Large Abscess Research Articles

Acute coronary syndrome caused by extrinsic coronary compression from an aortic root abscess in a patient with mechanical aortic valve endocarditis: a case report and literature review.

Background Extrinsic coronary compression is an extremely rare complication of aortic root abscess formation and can manifest as an acute coronary syndrome in infective endocarditis. Optimal management strategies are unknown and therefore illustrative case reports may be informative.Case summary We describe a 63-year-old man with a background history of a mechanical aortic valve who developed sepsis due to Escherichia coli bacteraemia from a presumed urinary source. He suddenly deteriorated with cardiogenic shock and anterior ST-segment elevation myocardial infarction on Day 16 and received emergency percutaneous coronary intervention for severe stenoses of left anterior descending and diagonal arteries. A transoesophageal echocardiogram 2 days later demonstrated a large aortic root abscess. He was transferred for emergency surgery which revealed a large aortic abscess surrounding the left main stem confirming extrinsic coronary compression. He received a redo tissue aortic valve replacement and repair of his abscess cavity.Discussion We describe a case where percutaneous coronary intervention and emergency surgery was used to treat extrinsic compression from an aortic root abscess; a complication that is associated with a high mortality. This is also a rare case of E. coli causing prosthetic valve endocarditis. We also explore the findings of 11 previous cases of extrinsic coronary compression from aortic root abscess.

Medical management of Rhodococcus equi infections: A clinical epidemiology perspective

SummaryRhodococcus equi infections cause severe pulmonary disease in foals, affecting animal welfare and increasing production costs in horse‐breeding farms. Extra‐pulmonary disorders (EPD) are relatively common and can occur independently of pulmonary disease; foals with EPD have a more guarded prognosis. The accompanying paper by Shaw et al. (2021) reports the successful diagnosis and medical treatment of a large abdominal abscess caused by R. equi infection. The authors report on the benefits of using gallium maltolate, a semimetal compound with antimicrobial activity, in combination with traditional R. equi infection antimicrobial treatment (combination of a macrolide and rifampicin). Experimental studies are needed to understand further the benefits of this combined therapy, to evaluate the synergistic effects and if it improves the concentration of antimicrobial drugs into infected tissues. The publication of this case report in Equine Veterinary Education is of clinical importance to equine practitioners when diagnosing and treating R. equi infected foals with or without EPD.

Surgical management of large subcutaneous abscess by using seton in a dairy cow- A case report

A one-year-old female 350kg Holstein Friesian crossbreed dairy cow was referred to the SAQ teaching veterinary hospital, Chattogram Veterinary and Animal Sciences University. The complaint was recorded as gradually swelling the right fore limb elbow area and formed a large mass from the last four weeks. On clinical examination the cow had pyrexia, mild dehydration and the elbow with knee joint of right fore limb had swelling and pain on palpation. Weight bearing lameness with large pus filled mass with inflammatory sign diagnosed on the affected limb through an aseptic needle aspiration.On the basis of clinical history, clinical examination and subcutaneocentesis,the case was diagnosed as subcutaneous abscess. A surgical operation was decided to correct the subcutaneous abscess. The animal was successfully treated by evacuating the pus and washed out with povidone iodine impregnated gauge. Seton was placed into the cavity for preventing secondary closure and facilitating the drainage of pus and allowed for epithelialization and heal from the inside and parenteral administration of antibiotics, antihistaminic, NSAID. The cow successfully recovered after two weeks without any other complication

Severe Keratitis and Corneal Perforation by Paenibacillus glucanolyticus

To report the first case of Paenibacillus glucanolyticus, a spore-forming bacteria, to be isolated in a human ocular infection. We describe a severe case of noncontact lens-related microbial keratitis due to P. glucanolyticus presenting with a large corneal abscess, severe ocular inflammation, and a large epithelial defect. The corneal scrapes with no growth initially cultured P. glucanolyticus on blood agar after 48 hours, with sensitivity to gentamicin and fluoroquinolones. No other organism was cultured. The patient had severe keratitis with a protracted course requiring cyanoacrylate glue patching because of keratolysis and perforation. The patient may benefit from a penetrating keratoplasty and extracapsular cataract extraction in due course to aid visual rehabilitation. This is the first reported ocular case of P. glucanolyticus demonstrating its bacterial virulence and pathogenic potential when infecting the cornea. Rapid identification with newer technology enable us to accurately identify these opportunistic bacteria and may give a more favorable visual outcome as correct sensitivities lead to timely treatment administration.

β-Amyloid may accumulate in the human brain after focal bacterial infection: An 18 F-flutemetamol positron emission tomography study.

β-Amyloid formation has been suggested to form part of the brain's response to bacterial infection. This hypothesis has been based on experimental animal studies and autopsy studies in humans. We asked if β-amyloid accumulates locally around a bacterial brain abscess in living human patients. Furthermore, because brain abscess patients may suffer from chronic cognitive symptoms after abscess treatment, we also asked if a brain abscess precipitates accumulation of β-amyloid in the neocortex in a manner that could explain abscess-related cognitive complaints. In a prospective study, we investigated 17 brain abscess patients (age 24-72years) with 18 F-flutemetamol positron emission tomography on one occasion 1 to 10months after brain abscess treatment to visualize β-amyloid accumulation. 18 F-flutemetamol uptake was reduced in the edematous brain tissue that surrounded the abscess remains. On this background of reduced 18 F-flutemetamol signal, three out of 17 patients showed a distinctly increased 18 F-flutemetamol uptake in the tissue immediately surrounding the abscess remains, suggesting accumulation of β-amyloid. These three patients underwent 18 F-flutemetamol positron emission tomography significantly earlier after neurosurgical treatment (p=0.042), and they had larger abscesses (p=0.027) than the rest of the patients. All 17 patients suffered from mental fatigue or some subjective cognitive symptom, such as attention difficulties or memory problems, but in none of the patients was there an increase in neocortical 18 F-flutemetamol signal. β-Amyloid may accumulate locally around the abscess remains in some patients with a brain abscess.

To drain or not to drain? Abscess or empyema?

We present a case posing the clinical dilemma of differentiating a large peripheral lung abscess from an empyema, discussing the imaging and management and the clinical issues posed.

Management Practices and Predictors of Outcome of Liver Abscess in Adults: A Series of 1630 Patients from a Liver Unit

The management practices of liver abscess (LA) have evolved over time. The precise diagnosis of etiology and complications is pivotal for appropriate management. Descriptive analyses of consecutive patients treated for LA using electronic medical records at a liver unit between years 2010 and 2020 and investigate relationships between clinical, imaging, laboratory and microbiological findings, treatment strategies and mortality. Of 1630 LA patients, the most common aetiologies were amoebic liver abscess (ALA; 81%) and pyogenic liver abscess (PLA; 10.3%, mainly related to biliary disease and/or obstruction). Abdominal pain (86%) and fever (85.3%) were the commonest presenting symptoms (median duration-10 days). Almost 10% had jaundice at presentation, 31.1% were diabetic, 35.5% had chronic alcohol use and 3.3% had liver cirrhosis. Nearly 54% LA were solitary, 77.7% localized to the right liver lobe (most commonly segment VII/VIII). Patients with large LA (>10cm, 11.9%) had more frequent jaundice and abscess rupture (p-0.01). Compared with ALA, patients with PLA were older, more often had multiple and bilobar abscesses with local complications. Over four-fifth of the patients received percutaneous interventions (catheter drainage [PCD; 36.1%] alone and needle aspiration [PNA] plus PCD [34.1%] as most common). Fifty-eight patients underwent endoscopic retrograde cholangiography for intrabiliary abscess rupture (n= 36) or cholangitic abscess (n= 22). The median duration of hospital stay and PCD were 7 (4-10) days and 5 (4-8 days), respectively. The overall in-hospital mortality was 1.1%. Presence of septic encephalopathy (HR: 20.8; 95% CI: 1.9-220.7; p-0.012), liver cirrhosis (HR: 20.1; 95% CI: 2.7-146.9; p-0.003) and jaundice (HR: 7.6; 95% CI:1.7-33.1; p-0.006) were independent predictors of mortality. The commonest presentation was middle age male with right lobe solitary ALA. Patients with large, bilobar and/or pyogenic abscess had more complications. Nearly 70% patients require percutaneous interventions, which if given early improve treatment outcomes. Presence of jaundice, liver cirrhosis and septic encephalopathy were independent predictors of mortality.

S2566 Large Intra-Abdominal Abscess in a Cirrhotic Patient With Ascites: A Rare Complication of Paracentesis?

INTRODUCTION: Ascites is a major complication of cirrhosis with 50% mortality in 2 years. Large-volume paracentesis (LVP) is safe and effective treatment for refractory ascites. Complications include bowel perforation, infection, bleeding, and ascitic fluid leakage. Abdominal abscess in cirrhotic patients with ascites has not been reported as a complication of LVP. We present a patient admitted with septic shock and a large abdominal abscess that may have represented a complication of paracentesis. CASE DESCRIPTION/METHODS: A 54-yo woman with ascites due alcoholic cirrhosis and untreated chronic hepatitis C had been managed with LVP every 2 wks for last 4 yrs. 2 d after her last tap, she presented locally with abdominal pain, hypotensive and in shock. She received fluids, pressors and IV antibiotics. CT showed 22 × 14 × 5 cm abscess in the right side of abdomen extending into prerectal area with foci of gas without definite communication with the bowel (Figure 1 A-B). She was transferred to our facility where, on arrival, she was afebrile, hypotensive, tachycardiac with a distended, diffusely tender abdomen with rebound tenderness. Labs showed WBC of 25.3 × 103/mm3 (90% neutrophils), hemoglobin 6.9 g/dL, platelets 555 × 103/mm3, total bilirubin 7.7 mg/dL, albumin 2.2 g/dL. Patient was admitted to ICU for pressors and IV antibiotics. A drain was placed in the abscess; the fluid grew pan-sensitive Enterococcus faecium, E. coli, Lactobacillus, and Candida dubliniensis. Fungal coverage added and she was discharged on 3 wks of IV piperacillin-tazobactam and fluconazole. Repeat CT 2 wks later showed improvement of the abscess and ascites (Figure 2 A-B). Antibiotics were stopped after repeat CT 3 wks later showed continued improvement (Figure 3). Several wks later, patient was admitted to local hospital with abdominal discomfort. Paracentesis excluded SBP but she died few days later of multi-organ failure. DISCUSSION: Intra-abdominal abscess resulting from or associated with paracentesis has not been reported in the literature. Our patient presented in shock with a large abscess 2 d after her last tap. No definite evidence of bowel perforation was seen on imaging, but the possibility that the abscess was caused by bowel injury secondary to paracentesis cannot be excluded. Whether the abscess was caused by the last tap before her acute illness or was already present is unclear, as ascitic fluid labs were not obtained.Figure 1.: A-B. CT abdomen pelvis cross sectional and coronal view showing a 22 × 14 × 5 cm abscess in the right side of the abdomen extending into prerectal region with foci of gas without definite communication with the bowel (solid white arrows).Figure 2.: A-B: CT abdomen pelvis cross sectional and coronal view showing improvement in size of the abscess (solid white arrows) and ascites.Figure 3.: CT abdomen pelvis cross sectional 6 weeks later showing interval improvement of abscess (solid white arrow) and ascites.

S3526 Parvimonas Micra Liver Abscess and Diverticulitis in an Immunocompetent Host: A Case Report

INTRODUCTION: Parvimonas micra (P.micra) is a Gram-positive (GP) anaerobic species, known as a commensal of the oral cavity and a common cause of periodontitis. It is reported twice in the literature as the infectious agent causing hepatic abscesses. Herein we present the case of multiloculated liver abscess and diverticulitis caused by P.micra. CASE DESCRIPTION/METHODS: A 54-year-old healthy man presented to the hospital for fever, malaise, and fifteen lbs weight loss for two weeks. Initial evaluation revealed a temperature of 102.9F, heart rate of 108, and blood pressure of 124/60mmHg. The physical examination was non-contributory. Laboratory studies revealed leukocytosis 23.67k/uL, AST 50U/L, ALT 80U/L, ALP 1015U/L, total bilirubin 0.5mg/dL. A CT-scan of the abdomen with intravenous contrast showed two multiloculated liver abscesses with sigmoid diverticulitis (Figure). Empiric antibiotics therapy with ceftriaxone and metronidazole was started. Blood cultures at admission were negative. The patient underwent ultrasound-guided drainage of the abscesses with the placement of 2 drainage catheters. The culture revealed P.micra. Antibiotics were switched to oral Amoxicillin/Clavulanic-acid. Follow-up colonoscopy showed sigmoid diverticulosis without evidence of malignancy. A repeat CT-scan confirmed abscesses resolution. DISCUSSION: Pyogenic liver abscess is a rare disease in the US, with an annual incidence of 2.9–3.6 cases/100,000 individuals. Biliary tract infections are the most common etiology. Seeding from diverticulitis or appendicitis through the portal vein is the second. PLA is often polymicrobial. Parvimonas micra is an anaerobic GP coccus. It is known to cause periodontitis in immunocompromised patients. Only 2 cases of liver abscesses secondary to P.micra have been reported, but none was associated with diverticulitis. Blood cultures are positive in half of the cases of PLA, with lower rates in anaerobes. Abscess culture has higher sensitivities (up to 80%). CT scan is the preferred imaging modality. Therapy includes antibiotics, percutaneous drainage of the abscess, and treatment of the underlying cause. Empiric antibiotic should cover GP cocci, gram-negative bacilli, and anaerobes. P.micra is highly susceptible to antibiotics. Surgical drainage is reserved for multilocular and larger abscesses. PLA remains a challenging disease despite advancements in diagnostic imaging and treatment. It is vital to screen for the associated conditions and rare organisms for successful therapy.Figure 1.: Liver abscess.Figure 2.: diverticulitis.

S2940 Peri-Gastric GIST Presenting With a Large Liver Abscess and Bacteremia

S2940 Peri-Gastric GIST Presenting With a Large Liver Abscess and Bacteremia

S2662 An Unexpected Cause of Refractory Liver Abscesses

INTRODUCTION: We report a case of multifocal liver abscesses with recurrent fevers refractory to prolonged antibiotic therapy and catheter drainage due to penetration of a toothpick into the portal vein. CASE DESCRIPTION/METHODS: A 72-year-old male with type II diabetes presented with fever, confusion, and right upper quadrant pain associated with malaise and unintentional weight loss. Objective findings were consistent with septic shock and acute liver injury. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed a 6.9 × 8.0 × 5. hepatic abscess and several scattered fluid collections (Figure 1). Immediate broad-spectrum antibiotics and percutaneous catheter drainage resulted in clinical improvement. Abscess fluid and blood cultures grew actinomyces odontolyticus and streptococcus viridans, respectively. Amebic serology was negative. Transition to appropriate outpatient antibiotics resulted in two readmissions for recurrent fevers with persistent drainage output for weeks. A repeat CT showed a shrunken abscess and a 4.6 cm radio-opaque linear foreign body penetrating through the gastric antrum into a branch of the left portal vein (Figure 2). Review of previous imaging confirmed the foreign body was present since first admission. Upper endoscopy showed a patch of erythematous mucosa in the antrum encircling a pinpoint opening to a fistulous tract and exuding purulent fluid (Figure 3). Exploratory laparotomy revealed a 4.5 cm wooden toothpick in the portal vein surrounded by a dense fibrotic scar. Foreign body removal and porto-enteric fistula repair were performed. Follow up CT showed complete resolution of the abscess. DISCUSSION: Penetrating foreign body is a rare cause of liver abscess. To our knowledge, penetration of a foreign body into the portal vein resulting in liver abscesses has never been reported. Discovery of foreign body requires a high index of suspicion as patients rarely remember ingesting the object, and it can be easily missed on CT. When suspected, a non-contrast CT is recommended with attention to coronal/sagittal views with signs such as thickened antral wall and fistulous tract. Non-specific clinical features such as hematemesis, subacute/chronic abdominal pain, and failure of antibiotic therapy can be suggestive. In the setting of any of these findings, foreign body should be considered in patients with unexplained liver abscess.Figure 1.: A large dominant hepatic abscess measuring 6.9 × 8.0 × 5.3cm, involving segments 4A and 4B of the liver, extending to and involving the anterior wall of the gallbladder, as well as several scattered small fluid collections (MRI of liver without contrast).Figure 2.: A 4.6cm radio-opaque linear foreign body penetrating through the gastric antrum into a branch of the left portal vein (CT of abdomen and pelvis without contrast).Figure 3.: A patch of erythematous mucosa in the pre-pyloric antrum encircling a pinpoint opening to a fistulous tract and scant purulent liquid; the foreign body was not visible (upper endoscopy).

Tuberculous retropharyngeal abscess presenting as severe dyspnea

<p>Tuberculous retropharyngeal abscess is an exceptional condition, with high potential of functional morbidity and mortality if not treated appropriately. The authors report a new case of airway obstructive retropharyngeal abscess revealing cervical Pott disease. A 59 years old man presented at Ear, neck and throat (ENT) department with severe acute dyspnea. The history revealed progressive chronic dysphagia associated with asthenia and important weight loss. Physical examination found a state 3 dyspnoeic patient, presenting hyper flexed neck with limited movements. Nasofibroscopy showed a huge retropharyngeal bulge. Computed tomography (CT) scan showed a large retropharyngeal abscess located in front of vertebral spondylodiscitis with anterior dislocation of C4-C5-C6 vertebrae. Trans-oral incision with drainage of the retropharyngeal abscess was performed under general anaesthesia. Bacteriologic assessment of the pus confirmed tuberculosis infection. Anti-tuberculous medication was delivered, associated with spinal stabilization by a rigid cervical collar. Tuberculous retropharyngeal abscess is a very rare condition. Early diagnosis and treatment are necessary to prevent neurological and life-threatening complications. Collaboration between ENTs, anaesthetists, neurosurgeons and infectious disease specialists remains incontournable.</p>

A 61-year-old Female with Right Upper Abdominal Pain.

Case PresentationA 61-year-old female presented to the emergency department with right upper quadrant abdominal pain following a cholecystectomy 18 days prior. Computed tomography (CT) of her abdomen demonstrated a large abscess in her post-hepatic fossa. She was admitted to the general surgery service and received an image-guided percutaneous drain placement with interventional radiology with immediate return of purulent material. She was discharged home after a three-day hospital course with outpatient antibiotics and follow-up.DiscussionPatients may have multiple complications following cholecystectomy, including infection, bleeding, biliary injury, bowel injury, or dropped stone. The emergency clinician must consider cholecystectomy complications including gallbladder fossa abscess in patients presenting with abdominal pain in the days to weeks following cholecystectomy, especially if they present with signs of sepsis. Critical actions include obtaining CT and/or ultrasonography, initiating broad spectrum antibiotics, and obtaining definitive source control by either surgery or interventional radiology.

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

BackgroundOrbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis.MethodA retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups.ResultsOf ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients’ age range was 5–70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm3 and 2572.94 ± 1075.75 mm3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis.ConclusionNon-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

AML-360: The Coexistence of Hyperimmunoglobulin E Syndrome and Myelodysplastic Syndrome

Context Hyperimmunoglobulin E syndrome (Job Syndrome) is one of the primary immunodeficiency syndromes and is generally inherited in an autosomal dominant fashion. This syndrome is characterized by elevation of serum immunoglobulin E level, chronic eczema, recurrent sinusitis and pneumonia, tendency for recurrent pyogenic infection, and soft tissue infections such as large abscesses. This disorder is associated with an increased risk for malignancies, especially lymphomas. Here, we report of a 45-year-old male with hyper-IgE syndrome who developed MDS transformed AML. Patient The patient had multiple erythematous papules and nodules with ulcerations on his face, left forearm, and legs. He had pancytopenia. Bone aspiration and biopsy were performed, which confirmed diagnosis of myelodysplastic syndrome with increased blasts. After 3+7 (idarubicin+cytarabine) induction chemotherapy, he had recurrent pneumonia, pre-septal cellulitis, a breast abscess, and catheter infection. We found elevated IgE. He was diagnosed with Hyperimmunoglobulin E syndrome. After receiving two cycles of azacytidine, he still had refractory disease. He was shifted to decitabine and venetoclax. He required intensive care unit hospitalization for gastrointestinal bleeding but passed away. Conclusion As in our case, hyperimmunoglobulin E syndrome should be considered in patients with hematological malignancies and recurrent soft tissue infections.

A case of retropharyngeal tuberculosis: the simple management of a serious case

The challenge in management of chronic retro-pharyngeal abscess lies in its proximity to vascular and neurological structures, the access to the abscess should be possible after evaluation of neurological stability and integrity of vascular structures. Tuberculous chronic retro-pharyngeal abscess is an unusual situation. And due to its scarcity, it is not considered in differential diagnosis which delays its management: this could lead to permanent neurological deficit and higher rates of mortality. This the case of a young 29-year-old male, already undergoing anti-tuberculosis treatment for 2 months for a tuberculous lymphatitis, and no history of immuno-suppression, presenting with a large retropharyngeal abscess, with no neurological symptoms or any other specific symptoms. The management of this disease can be simple provided the diagnosis is not delayed, the patient had no complications, and the follow up is performed by a team: otolaryngologist, a neurosurgeon and a phthisiology specialist.&lt;p&gt; &lt;/p&gt;

Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study

BackgroundCystic fibrosis (CF) is a chronic, genetic, incurable disease that affects primarily the respiratory and gastrointestinal systems. End-stage lung disease is the leading cause of death in people with CF, and lung transplant is required to preserve life. Anti-rejection medications are necessary post-transplant; however, these medications lower immune response and increase susceptibility to bacterial infections. Complications from infections post lung-transplant account for approximately 30% of CF-related deaths. Retropharyngeal abscess (RPA) is a rare deep neck infection that occurs most commonly in children. This is the case of a 45-year-old Caucasian male with CF who developed a retropharyngeal abscess post wisdom teeth extraction that seeded into hardware from a previous cervical disc fusion.Case presentationThe patient presented to the emergency department with severe neck and shoulder pain, limited range of motion in his arm and neck, and dysphonia. He reported feeling pain for 10 days and suspected the pain was caused by a weightlifting injury. The patient reported low-grade fever 5 days prior, which responded to acetaminophen. He was afebrile upon admission and in no respiratory distress. Diagnostic labs revealed WBC 22,000/uL and CRP 211 mg/L. The CT scan showed a large abscess in the retropharyngeal space between C2-C7. The immediate concern was airway obstruction and need for possible intubation or tracheostomy. The patient was transferred to ENT service with neurosurgery and transplant consults. The RPA was drained and lavaged. The cervical hardware was discovered to be infected and was removed. The source of the RPA infection was determined to be from the patient’s wisdom teeth extraction 6 months prior to RPA. The patient received 8 weeks of intravenous ceftriaxone for Streptococcus pneumoniae bacteremia and underwent revision of his cervical fusion 3 months after hardware removal.ConclusionsClinicians should consider prophylactic antimicrobial therapy for immunocompromised patients when they are at increased risk for transient bacteremia such as following invasive procedures (e.g., tooth extraction). Prophylactic antimicrobial therapy could prevent potentially life-threatening infections such as RPA in immunocompromised patients.

A large abscess of the uterus, opened in its cavity. Recovery

A Jewish woman, 65 years old, has been ill for several days, complains of a fever and pain in the lower abdomen. On 2 transverse fingers under the pubis, a tumor is felt, very painful, emanating from the small pelvis; complete prolapse of the vagina and incomplete uterus; with a double study of the reduction of the fallen out parts, it is determined that the fornices are free, and the above-mentioned painful swelling is a direct continuation of the significantly enlarged uterus.

Minimally invasive and inexpensive percutaneous abscess drainage using an indwelling needle cannula

PurposeAbscess is still a formidable disease and requires adequate drainage. Moreover, drainage in the head and neck area needs cosmetic care, especially in the pediatric population. In this report, we introduce our method of percutaneous abscess drainage using an indwelling needle cannula.Patients and methodsTen pediatric and five adult patients with cervical and/or facial abscess treated with this drainage method were retrospectively reviewed. Using an indwelling needle cannula (18-14 G Surflow®, Terumo, Tokyo, Japan), abscesses were penetrated under ultrasonic examination. Once purulent retention was identified, the inner metal needle was removed and the outer elastic needle was left and fixed. The outer needle was connected to the tube for continuous suction drainage for large abscess.ResultsThe primary diseases of these abscesses were cervical abscess of dental origin (5), purulent lymphadenitis (3), pyriform sinus fistula (2) and subperiosteal abscess due to mastoiditis (2), circumorbital cellulitis (1), infection of Warthin's tumor (1), and unknown origin (1). The median (range) duration of drainage was 4 days (3–9 days). Abscesses were successfully treated, and no patients required additional incision for abscess drainage. No apparent scars after drainage were observed.ConclusionThis technique resembles the usual venous placement of an indwelling needle cannula and is thought to be familiar to physicians. Although simple and inexpensive, this drainage is safe, effective, and minimally invasive for the treatment of abscess.

Management of complex hepatic abscess by percutaneous catheter drainage: a case report

Liver abscesses are a commonly encountered pathology in the tropical setting. Most commonly these are secondary to amoebic infestation. Majority of liver abscesses present with abdominal pain confined to the right hypochondrium. Smaller abscesses are easily dealt with by needle aspiration or catheter drainage under image guidance. Larger and complex abscesses are commonly dealt with by surgical drainage. We deal here with a case of complex liver abscesses which even had perforated into the pleural cavity. Keeping a close watch on the patient’s general condition which was satisfactory, we did not rush into a major surgical procedure. Wide antibiotic coverage and pulmonary care were initiated. Two pig-tail catheters were placed in separate abscesses and metronidazole irrigation periodically done. The daily drain output gradually reduced and we could successfully remove the two catheters at an interval. The patient made a good recovery and continues to do well on follow-up. We see in this case that even large and multiple abscesses if meticulously managed, surgical drainage can be avoided and catheter drainage provides satisfactory results. Good antibiotic coverage must continue in the follow-up period too.