Extraperitoneal Abscesses Research Articles

A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series.

Complications can arise secondary to anorectal suppurative diseases, with infections spreading along the extraperitoneal space, such as the peri-vesical, prevesical, pre-sacral, and pararectal spaces, resulting in abscesses at remote sites, which can make diagnosis more challenging. Due to the absence of peritonitis symptoms, there is a delay in presentation among such patients. Comprehending the intricacies of these areas and the way infection can spread within them is crucial for promptly identifying and effectively draining the extraperitoneal abscess. We present a case series of six patients with a mean age of 45, all males. A total of three patients had undergone incision and drainage after being diagnosed with anorectal suppurative disease and remained symptomatic after the initial surgical intervention of incision and drainage. Two patients initially diagnosed with anterior abdominal abscesses patients, after being treated with incision and drainage, continued to have purulent discharge from the drainage site. Finally, the last patient continued to present with perianal pain after an open hemorrhoidectomy. CTscans of all six patients showed collections in the extraperitoneal spaces correlated with the observed complications. To deepen our understanding of pelvic extraperitoneal spaces, cadaver dissections were conducted and compared with CT images. Through cadaver dissections and CT imaging, the study provides insights into the anatomy and interconnections of pelvic extraperitoneal spaces, emphasizing the importance of early CT scans for diagnosis. Understanding these intricate anatomical structures is essential for accurate diagnosis and efficient and effective treatment. Timely diagnosis is vital to prevent prolonged illness and reduce the risk of complications and mortality. The importance of early CT scans in suspected patients is underscored, which is highly important to expedite appropriate actions.

A rare case of acute presentation of a chronic massive extraperitoneal abscess: a case report

Extra-peritoneal abscesses are uncommon entities encountered during general surgical practice. They occur in a plane present between the peritoneum and the deep fascia anteriorly, posteriorly or in the pelvis. These abscesses commonly occur as a result of supra-levator and pre-peritoneal extension of an ischiorectal abscess. Treatment includes antibiotics and drainage. Here we have described a case of an abscess in the anterior extra-peritoneal plane extending from perirectal and pararectal space, drained surgically through a midline incision.

Intraperitoneal abscess from perforated diverticulitis with fistualization to extraperitoneal abscess into the scrotum: a case report

BackgroundScrotal abscesses are common skin abscesses seen in the general population; however, intraperitoneal abscesses tracking into the scrotum are rare. Intraperitoneal and retroperitoneal abscesses contiguous with the scrotum have been reported in the literature in specific populations. Wound cultures can aid in differentiating the source of the infections. Recurrent abscesses have been observed in high-risk populations, such as those with malignancy or who are immunocompromised.Case presentationWe present a 71-year-old male with pericolonic abscess following perforated diverticulitis. The abscess was drained with interventional radiology and was complicated by an extraperitoneal abscess that tracked to the scrotum. Incision and drainage of the extraperitoneal abscess and the scrotal abscess were required with intravenous antibiotic therapy. The abscess tracking into the scrotum is reported without evidence of patent processus vaginalis.ConclusionWe conclude that an intraperitoneal abscess can track to the scrotum through extraperitoneal fascial planes in the absence of a patent processus vaginalis. We show that extraperitoneal abscess spread to the scrotum is possible, with wound cultures helping to differentiate the source of the infection. High-risk patients with recurrent abscesses can also be susceptible to contiguous spread.

Self-catheterization of urinary bladder complicated with extraperitoneal abscess that mimics an infected bladder diverticulum

For patients who are suffering from neurogenic lower urinary tract dysfunction, intermittent urinary catheterization is an efficient way to empty the bladder.1 However, the method may result in various complications. Herein we present a rare complication of extraperitoneal abscess owing to intermittent urinary catheterization in a 62-year-old male who had cervical spine injury and was treated with intermittent urethral catheterization for neurogenic lower urinary tract dysfunction. Treatment and a literature review are also described.

Right Upper Quadrant Abdominal Pain Ten Years Post-laparoscopic Cholecystectomy

Purpose: A 72-year-old woman with past history of laparoscopic cholecystectomy 10 years ago presented with a 6-month history of intermittent right upper quadrant abdominal and flank pain without association with food intake. She denied fever and weight loss. Physical examination revealed erythema and tenderness in the right lateral aspect of the upper abdomen. Labs were unremarkable. Computed tomography (CT) of the abdomen showed a complex 21 x 5.8 x 8.8 cm perihepatic fluid collection with internal septations, which fistulized through the abdominal wall and formed a 5.6 x 2 cm subcutaneous fluid collection in the right flank. HIDA scan and MRCP ruled out bile leak. Ultrasound guided drainage of the abscess drained thick, greenish fluid. The patient was empirically started on ceftriaxone and metronidazole. Bacterial and fungal cultures as well as PPD, Echinococcus, and Entamoeba serology were all negative. Cytology revealed proteinaceous material with few inflammatory cells and many degenerated structures, suspicious for, yet not definitive of, Echinococcus cyst. Patient received a 6-week course of albendazole, and PAIR procedure (puncture, aspiration, injection, and re-aspiration) was performed with no improvement in symptoms. Repeat CT scan showed persistence of the abscess. An exploratory laparotomy was performed with 500 ml of fluid drained and evacuated 28 gallstones, confirmed by pathology, from the cavity. The fluid cultures were again negative. Repeat CT scan performed a month after the surgery showed near complete resolution of the abscess. Gallbladder perforation during laparoscopy cholecystectomy can result in spillage of gallstones into the peritoneal cavity, which may lead to the development of intra-abdominal abscesses that are easily misidentified as tumors or parasitic infections on radiography due to their similar appearance. The rarity and chronicity of this problem makes the diagnosis very challenging. Treatment requires exploratory laparotomy to remove all dropped gallstones. Less invasive procedures such as percutaneous drainage are effective for resolving acute symptoms, but allow recurrence of abscess. Most patients get a short course of antibiotics based on fluid cultures that typically reveal E. coli, Klebsiella pneumoniae, and Enterococcus. Interestingly, in our patient, the cultures were negative, suggesting that the development of the abscess was secondary to foreign body reaction to the dropped gallstones. Our case illustrates the importance of considering dropped gallstones in the differential diagnosis of intra- or extraperitoneal abscesses in any patient with a history of laparoscopic cholecystectomy, regardless of the time elapsed since surgery.

Extraperitoneal incisional abscess formation after colic surgery in 3 horses

SummaryIn this article we report 3 horses that developed an extraperitoneal abscess after colic surgery at the incision site. All 3 horses presented with nonspecific clinical signs and extraperitoneal abscess was diagnosed from ultrasound evaluations and cytological examination of abscess aspirates. One horse developed dehiscence of the incision after drainage of the abscess through the incision. In 2 cases a small standing paramedian incision was performed through which the abscess was drained and lavaged; complete resolution of the abscess and healing of the incision was achieved in both cases. Extraperitoneal abscess is a previously unreported incisional complication after colic surgery in horses. Early and careful ultrasonographic examination of the abdominal incision is required for diagnosis in cases with nonspecific clinical signs. A paramedian incision through therectus abdominismuscle into the abscess cavity permitted adequate drainage and debridement of the abscess in 2 cases.

Multilocular Flank Abscess Due to Stone Migration Following Laparoscopic Cholecystectomy with Spillage of Gallstones

We report a case of a patient who presented with a large flank abscess 18 months after laparoscopic cholecystectomy. The patient underwent repeated percutaneous drainage but the abscess recurred. Further evaluation with ultrasound revealed subcutaneous tracks from the flank leading to the abdominal cavity and suspected stones in one of the tracks. Laparoscopy revealed dense adhesions at the level of the right gutter leading to a retroperitoneal track heading over to the flank. The tracks were partially opened, debrided, and two gallstones were retrieved from one of the retroperitoneal tracks. The patient's recovery was uneventful. This case demonstrates the potential migration of dropped gallstones to extraperitoneal sites leading to infectious complications. Careful dissection of the gallbladder with an attempt not to rupture it is important in order to prevent this complication. Once rupture does occur, efforts should be made to retrieve dropped stones from the peritoneal cavity. Patients presenting with intra- or extraperitoneal abscesses following laparoscopic cholecystectomy and no obvious source of infection should be evaluated for dropped stones.

Omental and extraperitoneal abscesses complicating cholecystocolic fistula

Omental and extraperitoneal abscesses complicating cholecystocolic fistula

CT guided percutaneous drainage of retro- and extraperitoneal abscesses and fluid collection

Evaluation of course, success rate and complications after CT-guided percutaneous drainage of retroperitoneal and extraperitoneal abscesses and fluid collections (PAFD). Retrospective review of 47 PAFD in 42 consecutive patients (27 male, 15 female, age 58 [27-80] years) over a period of 7 years was performed. 47 clinically suspected abscesses proved to be 40 abscesses, three haematomas and 4 lymphoceles. Primarily, 67 drainage catheters were needed, which included three catheters in 4 patients and 4 catheters in one patient. Drainage time averaged 17.6 days (2-50). The most frequent drainage location was the iliopsoas region (27/47 collections). The cure rate was 87.2% (41/47 collections). Temporization was achieved in 8.5% (4/47); there were two drainage failures (one sepsis, one recurrence). No major complications were observed. Three catheter dislocations occurred as minor complications. CT-guided percutaneous drainage of retroperitoneal and extraperitoneal abscesses and fluid collections is safe, with a high cure rate and few complications.

FEEDING JEJUNOSTOMY: IS ITS ROUTINE USE IN MAJOR UPPER GASTROINTESTINAL SURGERY JUSTIFIED?

An audit of jejunostomy feeding following major oesophagogastric surgery was carried out. The aim was to measure caloric and nitrogen intake, weight change, and to record complications. Twenty consecutive patients undergoing elective upper gastrointestinal surgery resulting in either an oesophagogastric or oesophagojejunal anastomosis were studied prospectively. In the eighteen cases whose catheters functioned, average calorie and nitrogen intake per day over the first 10 postoperative days was 1360 Kcal and 7.2 g respectively and average weight loss at 10 days was 1.3 kg. There was one major complication due to catheter dislodgement, resulting in an extraperitoneal abscess and subsequent small bowel fistula. In one other case the catheter was blocked from the immediate postoperative period and this could not be remedied. In the eighteen patients who were fed via the jejunostomy for 10 days, mild diarrhoea occurred in eight cases, but was easily managed. As experience with the technique increased, there was a significant increase in the amount of calories and nitrogen administered. This audit has demonstrated that provided care is taken with the technique of insertion of the jejunostomy catheter, satisfactory nutritional support can be provided in patients following oesophageal anastomoses with a low morbidity rate.

Management and outcome of retroperitoneal abscesses.

Retroperitoneal space abscesses are unusual clinical problems encountered by general surgeons, internists, and surgical subspecialists. An insidious, occult illness marked by diagnostic delay, inadequate drainage, and considerable morbidity and mortality is common. Anatomic reviews detailing the complex extraperitoneal spaces have been published, but less attention has been focused on diagnostic and drainage techniques useful to the practicing surgeon. In a retrospective review of 50 extraperitoneal abscesses, attention was directed to clinical presentation, diagnosis, and therapy. On the average, 12.7 days were required to establish the diagnosis; 50% of patients suffered major complications. A strikingly high mortality was associated with positive blood cultures and persistent fever within 48 hours of drainage (75% and 71%, respectively). Computed tomography has greatly enhanced the diagnosis of extraperitoneal abscesses, and radiologic drainage in selected cases appears to be a useful initial approach. A simplified anatomic classification and treatment plan is proposed to facilitate comparison between clinical series.

A case of colossal extraperitoneal abscess caused with ruptur of symphysis pubis

A case of colossal extraperitoneal abscess caused with ruptur of symphysis pubis