical drainage and antimicrobial therapy. Conclusion: Timely diagnosis, appropriate imaging, surgical intervention, and targeted antimicrobial therapy are crucial for successful management of Deep Neck Abscess. This case demonstrates the importance of a multidisciplinary approach to prevent life-threatening complications and achieve favorable outcomes.

Testicular Compartment Syndrome in a Case of Fulminant Necrotizing Orchitis

Abstract Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.

Thigh Abscess Formation Due to Severe Sacral Pressure Ulcer Dissemination: A Case Report

Patients with chronic and non-healing pressure ulcers are susceptible to recurrent infections, often leading to complications, such as abscesses. However, to the best of our knowledge, no cases of abscesses disseminating from a pressure sore to the thigh have yet been reported in the literature. We report the case of a 53-year-old man with a severe pressure ulcer in the sacral area and an abscess extending to the thigh. The presence of an abscess in an area devoid of pressure ulcers was suspected. Prior to surgical intervention, a comprehensive evaluation was undertaken, culminating in debridement and subsequent reconstruction, yielding excellent results. Abscesses are often difficult to evaluate with physical examination alone. Therefore, the possibility of extensive abscess formation and dissemination should be considered in patients with severe pressure ulcers.

Kerion celsi: Clinical Features, Diagnosis and Therapeutic Approaches

Querion de Celso, also known as Celso abscess, is a rare and severe inflammatory condition that arises as a complication of folliculitis. It is characterized by the formation of a purulent and fluctuant abscess in the pilosebaceous region. This dermatological disorder is primarily associated with the invasion of pathogenic bacteria, most commonly Staphylococcus aureus, into the hair follicles and sebaceous glands. Clinically, kerion de Celso presents as a prominent, erythematous, warm, and fluctuant lesion, often accompanied by local pain, restricted movement, and potential systemic symptoms such as fever and malaise. The diagnosis of kerion de Celso relies on a comprehensive evaluation, including clinical assessment, histopathological findings, and microbiological analysis. These diagnostic modalities support the presence of an intense inflammatory response and aid in identifying the causative agent. Treatment of kerion de Celso necessitates a multidisciplinary approach. Systemic antibiotics are essential to eliminate the underlying bacterial infection, while analgesics and anti-inflammatory agents provide symptomatic relief. Surgical incision and drainage may be required in cases of extensive abscess formation. In more complex situations, immunosuppressive therapy may be considered to modulate the exaggerated inflammatory response. Adequate wound care and close follow-up are crucial to ensure successful resolution and prevent long-term complications. In summary, Celso's kerion is a rare but potentially severe condition that requires prompt recognition and appropriate management to minimize complications and promote healing. Understanding the clinical, etiological, and therapeutic aspects of this condition is essential for healthcare professionals to deliver optimal care and improve clinical outcomes.

Kerion of Celso: Clinical Features, Diagnosis and Therapeutic Approaches

Querion de Celso, also known as Celso abscess, is a rare and severe inflammatory condition that arises as a complication of folliculitis. It is characterized by the formation of a purulent and fluctuant abscess in the pilosebaceous region. This dermatological disorder is primarily associated with the invasion of pathogenic bacteria, most commonly Staphylococcus aureus, into the hair follicles and sebaceous glands. Clinically, kerion de Celso presents as a prominent, erythematous, warm, and fluctuant lesion, often accompanied by local pain, restricted movement, and potential systemic symptoms such as fever and malaise. The diagnosis of kerion de Celso relies on a comprehensive evaluation, including clinical assessment, histopathological findings, and microbiological analysis. These diagnostic modalities support the presence of an intense inflammatory response and aid in identifying the causative agent. Treatment of kerion de Celso necessitates a multidisciplinary approach. Systemic antibiotics are essential to eliminate the underlying bacterial infection, while analgesics and anti-inflammatory agents provide symptomatic relief. Surgical incision and drainage may be required in cases of extensive abscess formation. In more complex situations, immunosuppressive therapy may be considered to modulate the exaggerated inflammatory response. Adequate wound care and close follow-up are crucial to ensure successful resolution and prevent long-term complications. In summary, Celso's kerion is a rare but potentially severe condition that requires prompt recognition and appropriate management to minimize complications and promote healing. Understanding the clinical, etiological, and therapeutic aspects of this condition is essential for healthcare professionals to deliver optimal care and improve clinical outcomes.

Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options.

One of the most common disorders of the salivary glands is obstructive sialolithiasis. Salivary gland obstruction is important to address, as it can significantly impact patient quality of life and can progress to extensive cellulitis and abscess formation if left untreated. For small and accessible stones, conservative therapies often produce satisfactory outcomes. Operative management should be considered when stones are inaccessible or larger in size, and options include sialendoscopy, laser lithotripsy, extracorporeal shockwave lithotripsy, transoral surgery, and submandibular gland adenectomy. Robotic approaches are also becoming increasingly used for submandibular stone management. The purpose of this review is to summarize the modern-day management of submandibular gland obstructive sialolithiasis with an emphasis on operative treatment modalities. A total of 77 articles were reviewed from PubMed and Embase databases, specifically looking at the pathophysiology, clinical presentation, diagnosis, and management of submandibular sialolithiasis.

Validating the efficacy of interval appendectomy for acute appendicitis: representative three cases with different etiologies

BackgroundAppendectomy for acute appendicitis (AA) is considered one of the most common emergency surgeries. However, emergency appendectomy accompanied with complex lesions such as extensive abscess formation is not recommended in most cases. Therefore, non-operative management followed by interval appendectomy (IA) for AA has been tried. Herein, we present three AA cases with specific etiology that underwent interval appendectomy.Case presentationCase 1: A 68-year-old man was diagnosed AA with intestinal malrotation and intra-abdominal abscesses. He initially treated with conservative therapy and underwent laparoscopic IA after detailed preoperative examination.Case 2: A 22-year-old man had been under treatment for pancolitis-type ulcerative colitis (UC), also bothered by right-lower abdominal pain several times a year. The appendix always appeared swollen on every CT taken during symptoms. He underwent laparoscopic IA; pathological finding revealed typical UC histological features in the resected appendix. After the surgery, he never suffered from terrible right lower abdominal pain.Case 3: A 69-year-old woman complaining a right lower abdominal pain had undergone CT examination, which revealed AA with appendiceal mass, irregular wall thickness of the cecum, and mediastinal and para-aortic lymph node swelling. The operation was carried out after conservative therapy. The pathological diagnosis revealed BRAF mutated colorectal carcinoma. She had received systematic chemotherapy after the surgery, and all metastatic lesions have completely disappeared.ConclusionInterval appendectomy provided us with much clearer anatomical information and precise therapeutic strategies, avoiding technical and general operative complications, and also induced fast recovery and short length of hospital stay. Interval appendectomy is a reasonable procedure and could be recommended in case of AA with some different etiology.

A case report of multiple cerebral abscess formation complicating serogroup B Neisseria meningitidis meningitis

BackgroundInvasive meningococcal disease (IMD) presenting with meningitis causes significant mortality and morbidity. Suppurative complications of serogroup B meningococcal sepsis are rare and necessitate urgent multidisciplinary management to mitigate long-term morbidity or mortality.Case presentationWe present a rare case of invasive meningococcal disease in a 28-month old boy complicated by multiple abscess formation within a pre-existing antenatal left middle cerebral artery territory infarct. Past history was also notable for cerebral palsy with right hemiplegia, global developmental delay and West syndrome (infantile spasms). Two craniotomies were performed to achieve source control and prolonged antimicrobial therapy was necessary. The patient was successfully discharged following extensive multidisciplinary rehabilitation.ConclusionsLongstanding areas of encephalomalacia in the left MCA distribution may have facilitated the development of multiple meningococcal serogroup B abscess cavities in the posterior left frontal, left parietal and left temporal lobes following an initial period of cerebritis and meningitis. A combination of chronic cerebral hypoperfusion and some degree of pre-existing necrosis in these areas, may also have facilitated growth of Neisseria meningitidis, leading ultimately to extensive cerebral abscess formation following haematogenous seeding during meningococcemia. In this case report we review similar cases of cerebral abscess or subdural empyema complicating serogroup B meningococcal meningitis.

2497 Hydatid Cyst Masquerading as Appendicitis

INTRODUCTION: Human echinococcosis (HE) is a zoonosis and can cause life-threatening tissue cysts in the liver. We present a case of an unusual presentation of hepatic echinococcosis diagnosed and treated in the United States (US). CASE DESCRIPTION/METHODS: A 23-year-old woman who emigrated from Ecuador to the United States presents to the ED with headaches, fevers and abdominal pain associated with vomiting and rigors. She denied sick contacts and recent travel. She noted 4-5 similar episodes in the past that self-resolved. Her vitals were significant for a fever of 102.3°F and heart rate in 120s. Her labs were significant for a WBC 14.8 k/mm3 but the comprehensive metabolic panel was within normal limits. Exam revealed a supple neck and right lower quadrant tenderness. Due for concerns of appendicitis, she got a CT A/P C+, which was significant for a 4.2 × 2.6 cm and 1.3 cm low-density lesion in the right hepatic lobe. She was started empirically on flagyl and ciprofloxacin and discharged the next day. An outpatient MRI confirmed a cystic neoplasm in segment 5 of the liver with septation. Serum workup included a negative echinococcus antibody and she was referred to a surgical oncologist. She underwent liver segment 4 and 5-6 tumor resections without any complications. Pathology revealed calcified echinococcal cysts with extensive necrosis and abscess formation suggestive of microscopic areas of rupture. She was started on albendazole and is doing well. DISCUSSION: Echinococcosis is a zoonotic disease, with a two-host lifecycle and occurs in humans when Echinococcus eggs infect the liver (70%) and lungs (20%). After ingestion of eggs, the embryos escape and penetrate the intestinal mucosa, enter the portal circulation and then are trapped in the liver. Human cystic echinococcosis (CE) is the most common type of HE. The greatest prevalence of HE is in temperate areas such as parts of South America, North Africa, Asia and Australia. Diagnosis is made on imaging by US, CT and MRI. Treatment includes surgical resection, percutaneous drainage and anti-parasitic agents. Although the vast majority of cases occur outside the US, cases within the US exist and are incidentally found. Despite progress in controlling echinococossis, this condition remains a public health problem in endemic countries and a cause of morbidity and mortality. It should be included on the differential of a patient from an endemic area found to have cystic lesions on liver.

Dysregulation of Intestinal Epithelial Cell RIPK Pathways Promotes Chronic Inflammation in the IBD Gut.

Crohn's disease (CD) and ulcerative colitis (UC) are common intestinal bowel diseases (IBD) characterized by intestinal epithelial injury including extensive epithelial cell death, mucosal erosion, ulceration, and crypt abscess formation. Several factors including activated signaling pathways, microbial dysbiosis, and immune deregulation contribute to disease progression. Although most research efforts to date have focused on immune cells, it is becoming increasingly clear that intestinal epithelial cells (IEC) are important players in IBD pathogenesis. Aberrant or exacerbated responses to how IEC sense IBD-associated microbes, respond to TNF stimulation, and regenerate and heal the injured mucosa are critical to the integrity of the intestinal barrier. The role of several genes and pathways in which single nucleotide polymorphisms (SNP) showed strong association with IBD has recently been studied in the context of IEC. In patients with IBD, it has been shown that the expression of specific dysregulated genes in IECs plays an important role in TNF-induced cell death and microbial sensing. Among them, the NF-κB pathway and its target gene TNFAIP3 promote TNF-induced and receptor interacting protein kinase (RIPK1)-dependent intestinal epithelial cell death. On the other hand, RIPK2 functions as a key signaling protein in host defense responses induced by activation of the cytosolic microbial sensors nucleotide-binding oligomerization domain-containing proteins 1 and 2 (NOD1 and NOD2). The RIPK2-mediated signaling pathway leads to the activation of NF-κB and MAP kinases that induce autophagy following infection. This article will review these dysregulated RIPK pathways in IEC and their role in promoting chronic inflammation. It will also highlight future research directions and therapeutic approaches involving RIPKs in IBD.

Actinomycosis Presented as Acute Appendicitis

Actinomycosis causes a chronic suppurative, granulomatous disease which is characterized by extensive abscess formation, and sulfur granule formation. Actinomycosis may present different clinical forms: cervicofacial, thoracic, abdominal and cerebral actinomycosis. The diagnosis can only be made after surgery. In general, patients with abdominal actinomycosis have undergone abdominal surgery. We report four cases of primary appendiceal actinomycosis presenting as acute appendicitis without history of

Emphysematous pyelonephritis – case report and literature review

We present a rare case of emphysematous pyelonephritis in a 63-year-old female with a background history of poorly controlled diabetes mellitus and hypertension. The patient presented with fever, confusion and right loin pain. CT scan of abdomen and pelvis showed extensive right sided emphysematous pyelonephritis, with a significant amount of gas within the retroperito-neal space. Urine culture showed growth of E. coli . The patient underwent a right nephrectomy. Macroscopically there were multiple dilated necrotic areas within the renal parenchyma. The morphology on routine H&E stains revealed extensive suppu-rative inflammation, necrosis, abscess formation and gas bubbles. Large colonies of Gram negative bacilli were present.The morphological features were consistent with emphysematous pyelonephritis. Emphysematous pyelonephritis (EPN) is a severe, necrotising renal parenchymal infection that is characterised by the production of intraparenchymal gas. EPN predominantly affects female diabetics. The clinical course of EPN can be severe and life-threatening if not recognised and treated promptly.

The untold truth about “bath salt” highs: A case series demonstrating local tissue injury

The epidemic of injecting cathinone derivatives, marketed as "bath salts", by intravenous drug users among inner city Dubliners led to an associated rise in soft tissue complications. The spectrum of the cases encountered, ranging from self-limiting cellulitis to extensive abscess formation, at a single institution is described.

Staphylolysin is an effective therapeutic agent for Staphylococcus aureus experimental keratitis

Therapy of S. aureus keratitis is increasingly challenging due to emerging resistant strains. Staphylolysin (LasA protease) is a staphylolytic endopeptidase secreted by Pseudomonas aeruginosa. The purpose of the current study was to study the effect of treatment with staphylolysin on experimental keratitis caused by various Staphylococcus aureus strains. The therapeutic effect was studied in a keratitis model induced in rabbits by intrastromal injections of 10(3) S. aureus cells of three different methicillin-resistant S. aureus (MRSA) strains and one methicillin-susceptible S. aureus strain (MSSA). Topical treatment with either staphylolysin or bovine serum albumin (BSA; control) was applied every half hour for 5h, starting at 4h after infection. Corneas were removed for bacterial quantification. Histopathological analysis was performed on MSSA-infected rabbits, killed at either one or 84h after completion of treatment and on uninfected eyes 1h after treatment termination. The number of bacteria in the staphylolysin-treated corneas was significantly reduced in all infections with the four S. aureus strains studied as compared to controls: the staphylolysin-treated eyes infected with MRSA strains were either completely sterilized or showed a 3-4 orders of magnitude decrease in the number of cfu/cornea (p = 0.004 to 0.005); all of the staphylolysin-treated MSSA-infected eyes were sterile. Histopathological analysis of the methicillin-sensitive (MSSA) strain-infected eyes at 84h after completion of treatment showed moderate inflammation in the staphylolysin-treated eyes as compared with extensive abscess formation in the control group. The uninfected corneas showed only mild stromal edema in both the staphylolysin and BSA-treated groups. Staphylolysin provided long-lasting protection against several strains of S. aureus, evident by both its strong anti-bacterial activity and beneficial histopathological results of treatment.

Pylephlebitis Complicating Concurrent Sigmoid Endometriosis and Diverticulosis: A Case Report

Purpose To explain an unusually severe presentation of concurrent sigmoid diverticulosis and endometriosis. Intestinal endometriosis can be complicated by colonic obstruction, perforation, fistula formation, and sepsis. Suppurative thrombosis of the portal system (pylephlebitis) complicating intestinal endometriosis has not been previously reported. Methods A previously fit and well 44-year-old woman presented with a two-day history of severe, intermittent left iliac fossa pain and loose, brown stools. CT scan revealed thickening of the sigmoid colon and inferior mesenteric and intra-hepatic vein thrombosis with patchy liver perfusion. Conservative management failed and an exploratory laparotomy showed a sigmoid inflammatory phlegmon. The inferior mesenteric vein containing pus and thrombus was excised together with the sigmoid mass. Results Histology revealed sigmoid colonic diverticulosis and endometriosis associated with extensive subserosal abscess formation. Widespread suppurative necrotizing venulitis with partial thrombosis of mesenteric veins was found. Literature review revealed that endometriotic cells produce a variety of pro-inflammatory mediators. Conclusions We postulate that endometriotic tissue within the diverticular sigmoid colon triggered an inflammatory cascade, leading to bacterial translocation and pylephlebitis.

Tubo-ovarian Actinomycosis Complicated with Hepatic Abscess

Actinomycosis is a chronic, suppurative, granulomatous diseases characterized by extensive necrosis and abscess formation. Both hepatic and pelvic actinomycosis are rare diseases. Tubo-ovarian actinomycosis complicated with hepatic abscess is rarely reported. We present a 47 year old woman with a history of an intrauterine device (IUD) implantation for about 18 years, who presented with epigastric pain for one month. A computed tomography (CT) scan of abdomen revealed a mass (13×10×9.6 cm) over the left lobe of the liver and a right-sided tubo-ovarian lesion (6.6×5.9 cm). Exploratory laparotomy confirmed liver and tubo-ovarian abscesses. Pathology of the liver and the tubo-ovarian lesions both revealed actinomycosis infection. The patient received a 4-week intravenous ampicillin treatment, followed by oral amoxicillin for 6 months. No recurrence was noted in the follow-up. Actinomycosis should be considered in concomitant liver and ovary abscesses. Detailed history taking, such as IUD implantation, along with radiological examinations and pathological findings are important for diagnosing actinomycosis infection.

Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula

Infections of abdominal aortic endografts are rare. There are no reports on the association with spondylodiscitis. We report a case of a 74-year-old man who underwent endovascular aneurysm repair (EVAR) and subsequently femorofemoral bypass placement due to occlusion of the right limb of the endograft. Six months later, he presented with rectal bleeding, weight loss, back pain, and low abdominal pain. Computed tomography revealed extensive abscess formation with air in and around the endograft and psoas muscles, in continuity with destructive spondylodiscitis L3-4. There was a small bowel loop in close proximity to the occluded right leg of the endograft, which was filled with air bubbles. An axillofemoral bypass was created followed by a laparotomy. Intra-operatively, an iliaco-enteral fistula was found. The small bowel defect was sutured, the endograft completely removed, and the infrarenal aorta and both common iliac arteries were closed. Necrotic fragments of the former L3-4 disk were removed. The postoperative course was uneventful. Seven months postoperatively, the patient had recovered well. Iliaco-enteric fistula and spondylodiscitis are rare complications of aortic aneurysm repair. This is the first report of spondylodiscitis after EVAR.

Chirurgische Therapie der Divertikulitis

The prevalence of sigmoid diverticular disease is increasing in western, industrialised countries. Practice parameters recommend surgical treatment for complicated disease or after the second episode of chronic recurrent disease. Surgical intervention should also be considered for younger patients after a first episode severe enough to require treatment. The preferred surgical procedure is elective sigmoid resection with primary anastomosis. Additional resection of the lower colon descendens is necessary when this region is also affected. Two-stage surgery is recommended for patients in emergency situations, i. e. severe or generalized peritonitis or extensive localized abscess formation, especially when the treating hospital is non-specialized. Segmentary resection without anastomosis and Hartmann's procedure is performed first (blind closure of the rectum with terminal colostomy). Restoration of colorectal continuity is performed at the earliest three months postoperatively. The preferred surgical technique is laparoscopy, provided the surgeon has the necessary expertise. Numerous studies have proven significant advantages of laparoscopy, although it is a completely new procedure with a long learning curve of 50-60 operations. Therefore, conversion to the conventional method should not be seen as a personal failure but rather as a responsible decision in favor of the patient's well-being.

Extensive abscess formation after repeated paravertebral injections for the treatment of chronic back pain

Paravertebral injections are commonly used for the treatment of chronic back pain despite the lack of evidence for their efficacy. Here, we report a case in which repeated paravertebral injections of local anesthetics, corticosteroids and botulinum toxin resulted in extensive abscess formation involving the entire paravertebral musculature descending to the level of the midthighs. These abscesses induced a systemic inflammatory response syndrome and required surgical drainage as well as broad-spectrum antibiotic therapy.

Treatment of destructive aortic valve endocarditis with the freestyle aortic root bioprosthesis

Background Successful treatment of destructive aortic valve endocarditis with annular abscess formation requires extensive surgical debridement and reconstruction of the left ventricular outflow tract and aortic root. Homograft aortic roots are the conduits of choice, but because they are not available in all cases, alternative conduits are needed. Methods Owing to its features, which are comparable to those of homografts, the Freestyle aortic root xenograft was used in 10 consecutive patients aged between 32 and 77 years. All patients had extensive abscess formation, 5 presented with prosthetic valve endocarditis, 2 had additional mitral valve endocarditis requiring partial leaflet resection and reconstruction, 1 patient had an additional fistula into the right atrium, and 1 required coronary bypass. One patient developed a septic ventricular septal defect and fistula into the right atrium with tricuspid valve endocarditis. Results None of the patients required reoperation for bleeding. Two (20%) patients died in the postoperative period, 1 due to multiorgan failure, and 1 due to preexisting invasive pulmonary aspergillosis. At autopsy, neither had evidence of intrapericardial hematoma or suture dehiscence. One patient died 13 months postoperatively without clinical signs of valve dysfunction or recurrent endocarditis. All other patients are well at 12 to 42 months after surgery. Clinical examination and echocardiography at the most recent follow-up showed no signs of valve dysfunction, recurrent fistulation, or endocarditis. Conclusions The Freestyle aortic root appears to be an acceptable alternative to homografts in the treatment of severe endocarditis. Long-term valve durability in younger patients, however, remains to be determined.