Late Abscess Formation Research Articles

Late Abscess Formation Caused by Silk Suture Following Hysterectomy in a Female Dog

A 5-year-old female cross-breed dog was presented for a one-month history of lethargy, poor appetite and weight loss. A hysterectomy had been performed 2 years ago. Abdominal palpation revealed a mid-abdominal mass and haematological analysis showed leucocytosis with left shift. On abdominal radiographs, a 9 cm in diameter soft tissue opacity mass ventral to the colon and caudal to the left kidney was observed. The abdominal ultrasonography revealed a mass well circumscribed, with a hyperechoic capsule and hypoechoic center with echoic debris. The presumptive diagnosis was an abscess due to foreign body granuloma. Laparotomy was performed and a mass close to the left ovary was found. Adhesions and residues of the suture material were observed close to the right ovary and the uterine body stump. The mass, both ovaries and adhesions were removed. On cut section of the mass two cavities were observed. The small one contained three embedded silk suture residues. Histopathological examination confirmed the diagnosis of a chronic abscess caused by silk suture.

Enormous abscess growth at abdominal wall three years after laparoscopic herniorrhaphy

BACKGROUND: The laparoscopic approach reduces the risk of early postoperative infection which ranges from 0.3% to 0.5%. We report the first case of late abscess formation of a mesh after laparoscopic hernia repair. METHODS: A 30-year-old man who had had a laparoscopic hernia repair by total extraperitoneal approach 3 years ago. Physical examination was normal except hardness in all lower abdominal quadrant. In laboratory study, WBC: 13.2/mm3 (n: 4–10/mm3). [Cystic mass harmonized with abscess was found 15.73 × 12.29 cm in size in front of rectus near to psoas muscle at the back at abdominal and pelvic CT.] RESULTS: Percutaneous catheter (Boston Scientific® Sump drainage catheter 12F) was settled under local anesthesia. Approximately 2700 cc purulent drainage occured. Acinetobacter lwoffii had grown in purulent material's culture. Patient responded to ciprofloxacin, ceftazidime and piperacilin + tazobactam and therefore antibiotic therapy had been given. Seventy-seven days later, drainage was stopped from catheter and catheter had been removed. Patient has no complaint for 3.5 years. CONCLUSIONS: TEP is a safe and easy operation; however, it may be responsible for late abscess occurring.

Late abscess formation following indirect hernia repair utilizing silk suture

Inguinal hernia repair is the most common operation performed by pediatric surgeons. The critical portion of the operation is high ligation of the hernia sac, which is classically performed with silk suture. This foreign body has the potential to serve as a nidus for latent infection/rejection that may result in an abscess long after the operation. This complication has rarely been described in the literature. We have cared for six children who have presented with latent inguinal or pelvic abscesses following high ligation of the inguinal hernia sac with silk suture. The purpose of this report is to examine the varied presentations by which latent complications following herniorraphy may manifest. The pediatric surgeon should recognize that not every inguinal mass following a previous inguinal herniorraphy represents a recurrent hernia! A retrospective review of the charts of six patients with late abscess formation following antecedent inguinal hernia repair was undertaken. The details of the initial and operative endeavors were recorded with specific attention to the details of the initial operative hernia repair as well as the suture material utilized. Inguinal hernia repair continues to be the most common operation performed by pediatric surgeons. Utilization of braided, non-absorbable silk suture may result in latent abscess formation and the need for operative drainage of inguinal or pelvic abscess. Today, as other types of suture material are likely equally efficacious in the ability to effectively close the patent processus vaginalis, pediatric surgeons should consider utilizing non-braided, or absorbable suture material for high ligation of the indirect hernia sac to potentially prevent this complication.

Cochlear implant infection due to cholesteatoma

There are an increasing number of young children undergoing cochlear implantation. Cholesteatoma is a serious, although rare, long-term complication. We present the only documented case in which cholesteatoma has presented with late abscess formation in the bed of a cochlear implant package of a child. Cholesteatoma may be an iatrogenic complication of implantation surgery. Damage to the bony part of the external auditory canal should be avoided. The successful two-staged surgical treatment using explantation, debridement, gentamycin bead insertion, cholesteatoma excision and modified radical mastoidectomy is described. The intra-cochlear electrode was removed precluding cochlear implant reimplantation. This late presentation supports regular longterm otoscopic review of cochlear implant patients by experienced otologists. Suspicion should be raised in patients with persistent otorrhoea. Copyright © 2005 John Wiley & Sons, Ltd.

Outcomes of Colonic Stenting Using a Specifically Designed Expandable Metal Colonic Stent (Ultraflex™ Precision)

Outcomes of Colonic Stenting Using a Specifically Designed Expandable Metal Colonic Stent (Ultraflex Precision) Jose G. de la Mora, Todd Baron, Christopher Gostout, Nicole Pochron Background: Colonic stenting is now accepted for obstructing lesions, either as a temporary or definitive treatment. Until now, studies have used stents not designed specifically for use in the colon. The Ultraflex Precision stent is designed specifically for the colon, with a larger diameter (25 vs 20 mm), proximal flare (30 mm) and atraumatic ends. The aim of this study is to describe the results using this stent at our institution. Material & Methods: A retrospective review of patients that underwent placement of this stent (S), were included. Variables were: diagnosis, site, need for dilation, use of fluoroscopy, S length, placement success, complications, follow-up and final outcome. Results: 38 S were placed in 30 patients. In 6 cases 2 S were used and 3 S in one patient. Diagnosis was: cancer in 23, post-radiation in 2 and 1 each for: diverticular stricture, crohn’s, extrinsic tumor, anastomotic stricture and pancreatitis with colonic involvement. 13 lesions were located in descending colon, 15 in rectosigmoid and 2 in transverse. S lengths used were 5.7 cm (10), 8.7 cm (20) and 11.7 cm (8). Fluoroscopy was used in 28 patients with endoscopic control in 23. No dilatation was performed in 26; in 3 cases dilatation was performed after deployment . Placement success was 27/30 (90%) with two misplaced & repositioned S, and 1 that failed to expand. Severe pain occurred in 6 cases, evident perforation in 2 and suspected perforation (with late abscess formation) in 2 patients. One pt. experienced bacteremia with fever. Both evident perforations occurred in cancer pts. , The two cases with abscess formation occurred in benign disease (pancreatitis and post-radiation). Colostomy was performed in 2 and conservative treatment in two, one of which died from disease progression. Follow-up was available in 24, for a mean of 2 months (1-180 days). No stent malfunction was seen in 21 (2 abscess excluded) up to proctocolectomy (in 5) or death from disease progression (in 4). One stent required trimming. One intraoperative perforation occurred at the stent site. Conclusions: Placement success is similar to previous series using other types of stents not specifically designed for the colon. No migrations occurred, and other complications presented also at a similar rate. The later cases could be due to the fact that they were not neoplastic, although the increased diameter of the new stents cannot be excluded as an additional factor. Abstracts

Late abscess formation after spilled gallstones masquerading as a liver mass

The most common complication during laparoscopic cholecystectomy is the spillage of stones into the abdominal cavity. Although spillage occurs in 30% of cases, the potential adverse effects of this event are rare and generally manifest within months. When complications do occur, however, they may cause significant morbidity for the patient. We report an unusual case in which an inflammatory mass mimicking a liver tumor developed 5 years after the stones had been lost during a laparoscopic cholecystectomy. We therefore urge all surgeons to make every attempt to retrieve gallstones from the abdominal cavity once they have been accidentally dropped.

The effect of fibrin glue on intraperitoneal contamination in rats treated with systemic antibiotics

Intraperitoneal fibrin sealant lowers septic mortality in a rat model of peritoneal contamination (2 × 10 6 organism inoculum) at the cost of increased late intraabdominal abscesses. This study utilized parenteral antimicrobials to determine if the protective effect of intraperitoneal fibrin could be achieved without increasing the late abscess formation rate. One hundred and fiftyfive rats were divided into four groups. Gelatin capsules containing various dilutions of feces (10 10 CFU/ml) and barium sulfate were placed into the abdomen in all groups. Group I controls had no antibiotics or fibrin. In group II, the capsule was surrounded by a solution of cryoprecipitate, thrombin, and calcium (fibrin “glue”). Groups III (no fibrin, antibiotics) and IV (fibrin, antibiotics) received a broad-spectrum cephalosporin intramuscularly postoperatively and then daily. Surviving rats were sacrificed on the tenth postoperative day. At a moderate volume of fecal inoculum (0.3 ml), fibrin reduced mortality from 100% in the control group to 0% in treated animals ( P < 0.001) that did not receive antibiotics. Abscesses formed in 10% of the surviving fibrin-treated rats which were implanted with 0.1 ml of inoculum. In the 0.2 and 0.3 ml inoculum groups substantially more abscesses occurred (75 and 70%, respectively). The protective effect of fibrin was not manifested in the antibiotic-treated rats since no deaths occurred in either group. At higher and lower inoculum doses, no significant differences between fibrin and control groups were observed in mortality or abscess formation, whether or not antibiotics were given. We conclude that intraabdominal abscess formation among survivors is not intrinsic to fibrin but rather, a consequence of survival in rats that otherwise would have succumbed to early sepsis. Fibrin glue can be used topically in the peritoneum without increased abscess formation, providing antibiotics are given.

Therapeutic efficacy of 29 antimicrobial regimens in experimental intraabdominal sepsis.

An animal model of colonic perforation was used to examine the efficacy of 29 antimicrobial regimens in the treatment of intraabdominal sepsis. Efficacy was judged on mortality during the first 12 days after challenge and on the incidence of intraabdominal abscess noted at necropsy upon completion of the experiment. In general, antimicrobial agents that are active against coliform bacteria prevented early mortality, whereas drugs that are active against Bacteroides fragilis were most effective in reducing the incidence of late abscess formation. Exceptions were metronidazole, which produced a significant reduction in early mortality, and chloramphenicol, which caused only a modest reduction in the incidence of abscess. Optimal results were obtained with several regimens that showed good in vitro activity against both coliforms and B. fragilis.