Management Of Abscess Research Articles

Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data

BACKGROUND Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions. AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage. METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (n = 28) and a well liquefaction group (n = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation. RESULTS Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, P = 0.044], absence of pneumonia (OR = 0.218, P = 0.013), left-lobe abscess location (OR = 4.293, P = 0.041), cystic features (OR = 5.104, P = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, P = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209. CONCLUSION Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.

Hydrogel spacer infection during prostate cancer radiotherapy: a case report of successful abscess management through radical prostatectomy

Hydrogel spacer infection during prostate cancer radiotherapy: a case report of successful abscess management through radical prostatectomy

Novel case of pediatric basal ganglia abscess due to Streptococcus intermedius amid a rise in neuroinvasive infections during the COVID-19 pandemic: illustrative case.

Pediatric basal ganglia abscesses are extremely rare, with only 2 other published cases in the literature. To the authors' knowledge, this is the first case of a primary bacterial abscess caused by Streptococcus intermedius in the basal ganglia of a pediatric patient. This case coincides with a rise in neuroinvasive streptococcal infections among children during the COVID-19 pandemic. Prompt MRI with diffusion and attenuation analyses allowed for abscess identification and treatment with neurosurgical drainage, leading to full recovery. Although intracranial abscesses in deep parenchymal locations are extremely rare in healthy children, the recently increased incidence of neuroinvasive infections and the devastating sequelae of delayed or missed diagnosis make early recognition and treatment essential. To this end, reporting and recognition of the varied presentations of this pathology is crucial. Herein, the authors highlight that in light of the surge in cases in recent years, patients suspected of having an intracranial abscess should not be delayed in receiving cranial imaging and treatment, as rapid identification and management of abscesses are crucial to reduce the likelihood of long-term complications. https://thejns.org/doi/10.3171/CASE24562.

Extensive spinal epidural abscess treated utilizing a single limited incision: illustrative case.

Extensive spinal epidural abscess is an uncommon and potentially life-threatening condition that mandates appropriate early diagnosis and treatment to avoid potentially disastrous complications. Limited literature is available guiding the management of such an entity. The authors report the case of a 59-year-old female patient with a history of 5 days of severe back pain, fever, and associated lower limb neurological deficit. MRI revealed an epidural abscess extending from C2 to the sacrum. One-level segmental decompression was performed at the level of L2-3 in combination with the use of an epidurally introduced silicone catheter. Cultures came back positive for methicillin-resistant Staphylococcus aureus. The patient received 6 weeks of antibiotics. The infection was successfully treated after surgery and systemic antibiotic therapy, and full neurological recovery was observed. This is the first report in the literature to describe successful surgical management of an extensive C2-S1 epidural abscess through a single incision and one-level decompression. This less invasive technique could treat the holospinal abscess without the need for other procedures. https://thejns.org/doi/10.3171/CASE24654.

Pigtail catheter versus open surgical drainage in liver abscess management

Individualized treatment programs for liver abscesses are essential. Therefore it is of interest to compare and evaluate pigtail-catheter with open surgical drainage in liver abscesses. Hence, a total of 126 patients were divided randomly into 2 groups with 63 each open surgical drainage group and pigtail-catheter drainage group. We found that statistically significant difference was seen between the 2 groups for various variables. Moreover, pigtail-catheter drainage showed comparatively more effective results than open surgical drainage.

Surgical management of a brain abscess in a cat

AbstractA 3‐year‐old, male, neutered, domestic, medium‐haired, crossbreed cat presented to a veterinary emergency department with a history of inappetence and neurological clinical signs following an unwitnessed catfight. Initial neurological clinical signs included mild obtundation, proprioceptive ataxia, wide‐based stance and rightward circling. The cat had bilaterally absent menace responses and bilaterally dilated pupils. Placing proprioception was reduced in the right thoracic and pelvic limbs, while myotatic and withdrawal reflexes were normal. There was no evidence of paresis. Initial management included a course of antibiotics and analgesia. The cat returned to the emergency department 12 hours later for reassessment due to a deterioration in neurological status. Repeat neurological examination revealed similar clinical findings, although there was development of a spontaneous horizontal nystagmus with the fast phase to the right, and the cat was also severely obtunded, with minimal response to external stimuli. Neurological findings and previous history suggested a structural lesion of the forebrain (possibly with a thalamic component and/or an increase of intracranial pressure) with lateralisation to the left. This deterioration prompted advanced imaging with computed tomography. The computed tomography study revealed a comminuted skull fracture and multiloculated cerebral abscess. An emergency craniectomy was performed to drain purulent material and relieve the increased intracranial pressure. Post‐surgical recovery was uneventful, with significant improvement in the cat's neurological status within 24–48 hours. This case highlights the critical need for a prompt diagnosis and surgical intervention of brain abscesses in veterinary patients, while also emphasising the favourable outcomes associated with timely treatment.

Management of paediatric neck abscess with needle aspiration against surgical drainage: Systematic review and meta-analysis.

Management of paediatric neck abscess with needle aspiration against surgical drainage: Systematic review and meta-analysis.

Safety and efficacy of a surgical ambulatory care pathway for superficial abscesses.

Superficial abscess of the skin is a common emergency presentation often requiring surgical management. Ambulatory Care Pathways (ACPs) are a method that can reduce the burden of this disease on hospital bed pressure by treating patients with superficial abscesses as day cases. We conducted a prospective cohort study to assess the safety and effectiveness of an ACP for patients meeting strict criteria with a superficial abscess. Data on a new ACP for the management of superficial abscesses was collected for 12 months from June 20th, 2021 and compared to a retrospective control cohort of patients managed on an inpatient care pathway. Primary outcomes were length of inpatient stay and cost of admission, secondary outcomes were delays to theatre, complications, hospital or theatre readmission within 30 days. In total, 151 patient presentations were assessed, 79 in the ACP and 72 in the retrospective cohort. The mean age in our retrospective cohort was 36.3 ± 14.2 years, which was similar to our ACP cohort at 33.2 ± 12.5 (P = 0.16). Both cohorts had similar patient demographics. Inpatient bed days were significantly shorter for ACP patients with a median of 0.30 (IQR 0.20-0.95) days, compared to 1.53 (IQR 1.06-1.70) days for the retrospective cohort (P < 0.001). Both corhorts had similar postoperative complication rates (P > 0.4). Managing selected patients who present out of hours with a superficial abscess using an ambulatory care pathway reduced cumulative inpatient length of stay and resulted in no increase in patient morbidity.

Pattern and Trends in Management of Deep Neck Abscesses

Abstract Introduction: Deep neck spaces are potential spaces at risk for infections and abscess collections, they continue to be a source of significant morbidity and mortality which may reach as high as 48% and 2%, respectively. The diagnosis and treatment of these conditions are challenging. Clinical signs and symptoms can differ from one patient to another according to affected space. Review of contemporary literature revealed several aspects of diversity regarding the incidence, etiology, diagnosis, and treatment of such infections. Aim of Study: This retrospective study aims to clear the points of diversity and to determine modalities of different types of neck space abscesses. Materials and Methods: This is a descriptive retrospective study design conducted at Ohud Hospital, Medinah, Saudi Arabia. A total of 18 cases of deep neck space infection (DNSI) met our inclusion criteria. A datasheet that has the parameters - age, gender, symptoms, site involved, bacteriology, culture growth, intervention required, complications - was used. The data in our research were analyzed and compared to other papers to figure out and suggest the latest recommendations. Results: Eight patients (44.5%) presented primarily with retropharyngeal abscesses and four patients (22%) had Ludwig’s angina, the remaining six patients (33.5%) presented with submandibular or submental abscesses. Four patients (50%) of the retropharyngeal abscess group had history of trauma to the pharynx by sharp objects while two patients (25%) the abscess was tuberculosis. Five patients out of 10 (50%) who had Ludwig’s angina or submandibular abscess had a dental infection as a predisposing cause. Leukocytosis and fever were the most common clinical presentation. Lateral neck view was done in 17 patients, which was positive in 16 (94%). Computed tomography scan was used in only seven patients (39%) and was positive in all of them (100%). Bacteriologic study was done in only 14 patients (78%) and was positive in 12 cases. All patients were subjected to surgical drainage either due to no improvement or worsening of symptoms after 24 h. Conclusions: Many studies discussed different aspects of DNSI including the presentations, causes, microbiology, investigations, complications, and management. The results and conclusions may or may not match in the studies. We present our experience and clarify pattern and the trends of the management.

Conservative management of an expanding intracranial epidural abscess: illustrative case.

Management of intracranial epidural abscess (ICEA) typically requires a combination of surgical drainage and antibiotic therapy. However, the indications for neurosurgical drainage of ICEA have not been well established by evidence-based data and remain controversial. This article describes a case of ICEA that enlarged during antibiotic therapy but was managed successfully without neurosurgical drainage. A 13-year-old boy was admitted to the authors' hospital with a 6-day history of high fever, fatigue, and headache. Computed tomography and magnetic resonance imaging (MRI) revealed an ICEA in the right middle fossa with right-sided sinusitis. Initial empiric intravenous antibiotic therapy resulted in rapid improvement in clinical course. Despite clinical improvement, the abscess progressively enlarged by 158% after 2 weeks. Based on the patient's symptoms, age, and location of the lesion and considering the invasive surgical risks, neurosurgical drainage was not performed. Subsequently, the abscess began to decrease in size, and the patient was discharged after 5 weeks of hospitalization. Follow-up MRI at 6 months confirmed complete resolution of the abscess. Despite abscess enlargement, conservative management might be feasible when the patient demonstrates symptomatic improvement; thus, a tailored approach combining close monitoring with serial imaging is recommended. https://thejns.org/doi/10.3171/CASE24702.

Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom.

Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom.

Management of Bartholin abscess in a teaching hospital, ESUTH, Parklane, Enugu, Nigeria: A 5-year review

Management of Bartholin abscess in a teaching hospital, ESUTH, Parklane, Enugu, Nigeria: A 5-year review

Effectiveness of endoscopic transnasal pituitary surgery versus antibiotic therapy in the management of pituitary abscess: a report of two cases.

Effectiveness of endoscopic transnasal pituitary surgery versus antibiotic therapy in the management of pituitary abscess: a report of two cases.

Comparison of different treatment modalities for perianal abscess in infants: a retrospective cohort study

The optimal management of perianal abscess ( PA) in infants remains controversial. This study aimed to compare incision and drainage (ID), incision and drainage with primary fistulotomy (IDF), and conservative management(CM)for the treatment of infants with PA (< 1 year). A retrospective cohort study was conducted for infants with PA between 2014 and 2020. Patients undergoing IDF were assigned to the IDF group, those undergoing ID were assigned to the ID group, and those whose parents declined surgery were assigned to the CM group. A total of 597 patients were identified (591 boys and 6 girls); 282 in the IDF group, 162 in the ID group, and 153 in the CM group. The median age at first visit was 43 days (range 30–90 days). The median follow-up was 5.8 years (range 3–9.4 years). The baseline characteristics of the three groups were similar (except for abscess size, length of stay, and inpatient costs). The cure rate in the IDF group (97.8%, 276/282) was higher than that in the ID group (82.1%, 133/162; p < 0.001), and the CM group (80.4%, 123/153; p < 0.001). No severe complications were found in the ID or CM groups. The IDF group had 3 cases of sepsis, including 1 with a concurrent central nervous system infection. No fecal incontinence was observed in any of the patients. PA in infants may be a self-limiting disease. CM should be the first-line approach in most cases of PA in infants.

Frequency, Clinical Presentation, and Management of Bartholin's Abscess: A Case Study Conducted at Rabia Balkhi Hospital, Afghanistan in 2022

Frequency, Clinical Presentation, and Management of Bartholin's Abscess: A Case Study Conducted at Rabia Balkhi Hospital, Afghanistan in 2022

Ultrasound-Guided Percutaneous Catheter Drainage in Periappendiceal abscess Management: Retrospective Insights.

To retrospectively evaluate the comparative efficacy and safety of percutaneous catheter drainage (PCD) combined with antibiotic therapy versus emergency laparoscopic surgery (ELS) for treating periappendiceal abscesses. A retrospective study was conducted on 90 patients diagnosed with periappendiceal abscesses at Harbin Hospital of Traditional Chinese Medicine between March 2022 and December 2023. The study compared clinical outcomes between two groups: one receiving percutaneous catheter drainage (PCD) with antibiotic therapy and the other undergoing emergency laparoscopic surgery. The comparison encompassed key outcomes such as operative time, gastrointestinal function recovery, length of hospital stays, postoperative complication rate, recurrence rate, and the need for additional interventions. The PCD group exhibited a significantly shorter operative time (P=0.02) and fewer postoperative complications (P=0.008) compared to the ELS group. During outpatient follow-up, six patients in the PCD group had a recurrence of appendicitis, which was statistically significant compared to the ELS group. Ultrasound-guided PCD has been shown to be effective and safe in the management of periappendiceal abscesses in our single-center clinical study. It offers several benefits over ELS, such as reduced operative time and a decreased incidence of postoperative complications. Our results suggest that PCD, in conjunction with antibiotic therapy, is a feasible alternative to surgery, significantly reducing patient discomfort and healthcare resource consumption. However, these findings are specific to our center, and further multicenter studies are required to confirm these results and to establish guidelines for the optimal application of PCD in clinical practice.

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.

Diagnostic Approach to Patients with Hepatic Abscess: A Case Report

Hepatic abscess is a severe infection characterized by pus accumulation within the liver, often caused by bacterial or amoebic pathogens. This case report discusses the diagnostic challenges and management of bilateral hepatic abscesses in a resource-limited setting. A 43-year-old male presented with right upper quadrant abdominal pain, jaundice, and systemic symptoms. Diagnostic investigations, including ultrasonography and contrast-enhanced CT scan, revealed abscesses in the right and left hepatic lobes. Laboratory findings showed leukocytosis, hypoalbuminemia, and elevated liver enzymes. The patient was treated with empiric antibiotics and underwent laparotomy for abscess drainage, yielding 1700 cc of pus. Postoperative recovery was uneventful, with significant clinical improvement. This study highlights the importance of a combined medical and surgical approach in managing complex hepatic abscess cases, particularly in settings with limited diagnostic resources. The findings emphasize early diagnosis, multidisciplinary care, and tailored treatment strategies to improve outcomes for patients with hepatic abscesses, especially in underserved regions.

Clinical presentation and surgical management of intra-abdominal abscesses: a retrospective study

BackgroundIntra-abdominal abscesses pose a significant challenge due to their complex nature, potential complications, and diagnostic difficulties. This retrospective study aims to assess the etiological factors, clinical presentations, diagnostic methods, and treatment outcomes associated with intra-abdominal abscesses.MethodsThis cross-sectional, retrospective study reviewed medical records of 47 patients diagnosed with intra-abdominal abscesses at Babol University of Medical Sciences, Iran, between 2011 and 2020. Data collected included demographic details, clinical and laboratory findings, imaging results, treatment methods, and patient outcomes.ResultsThe study included 47 patients, with a mean age of 47 years, comprising 20 females and 27 males. The most common symptoms were abdominal pain (85.1%), fever (61.7%), and anorexia (59.57%). Contrast-enhanced CT scan was the predominant diagnostic tool used (55.31%), followed by ultrasound (34.04%). Most abscesses were intraperitoneal (70.21%) and of gastrointestinal origin (61.7%), with appendicitis being the leading cause. Open surgery was the most common treatment method (65.95%), with a higher complication rate observed in surgical cases. There was a significant association between previous surgical history and the development of gastrointestinal abscesses (P = 0.004). No significant differences were found between abscess origin and demographic factors, treatment methods, or complications (p > 0.05).ConclusionIntra-abdominal abscesses are commonly associated with non-specific symptoms and are most frequently intraperitoneal, originating from gastrointestinal pathology. CT scan remains the gold standard for diagnosis, and open surgery is often required for treatment. The findings underscore the importance of timely diagnosis and individualized treatment strategies, to minimize complications and improve outcomes.

Laryngeal Abscess: A 34-Year Review

This study aimed to investigate the frequency, clinical-epidemiological characteristics, and management of laryngeal abscesses in our hospital setting. We included all patients treated for primary laryngeal abscesses in the Otorhinolaryngology Department of a tertiary hospital over a 34-year period. Patients with abscesses believed to have originated from adjacent regions were excluded. Thirteen patients with laryngeal abscesses were identified, with epiglottitis being the most common etiology (61%). Three patients were immunosuppressed. Four patients required urgent tracheotomy, and one underwent cricothyrotomy due to upper airway obstruction. All cases were drained under general anesthesia via a transoral route. Five patients required admission to the intensive care unit, and two experienced severe complications. There were no fatalities. Laryngeal abscesses are rare, with epiglottitis being the predominant cause. These cases pose a high risk of upper airway obstruction, highlighting the importance of early diagnosis and prompt treatment by a multidisciplinary team to prevent complications.