Large Amount Of Pus Research Articles

Rare post-operative intracranial abscess due to Serratia marcescens: what we can learn from it?

BackgroundNosocomial infections caused by Serratia marcescens mostly occurred in pediatrics and it was very rarely reported after adult surgery. Here, an intracranial abscess caused by Serratia marcescens was reported.Case summaryWe report a rare case of a postoperative intracranial abscess caused by Serratia marcescens in a 63-year-old male patient with a left parietal mass. The patient underwent resection of the mass on June 1, 2022, and the postoperative pathology revealed an angiomatous meningioma, WHO I. He then experienced recurrent worsening of right limb movements, and repeated cranial CT scans showed oozing blood and obvious low-density shadows around the operation area. Delayed wound healing was considered. Subsequently, a large amount of pus was extracted from the wound. The etiological test showed that Serratia marcescens infection occurred before the removal of the artificial titanium mesh. Antibiotics were initiated based on the results of drug susceptibility tests. At present, the patient is recovering well and is still closely monitored during follow-up.ConclusionIt is rare for Serratia marcescens to cause brain abscesses without any obvious signs of infection. This report provided in detail our experience of a warning postoperative asymptomatic brain abscess caused by an uncommon pathogen.

Case report of a submandibular abscess lethally tracking down through the mediastinum presenting as cardiac empyema

A 46-year-old male presented to our emergency with sudden severe shortness of breath and was found to have massive pericardial effusion causing cardiac tamponade and atrial fibrillation. He had to undergo immediate pericardiocentesis to relieve his symptoms and it drained frank pus indicating pericardial empyema as the underline cause of tamponade. On physical examination, patient was found to have a left submandibular tender swelling. He had increased inflammatory markers and on further imaging the CT showed massive diffuse mediastinal abscess. The patient had to undergo urgent surgery by multiple specialist surgeons in which large amount of pus was drained from the submandibular and mediastinum resulting in improvement of his condition and speeded his recovery. Key Messages • Thorough history and examination are of utmost importance. • Immediate treatment of pericardial tamponade is lifesaving. • High index of suspicion of descending mediastinitis should arise whenever purulent pericardial drainage is encountered. • Early diagnosis of mediastinal abscess by doing early radiographic investigations reduce mortality. • Head and neck abscesses must be treated properly to prevent life-threatening conditions.

Drawbacks of the use of cotrimoxazole in foreign-body infections

IntroductionThe anti-staphylococcal efficacy of cotrimoxazole in the setting of difficult-to-treat infections seems to be compromised by large amounts of pus and devitalized tissue, and, therefore, high levels of thymidine. Our objective was to evaluate the activity of cotrimoxazole against a staphylococcal foreign-body infection experimental model, which also yields significant quantities of thymidine. Material and methodsWe used a rat tissue-cage model of infection (with high inherent thymidine levels) caused by a strain of methicillin-susceptible Staphylococcus aureus (MSSA; ATCC 29213). MIC values were determined (microdilution method) and compared in the presence or absence of tissue-cage fluid samples. ResultsThe inefficacy of cotrimoxazole was found to be similar to that of the control group. The MIC of cotrimoxazole was 4•8 fold higher in the presence of rat tissue-cage fluid. ConclusionsThe inefficacy of cotrimoxazole in our foreign-body infection model by MSSA, and the probable negative impact of the presence of thymidine on its efficacy, challenge the use of this drug in acute phases of foreign-body infections. It should be reserved as an alternative treatment when the infection is more controlled.

A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei

BackgroundMelioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis.Case presentationA 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient.ConclusionBurkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome.

Drawbacks of the use of cotrimoxazole in foreign-body infections

IntroductionThe anti-staphylococcal efficacy of cotrimoxazole in the setting of difficult-to-treat infections seems to be compromised by large amounts of pus and devitalized tissue, and, therefore, high levels of thymidine. Our objective was to evaluate the activity of cotrimoxazole against a staphylococcal foreign-body infection experimental model, which also yields significant quantities of thymidine. Material and methodsWe used a rat tissue-cage model of infection (with high inherent thymidine levels) caused by a strain of methicillin-susceptible Staphylococcus aureus (MSSA; ATCC 29213). MIC values were determined (microdilution method) and compared in the presence or absence of tissue-cage fluid samples. ResultsThe inefficacy of cotrimoxazole was found to be similar to that of the control group. The MIC of cotrimoxazole was 4–8 fold higher in the presence of rat tissue-cage fluid. ConclusionsThe inefficacy of cotrimoxazole in our foreign-body infection model by MSSA, and the probable negative impact of the presence of thymidine on its efficacy, challenge the use of this drug in acute phases of foreign-body infections. It should be reserved as an alternative treatment when the infection is more controlled.

Primary gastrointestinal stromal tumour of the ileum pre-operatively diagnosed as an abdominal abscess.

The present case report described the acute presentation, diagnosis and management of a primary gastrointestinal stromal tumour (GIST) of the ileum. A male patient (age, 51 years) was admitted to Maggiore Hospital (Parma, Italy) due to presenting with fever, dysuria and lower abdominal pain. Ultrasonography and computed tomography showed a 7,5×5,5-cm pelvic mass containing air and purulent fluid indicative of an intraperitoneal abscess. The patient was subjected to diagnostic laparoscopy, which revealed a huge, soft cystic mass arising from the small bowel. The procedure was then converted to an open exploration through a midline incision. Ileal resection including a Meckel's diverticulum was performed. Macroscopic examination revealed that the cystic mass was filled with a large amount of pus, probably due to communication between the tumour mass and the small bowel lumen. In fact, the surgical specimen showed enteric leakage from the ileal mucosal ulcer into the tumour mass. Histopathology and immunohistochemistry of the abscess wall identified a spindle-cell mesenchymal-type, c-KIT-positive neoplasm. The post-operative course was uneventful and adjuvant imatinib mesylate was administered for 1 year. Follow-up by computed tomography demonstrated no tumour recurrence at 72 months after surgery.

Successful Treatment of Pump Pocket Infection after Left Ventricular Assist Device Implantation by Negative Pressure Wound Therapy and Omental Transposition

A 52-year-old man suffering from dilated cardiomyopathy underwent implantable left ventricular assist device (LVAD) insertion as a bridge to transplantation. He presented with evidence of LVAD-related mediastinitis and pump pocket infection 57 days after the LVAD implantation. The mediastinum was reopened and irrigated. A large amount of pus was observed around the outflow and inflow conduits and in the pump pocket. Negative pressure wound therapy (NPWT) was initiated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood and mediastinal pus. Enterobacter cloacae was also isolated by mediastinal pus culture after the beginning of the NPWT. Three weeks after the start of the NPWT, the pus culture became negative, and omental transposition and sternal closure were performed. Intravenous antibiotics were administered until day 42, with the treatment subsequently switched to oral antibiotics. He was discharged from the hospital on day 57 and followed up at the outpatient clinic. Our findings suggest that NPWT followed by omental transposition be useful to treat mediastinitis or pump pocket infection after implantable LVAD insertion.

Misleading Chest Pain

Chest pain is a common complaint in a patient presents to the emergency department(ED) and it caused by several life threatening conditions such as esophageal perforation. A 78 years old man known case of ischemic heart disease came into the ED with complaint of chest pain, physical examinations were normal on arrival. Electrocardiogram and chest x ray were no specific. Eventually he was admitted in CCU with acute coronary syndrome. During admission the patient got fever and productive cough. Despite antibiotic administration, patient was deteriorated and in this stage chest CT scan showed pulmonary abscess. Having no results in spite of utilizing board spectrum antibiotic, abscess drainage under guide of sonography was performed. A large amount of pus and food particle was drainage. Gasterographin study indicated esophageal perforation and entrance of contrast to mediastan and right sided pleura. With chronic perforation he was admitted in intensive care unit (ICU) with conservative management. After two weeks, the patient was discharged from hospital with good recovery and acceptable outcome. Chest pain is a common complaint in the emergency visits. Perhaps putting wrong the first step, begin a series of measures to be unnecessary in patients and delay the correct diagnosis. Esophageal perforation is a life-threatening condition that must be identified and treated early to minimize morbidity and mortality.

Bronchopleural fistula after non small cell lung cancer radiofrequency ablation: what it implying to us?

Radiofrequency ablation (RFA) is an alternative method to treat the inoperable NSCLC and there were few serious complications after RFA therapy have been reported. Here, we reported a NSCLC patient endured empyema after treatment by RFA for one month. There was a 20 × 25 × 20 mm mass on the right middle lobe by CT scan before RFA and a huge gas cavity with liquid was found in the right chest cavity after RFA treatment for twenty- eight days. A hole in the right middle lobe was found with large amount of pus in the pleural cavity as well as the bronchopleural fistula (BPF) during the operation. Results from the postoperative pathology showed a multiple small foci differentiated adenocarcinoma, partial bronchiolar-alveolar carcinoma, 0.5 cm away around the hole at the same time. It is difficult to diagnose and treat the rare complication of BPF, while, the larger field of ablation might be helpful to postpone the tumor local progression. Therefore, surgery was a good option for BPF especially when an empyema occurred.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8028049341122276.

Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report

IntroductionPrimary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy.Case presentationA 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient.ConclusionsThe satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.

Experience with Vacuum-Assisted Wound Closure of Mediastinitis Following Graft Replacement of the Ascending Aorta: Success of Treatment by Preservative Therapy Only

A 76-year-old woman underwent ascending aorta replacement due to acute type A aortic dissection. She suffered from a deglutition disorder, had a gastric fistula and received enteral nutrition after the operation. Two months later, a large amount of pus was discharged from the sternotomy wound. Methicillin-resistant Staphylococcus aureus (MRSA) was detected from the pus culture. She was successfully treated by two applications of sufficient debridement and vacuum-assisted closure therapy. Her nutritional status was normal during the period of the tubal feeding. At the 1-year follow-up, there was no sign of recurrence.

Hydatid cyst of liver complicated with Budd-Chiari syndrome and portal vein thrombosis

Hydatid cyst of liver complicated with Budd-Chiari syndrome and portal vein thrombosis

Peritonitis After Endoscopic Caecostomy With a Chait Trapdoor Catheter

Peritonitis After Endoscopic Caecostomy With a Chait Trapdoor Catheter

Infected Coronary Artery Pseudoaneurysm After Repeated Percutaneous Coronary Intervention

Coronary stent infection is exceedingly rare, with only 23 reported cases. We present a patient with an everolimus-coated stent infection that led to an infected pseudoaneurysm in the left anterior descending artery. Medical therapy failed and the patient underwent emergent surgical intervention; however, he died of multiorgan failure after the operation.

Acute spinal cord compression due to epidural lipomatosis complicated by an abscess: magnetic resonance and pathology findings

A 68-year-old male presented with rapidly progressive paraplegia. MR images of the thoracic spine were interpreted as being consistent with an abscess within an epidural lipomatosis compressing the spinal cord. Laminectomy was performed, and a large amount of pus was drained from the epidural lipomatosis, from which Staphylococcus aureus was isolated. This is the first reported case of an abscess involving an epidural lipomatosis.

Infected aortic aneurysm, purulent pericarditis, and pulmonary trunk rupture caused by methicillin-resistant Staphylococcus aureus

A 66-year-old woman presented with cardiac tamponade. Pericardiocentesis revealed purulent pericarditis. Enhanced computed tomography showed a saccular aneurysm of the aortic arch. An irregularly shaped and partially enhanced mass was seen adjacent to the aneurysm, which suggested development of a mycotic pseudoaneurysm. Surgical drainage was performed through a subxiphoid incision, and continuous irrigation was commenced. On the following day, however, massive bleeding was recognized through the drains. The patient was immediately transferred to the operating theater, and extracorporeal circulation was established. A perforation 1 cm in diameter was found on the anterior surface of the pulmonary trunk, and a large amount of pus came out from the tear. The ascending aorta and the arch were found to be infected. Surgical repair was impossible due to extensive infection, and the patient died. Methicillin-resistant Staphylococcus aureus was isolated from the pericardial effusion, blood, and intraluminal thrombus of the aortic aneurysm.

Acute abdominal pain in a 16-year-old woman: the pitfalls of sexual history

A 16-year-old woman presented to the authors' emergency department in the early hours of the morning with a 3-day history of cramping lower abdominal pain and watery diarrhoea, following a meal of reheated rice. The remainder of her history (including gynaecological history) was unremarkable. Examination revealed that she was clinically dehydrated, had a tachycardia of 100 beats per minute, and although she did not display any signs of peritonism, she did have lower abdominal tenderness, not more so on any one side. Rectal examination was deferred by the patient. Chest and abdominal radiographs (Figures 1 and 2) were unremarkable, and initial blood tests revealed a white blood cell count of 3.4×109/litre, with C-reactive protein of 156 mg/litre. Her urine did not contain nitrites, leucocytes or blood, and a beta-human chorionic gonadotrophin pregnancy test was negative. A diagnosis of gastroenteritis and tachycardia secondary to dehydration was made and the patient was admitted to hospital. The following day her abdominal pain worsened and despite rehydration she remained tachycardic, developing profound swinging pyrexia (peak of 40°C). On examination, her abdomen was noted to be extremely tender and peritonitic below the umbilicus, with marked guarding on examination. She was immediately referred to both general surgery and gynaecology teams. The on-call gynaecologist was able to question the patient about her sexual history separate from her family, who until now had been with her at all times. At this stage, the patient admitted that she had sexual intercourse for the first time 4 days before admission, but denied any relation to the onset of symptoms. Vaginal examination was refused, but the patient did allow a rectal examination, performed by the general surgical consultant, revealing marked tenderness and fullness in the pouch of Douglas. Although the sexual history was noted, it was felt that appendicitis was the most likely cause for her pain, and the patient was taken to theatre for a diagnostic laparoscopy. At laparoscopy, a large amount of pus was seen in the abdomen limiting visualization and necessitating conversion to laparotomy. Although a mildly inflamed appendix was seen and appendicectomy performed, this did not account for the pus, and further careful examination of the abdominal cavity was carried out. In the pelvis and careful palpation of the pouch of Douglas revealed a traumatic, full thickness, 1 cm transverse tear of the posterior vaginal wall, through which the cervix could be felt. After discussion with the gynaecology team, this was treated with copious pelvic lavage and a carefully placed pelvic drain. Further questioning during the postoperative period revealed that the intercourse had been consensual but very painful. The patient had an uneventful postoperative recovery and was discharged after 7 days to be followed up in the gynaecology outpatient department.

Bilateral adrenal abscesses and skin lesions in an immunocompetent patient

A 45-year-old non-diabetic man presented with a 4-month history of fever accompanied by 5 kg weight loss. Examination revealed multiple non-itchy papules with central umbilication distributed over face, neck, and trunk (figure, A). Contrast enhanced computed tomography (CECT) of the abdomen revealed bilateral adrenal abscesses (figure, B). Adrenal function was preserved. Skin biopsy from one of the papules over the chest revealed dermal histiocytic infilteration, containing numerous Histoplasma capsulatum organisms. ELISA for HIV was negative and serum immunoglobulin levels were normal. The patient was treated with intravenous amphotericin B for 18 days with a cumulative dose of 586 mg, and showed marked improvement, with disappearance of fever and skin lesions. The size of the adrenal glands and the morphology of adrenal lesions remained unaltered. The patient was discharged on oral itraconazole 200 mg twice a day. There was no recurrence of symptoms. A repeat CECT of the abdomen, done 6 weeks later, revealed an increase in the size of the bilateral adrenal abscesses. Cytopathological examination of pus aspirated from right adrenal gland showed numerous H capsulatum organisms. Low-dose (1 μg) adrenocorticotrophic hormone stimulation test revealed evidence of mild adrenal insufficiency at this stage. He was treated with intravenous amphotericin B (total dose 2 g) and repeated aspirations of adrenal abscesses with intralesional instillation of amphotericin B (350 mg over seven sittings). The size of the adrenal abscesses remained the same. Open drainage was then done where large amount of pus was drained, which again showed the presence of H capsulatum. Subsequently the patient showed clinical and radiological improvement. The patient is currently on maintenance itraconazole therapy with no new lesions, or progression of old lesions. Bilateral adrenal abscesses and skin lesions in an immunocompetent patient

A CASE OF INTRAMURAL TYPE OF PERICHOLECYSTIC ABSCESS WHICH SHOWED AN INTERESTING SHAPE IN CT SCAN FINDINGS

Pericholecystic abscess is formed by a leakage of infected bile juice from necrosed and/or perforated portion of the gallbladder mucosa due to cholecystitis. In this paper a case of pericholecystic abscess which showed an interesting CT findings of the gallbladder is reported. A 75-year-old male was admitted to the hospital because of a sudden onset of right upper abdominal pain after a lunch. Abdominal CT scan findings of the gallbladder performed preoperatively had a strange shape which seemed like a record disk. It was composed of a thin capsule, a large low attenuation area like a record disk, an enhanced small area like a ring and a small low density area like a axis. At the operation the serosal layer was extremely swelling and a large amount of pus was discharged by the incision. A simple cholecystectomy was performed. The serosal layer of the specimen was extremely swelling and thickening, and the abscess developed all over the subserosal area, whereas muscle layer and mucosal layer became atophic like a stick. A low attenuation area like a disk in CT findings exactly corresponded to the pericholecystic abscess developed in the subserosal layer. Pericholecystic abscesses are classified into three types, viz, gallbladder bed type, intramural type, and free peritoneal cavity type. Our case was diagnosed as typical intramural type of pericholecystic abscess.

Pyomyositis — An under-reported disease in temperate climates

Two cases of pyomyositis were seen over a period of 2 weeks. Both patients were young local residents in whom large amounts of pus were found deep within skeletal muscles. The first case had an unusual presentation involving more than one muscle. The causative organism in the first case was Staphylococcus aureus. In the second case it was Streptococcus pyogenes.