Pelvic Abscess Research Articles

NOT FOR VETERINARIANS ONLY: A VERY RARE CASE OF PYOMETRA IN AN ELDERLY FEMALE

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Pyometra is a very rare but serious and potentially life threatening condition. It is defined as an accumulation of purulent material within the uterine cavity. It is a common presentation in the veterinary world however exceedingly rare in humans. CASE PRESENTATION: This is a 72-year-old female who presented to the emergency room with complaint of suprapubic abdominal pain and fullness. She reports having mild abdominal pain and fullness for 3 months however it progressively became worse over 2 weeks prior to presentation. She reported the pain to be very severe and sharp in nature. She denied any fever, chills, weight loss, dysuria, or vaginal discharge. In the ER CT of the abdomen and pelvis was obtained which revealed an intrauterine mass measuring 9.7x9.8x10.5 cm. Laboratory workup revealed leukocytosis with white blood cell count of 17.05x10^3. All other pertinent labs were within normal limits. She was transferred to our hospital and admitted to the medical floor. A pelvic ultrasound was then obtained which again revealed an enlarged uterus with a complex cystic appearing lesion. Ob/Gyn was consulted and she underwent a Pap smear and endometrial biopsy with culture. Pathology was negative for any malignancy however culture did grow streptococcus viridans. Patient was started on clindamycin and levofloxacin per infectious disease recommendations. She was then transferred to the intensive care unit as she became hypotensive and was then started on norepinephrine drip. Patient then underwent a dilatation and curettage which revealed copious amounts of purulent drainage in the uterus. Cultures again grew streptococcus viridans and she was continued on antibiotics. A repeat CT abdomen and pelvis was obtained which showed resolution of lesion. Patient remained in the ICU for monitoring and on postoperative day 4 went into cardiac arrest and subsequently deceased. DISCUSSION: Pyometra is reported to occur in 0.1-0.2% of all gynecologic patients [1]. The condition is commonly caused by malignant or benign tumors, radiation cervicitis, atrophic cervicitis or with the use of an intrauterine device. The classic triad of symptoms are vaginal discharge, postmenopausal bleeding and lower abdominal pain, however >50% of patients can be asymptomatic [2]. Pubmed literature review will reveal only a handful of such cases that have been reported. Most common microorganisms causing pyometra are E.coli and bactericides fragilis. A recent case report with literature review revealed a mortality rate of 22.2% [3]. Most suggest a CT scan and a pelvic ultrasound to obtain an accurate diagnosis and prompt initiation of antibiotics along with drainage of the pyometra. CONCLUSIONS: Pyometra is exceedingly rare however life threatening. This case illustrates the severity of the condition requiring prompt recognition and treatment. REFERENCE #1: Khan A, Prasad J. Perforated Pyometra Presenting As A Pelvic Abscess: A Case Report. International Journal of Case Reports and Images. 2012;3(2):10-14 REFERENCE #2: Schmiech K, Woods C, Hylton J, et al. Case Report: Recurrent Pyometra in an Adolescent. Journal of Pediatric and Adolescent Gynecology. 2020 October;33(5):574-576 REFERENCE #3: Uno K, Tano S, Yoshihara M, et al. A Case Report and Literature Review of Spontaneous Perforation of Pyometra. Journal of Emergency Medicine. 2016 May;50(5):231-236 DISCLOSURES: No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Rahul Dadhwal, source=Web Response No relevant relationships by Jared Head, source=Web Response No relevant relationships by Aisha Mujahid, source=Web Response No relevant relationships by Salim Surani, source=Web Response

S3073 A Rare Cause of Repeat Hemorrhage: When Cytomegalovirus Hides in the Small Bowel

Introduction: Cytomegalovirus (CMV) is an opportunistic infection typically seen in immunocompromised patients, like those with Human Immunodeficiency Virus (HIV) or organ and stem cell transplant recipients. CMV infections are exceedingly uncommon in the immunocompetent duodenum. We describe such a case, confirmed with biopsy and complicated by severe repeated gastrointestinal hemorrhage. Case Description/Methods: A 74-year-old male with PMH of diabetes, bladder cancer (status-post resection and ureteral stent placement), presented to the ED with general malaise. Was found to meet sepsis criteria and was anemic with bright red blood on rectal exam. CT abdomen and pelvis revealed multiple pelvic abscesses and free air. Stool testing was positive for C. diff and oral vancomycin and IV zosyn were started. Patient was admitted to telemetry and required 3 separate units pRBC for persistent anemia. CTA abdomen performed on day 3 revealed a duodenal bleed. IR performed an embolization, however, patient remained unstable and required intubation and pressors. Anemia continued to worsen, and patient received an additional 2 units pRBC. GI performed a bedside EGD revealing a large clot and duodenal ulcer. Sepsis continued to worsen, and antibiotics were broadened to meropenem and vancomycin. Anemia continued to worsen, and an additional EGD was performed with source control reported. Patient was extubated, and shortly thereafter, had melena, so a final EGD was performed, identifying friable mucosa and a bleeding duodenal vessel. Hemospray and a clip were deployed to contain bleeding, and the patient received a seventh unit of blood. Biopsied duodenal tissue stain showed CMV (Figure 1A) and histology revealed inclusions (Figure 1B), so ganciclovir was started. Recurrent bleeding subsequently resolved, and patient was discharged to subacute rehabilitation to complete a course of IV ganciclovir. Discussion: Though rare in immunocompetent patients, CMV infections should be considered in severe or persistent gastrointestinal bleeds. CMV duodenitis, while very uncommon, has been documented in case reports and is associated with ischemia and massive hemorrhage. In this case, the patient ultimately required seven units of blood, intubation, and numerous endoscopic procedures as a result of CMV duodenitis. Clinical improvement was seen only once the underlying infection was treated and illustrates the need to consider CMV infection in the differential for recurrent gastrointestinal bleeding.Figure 1.: A: Immunohistochemical stain of tissue from duodenal biopsy identifying CMV. B: Histology of duodenal tissue biopsy under high power showing CMV inclusions.

S1934 Acute Colonic Ischemia: A Rare Complication of Stevens-Johnson Syndrome

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions characterized by necrotic epidermal detachment and blister formation. Mucosal involvement of oropharyngeal, ocular, and urogenital surfaces is most common, but involvement of the small bowel and colon is distinctively rare. We present a unique case of SJS with colonic involvement resulting in acute colonic ischemia. Case description/methods: A 36 year-old female with systemic lupus erythematosus, hypertension, and asthma presented with one day of fever and emesis after taking ibuprofen for sore throat. On admission, she was febrile to 104°F. Laboratory evaluation was non-diagnostic. A diffuse pink morbilliform rash was noted, which rapidly progressed to widespread erythema, targetoid lesions, and bullae. Skin biopsy was consistent with SJS. A week into hospitalization, she developed respiratory failure requiring intubation and transfer to the intensive care unit. CT of the chest, abdomen, and pelvis revealed multifocal pneumonia but normal small and large bowel. She was treated with broad spectrum antibiotics and one dose of subcutaneous etanercept. The patient then developed worsening abdominal pain and distension. Repeat abdominal CT showed marked diffuse colonic distension with pneumatosis from the cecum to proximal transverse colon (Fig. 1). Abdominal arterial vasculature was patent. Exploratory laparotomy confirmed full thickness colonic ischemia. She underwent right and transverse colectomy with end ileostomy. Histology of the colonic mucosa was consistent with ischemia. She was started on IVIG and IV methylprednisolone therapy. The patient gradually improved. Her recovery was complicated by intra-abdominal and pelvic abscesses requiring percutaneous drainage, along with persistent abdominal pain. Further evaluation of her pain included a normal ileoscopy and upper endoscopy and an abdominal CT demonstrating enteritis which was managed with supportive care. The patient was ultimately discharged to a rehabilitation facility. Discussion: SJS/TEN is a potentially fatal and often drug-induced dermatologic reaction involving mucocutaneous membranes. We present a case of SJS thought secondary to ibuprofen use resulting in acute colonic ischemia, which is infrequently encountered and associated with significant morbidity. Clinicians must maintain high suspicion for gastrointestinal involvement of SJS/TEN to allow for prompt diagnosis and intervention.Figure 1.: Colonoscopy revealing a 5 cm polypoid mass at the hepatic flexure.

S1879 Management of Large Left Pelvic Abscess Secondary to Acute Diverticulitis

S1879 Management of Large Left Pelvic Abscess Secondary to Acute Diverticulitis

A Case Series of Complex Pelvic Abscesses: Importance of Early Recognition and Institution of Individualised Treatment

Pelvic abscesses are collections of pus localized within the pelvic cavity. It may arise from intraabdominal abnormalities or a cranial extension of deep anorectal sepsis. Early recognition and diagnosis, often challenging, facilitates expedient definitive management of potential life-threatening sepsis. We describe the clinical presentation of three patients diagnosed with pelvic abscesses. The management strategies employed for each patient differed, and we described a patient-centred approach to address the underlying problem. Clinical suspicion and meticulous clinical assessment are essential for accurate and early diagnosis. Radiological and laboratory investigations can be helpful to confirm the diagnosis and aid in planning for its immediate management and subsequent definitive treatments. Meticulous attention should be paid to identifying the problem, as this will determine the best management strategy. By addressing the underlying problem adequately, we would avoid future recurrence. A pelvic abscess can be diagnosed early with a high clinical index of suspicion and confirmed with appropriate investigations. Complex pelvic collections can originate from various sources, and establishing the exact aetiology may often be difficult. A multidisciplinary approach to holistic and patient-centred care effectively achieves good patient outcomes.

Metastatic urothelial carcinoma to the colon presenting with pelvic abscess tracking to the right hip joint.

Metastatic urothelial carcinoma to the colon presenting with pelvic abscess tracking to the right hip joint.

Minimally invasive treatment of paracolar abscesses in acute diverticulitis

The OBJECTIVE was to study the informative value of ultrasound examination in patients with paracolar abscess, to evaluate the therapeutic and diagnostic effectiveness of minimally invasive treatment of abdominal and pelvic abscesses in this pathology. METHODS AND MATERIALS. In the period from 2016 to 2021, 85 patients who underwent minimally invasive drainage of paracolar abscesses were treated under ultrasound and RTV guidance. In 72 (84.7%) patients, the diagnosis was confirmed on MSCT. Transvaginal ultrasound was performed in 12 (14.1%) patients, and transrectal ultrasound was performed in 25 (29.4%) patients. In 18 (21.1%) cases, the diagnosis was determined on pelvic MRI. RESULTS. Diverticulitis in 65 (76.4 %) patients led to the development of paracolitis, with the formation of intraperitoneal and retroperitoneal inflammatory infiltrates in 40 (47 %) patients and in 25 (29.4 %) patients. Percutaneous drainage was performed in 85 cases. By volume, the abscesses were divided as follows: in 19 (22.3 %) patients, dimensions were 8–10 cm; in 42 (49.4 %) patients, dimensions were 5–8 cm; in 24 (28.2 %) patients, dimensions were up to 5 cm. The most severe group consisted of patients with an abscess volume of 8 to 10 cm. The duration of standing drains in patients with sizes 8–10 cm was 16–18 days, with sizes 5–8 cm–10–14 days, with sizes up to 5 cm – no more than 10 days. Rdical surgical treatment was performed in 15 (17.6 %) patients. CONCLUSION. A paracolar abscess is an indication for its minimally invasive drainage. We considered the technique of minimally invasive drainage as a possible «bridge» to elective surgery for diverticular disease of the colon. Ultrasound examination has a high sensitivity and specificity in diverticular disease of the colon. This makes it possible to use it not only as a method of primary examination and minimally invasive drainage of the abscess, but also as a way to objectify the dynamics of the affected area of the colon.

Live surgery of colorectal endometriosis broadcasted from a surgeon's routine operating theater is not associated with higher complications rate.

Although live surgeries are routinely included in surgical congress programs, they are the subject of an ongoing debate in terms of patient safety and teaching value. The goal of our study was to assess the risk of postoperative complications related to live surgery broadcast from the surgeon's routine theater, in patients managed for deep endometriosis infiltrating the digestive tract. We report a retrospective comparative study, enrolling women managed for colorectal endometriosis by a gynecologic surgeon, from September 2013 to March 2020 in two referral centers. We compared the rate of postoperative bowel fistula in women managed during live surgery in the routine operating theater, with that observed in women for whom surgery was not broadcast. Among 813 women, 33 (4.1% of cases) underwent surgical procedures transmitted live to various conference rooms located outside the hospital and were compared with 780 patients who underwent non-broadcast surgery. Women's age, body mass index, past surgical and obstetrical history, and major preoperative complaints were comparable. Cases presented with impaired constipation score, more frequent sciatic pain, and infiltration of the vagina, whereas overall revised American Fertility Society classification scores were more severe in controls. The rate of rectal nodules over 3cm in size was comparable between the two groups (72.7% in cases vs. 72.1% in controls). Operative time was also comparable (153±52 minutes vs. 148±79minutes). Cases were more frequently managed by disk excision of rectal nodules (63.7% vs. 30.3%), and more frequently involved the sacral plexus (18.2% vs. 7.3%). Postoperative complications were comparable between the two groups, in terms of bowel fistula (3% in the live surgery group vs. 4.1% in controls), pelvic abscess requiring secondary laparoscopy (3% vs. 4.9%), or bladder dysfunction requiring self-catheterization after discharge (6.1% vs. 5.3%). Performing laparoscopic management of colorectal endometriosis with live transmission of surgery from a surgeon's routine operating theater, is not related to a higher risk of major postoperative complications.

Atraumatic splenic rupture secondary to complicated diverticulitis with pelvic abscess.

ANZ Journal of SurgeryVolume 92, Issue 4 p. 894-896 IMAGES FOR SURGEONS Atraumatic splenic rupture secondary to complicated diverticulitis with pelvic abscess Sean S. W. Park BMed/MD, MClinEpid, MSc, Corresponding Author Sean S. W. Park BMed/MD, MClinEpid, MSc [email protected] orcid.org/0000-0001-6902-0446 Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Correspondence Dr. Sean S. W. Park, Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia. Email: [email protected] Contribution: Conceptualization, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorHock Cheah BMed, Hock Cheah BMed Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Resources, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorHaisley Formosa BMedSc, MD, Haisley Formosa BMedSc, MD Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Data curation, ResourcesSearch for more papers by this authorPaul Chen BHB, MBChB, MS, FRACS, Paul Chen BHB, MBChB, MS, FRACS Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Conceptualization, Supervision, Validation, Writing - review & editingSearch for more papers by this author Sean S. W. Park BMed/MD, MClinEpid, MSc, Corresponding Author Sean S. W. Park BMed/MD, MClinEpid, MSc [email protected] orcid.org/0000-0001-6902-0446 Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Correspondence Dr. Sean S. W. Park, Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia. Email: [email protected] Contribution: Conceptualization, ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorHock Cheah BMed, Hock Cheah BMed Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Resources, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorHaisley Formosa BMedSc, MD, Haisley Formosa BMedSc, MD Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Data curation, ResourcesSearch for more papers by this authorPaul Chen BHB, MBChB, MS, FRACS, Paul Chen BHB, MBChB, MS, FRACS Discipline of General Surgery, Gosford District Hospital, Gosford, New South Wales, Australia Contribution: Conceptualization, Supervision, Validation, Writing - review & editingSearch for more papers by this author First published: 02 September 2021 https://doi.org/10.1111/ans.17184Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume92, Issue4April 2022Pages 894-896 RelatedInformation

Management of postoperative complications after laparoscopic left hemicolectomy: an approach in modern times after incorporation of indocyanine green and full mobilization of the splenic flexure.

The aim of this study was to report our experience in the management of complications after laparoscopic left hemicolectomy (LLH) after the incorporation in our clinical practice of intraoperative indocyanine green (ICG) fluorescence angiography (FA). In our last period after incorporation of ICG-FA, 277 unselected consecutive patients underwent laparoscopic colorectal surgery with this technology. Ninety-seven (35%) right hemicolectomy, 19 segmental resection of the splenic flexure (6.9%), 54 anterior resection of the rectum (19.5%) and 107 LLH (38.6%) were performed. Complications were graded according to Clavien-Dindo classification, and anastomotic leakages (AL) were graded according to Clavien-Dindo classification and to International Study Group of Rectal Cancer (ISGRC) classification. Eight surgical and one medical complications (8.4%) were observed. Two AL occurred (1.9%). One drained spontaneously by drainage placed intraoperatively (Clavien-Dindo I, ISGRC A) and one treated by laparoscopic peritoneal lavage, leakage suture and ileostomy (Clavien-Dindo III-b, ISGRC C). Other complications were: wound infection (Clavien-Dindo II) (2); postoperative anemia caused by rectorrhagia (Clavien-Dindo II) (2); pelvic abscess between bladder and uterus (Clavien-Dindo III-a) (1); hemoperitoneum secondary to inferior mesenteric artery bleeding treated with peritoneal lavage and hemostasis (Clavien-Dindo III-b) (1); atrial fibrillation (Clavien-Dindo II) (1). All complications have been resolved. The complication rate after LLH after the incorporation of ICG-FA is low, since the number of AL have dramatically decreased in comparison to our previous experience. The management of these patients proved to be safe and effective due to in all cases the complication has been resolved. Further studies are required to standardize the management of these patients.

V12-11 THE EFFECT OF VESICOPEXY ON URINARY CONTINENCE RECOVERY FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-11 THE EFFECT OF VESICOPEXY ON URINARY CONTINENCE RECOVERY FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: TECHNIQUE AND OUTCOMES Alireza Ghoreifi, Wesley Yip, Kian Asanad, Marissa Maas, Guadalupe Gonzalez, Jamal Nabhani, and Hooman Djaladat Alireza GhoreifiAlireza Ghoreifi More articles by this author , Wesley YipWesley Yip More articles by this author , Kian AsanadKian Asanad More articles by this author , Marissa MaasMarissa Maas More articles by this author , Guadalupe GonzalezGuadalupe Gonzalez More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is a challenging issue in patients undergoing robotic-assisted radical prostatectomy (RARP). Multiple techniques that aim to restore normal lower urinary tract anatomy have been proposed to improve postoperative continence. The aim of this video is to present a new technique of vesicopexy and its effect on early postoperative urinary continence recovery in patients undergoing RARP with an anterior approach. METHODS: In this technique, following the completion of the urethrovesical anastomosis, the bladder is fixed to the anterior abdominal wall using a 2-0 V-Loc™ barbed suture. Pelvic floor exercises using Kegel technique were recommended to all patients following catheter removal. Urinary continence was assessed using a pictorial pad usage questionnaire at 1 and 3 months postoperatively. Continence was defined as no or only safety pad usage. The illustrative case in the video is a 68-year-old male with prostate cancer, who underwent RARP with vesicopexy using the Da Vinci Xi robot platform. We also report the feasibility and outcomes of this technique in 60 consecutive patients who underwent RARP and vesicopexy between March 2019 and December 2020. RESULTS: A total of 60 patients were included in the pilot study. The median age was 65 years, and median body mass index was 28. The median preoperative International Prostate Symptom Score was 10. 12 (20%) patients underwent a bladder neck reconstruction, and nerve sparing was performed unilaterally in 24 (40%) and bilaterally in 24 (40%) patients. Salvage surgery was performed in one patient following failed cryotherapy. The remainder of the baseline and clinical features of the patients are shown in Table 1. At 1- and 3-month follow-ups, continence rates were 52% and 85%, respectively. Postoperative complications were seen in 5 (8.3%) patients (3 urine leak, 1 pelvic abscess, and 1 urinary retention) that were managed medically/conservatively. CONCLUSIONS: Vesicopexy is a safe, feasible and simple technique that may lead to a satisfactory recovery of early continence in patients undergoing RARP with an anterior approach. The next step is to evaluate this technique through a randomized controlled trial. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1027-e1027 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Wesley Yip More articles by this author Kian Asanad More articles by this author Marissa Maas More articles by this author Guadalupe Gonzalez More articles by this author Jamal Nabhani More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Loading ...

Pelvic actinomycosis: A confusing diagnosis.

Introduction and importanceActinomycosis is a rare chronic and suppurative infection caused by anerobic Gram Positive bacteria: actinomyces. Pelvic location is extremely rare, usually associated with history of IUD contraception and doesn't have specific signs. Pelvic actinomycosis diagnosis may be confused with pelvic gynecologic malignancies or abscess. We present a retrospective and descriptive study of twelve patients with pelvic actinomycosis diagnosed and managed in our department from January 2000 to December 2011.Cases presentationThe patients' mean age was 47 years. 75% of them had a history of IUD for a mean period of 8,44 years. Pelvic pain was the most common complaint. In four cases, pre-operative clinical presumption was tubo-ovarian abscess. Gynecologic malignancies were suspected in 8 patients. Pelvic actinomycosis management was based on surgery and long-term antibiotic.Clinical discussionPelvic actinomycosis is an extremely rare chronic infection, presenting 3% of human actinomycosis. Common clinical presentations include vaginal discharge, tubo-ovarian abscess and pelvic tumors mimicking gynecologic malignancies. It is difficult to diagnose. Association with IUD history was recognized. Management is based on surgery and long-term antibiotic administration.ConclusionPelvic actinomycosis is an extremely rare chronic infection. This entity is difficult to diagnose. Accurate diagnosis can reduce complications and unnecessary surgeries, and can preserve fertility.

Drenaje percutáneo transglúteo

Background: Percutaneous drainage is an alternative to surgery in the management of pelvic abscesses. The aim of this study is to evaluate the safety and efficacy of the transgluteal approach. Material and methods: Transgluteal percutaneous drainages were performed by 3 surgeons using computed tomography guidance. The Seldinger technique was used with 8 Fr and 10 Fr catheters under local anesthesia. Drainage was considered successful if the abscess regressed and did not recur. Results: Mean age was 49.2 years. Escherichia coli was the most common microorganism identified. In 50% of the cases, the abscesses occurred postoperatively. Mean duration of drainage was 9.2 days. Drainage was successful in all the cases and there were no major complications. Conclusion: Transgluteal computed tomography-guided approach is safe and well-tolerated for the treatment of deep pelvic abscesses

Risk factors for surgical site infection and association of surgical site infection with survival of lower rectal cancer patients without clinical lateral pelvic lymph node metastasis (clinical Stage II/III): Analysis of data from JCOG0212

This study aimed to examine the risk factors for surgical site infection (SSI) and the association of that with recurrence in JCOG0212. The results for secondary endpoints showed that compared with the mesorectal excision (ME) alone group, ME with lateral lymph node dissection (LLND) group showed significantly longer operative time and significantly higher blood loss. These results suggested that LLND was a risk factor for SSI. All 701 patients registered in JCOG0212 were analyzed in this study. Wound infection was defined as incisional/deep SSI, and pelvic abscess and anastomotic leakage were defined as organ/space SSI. The risk factors for the incidence of SSI and the effect of SSI on relapse-free survival (RFS) were investigated. Multivariable odds ratio of Grade 2 or higher all SSI was 0.58 [95% Confidence interval: 0.36–0.93] for female (vs. male) and that of Grade 2 or higher incisional/deep SSI was 2.24 [1.03–4.86] for blood infusion. For RFS, patients with Grade 3 or higher all SSI showed poor prognosis (multivariable hazard ratio: 1.66 [1.03–2.68]). LLND is not significant factor for the incidence of all SSI. Male sex might be a risk factor of Grade 2 or higher SSI, and blood transfusion is a possible risk factor of Grade 2 or higher incisional/deep SSI. Grade 3 or higher all SSI might be a significant worse prognostic factor for lower rectal cancer.

Implementation of a broader pre-operative antibiotic coverage and chlorhexidine irrigation associated with a lower postoperative surgical site infection

<h3>Objectives:</h3> Post-operative surgical site infections (SSI) cause major health and economic burden on the patients and the healthcare systems. Multiple risk factors such as obesity and medical comorbidities are known to increase the risk of SSI in gynecologic oncology patients. Commonly used preoperative antibiotic regimens focus on targeting the skin flora as described by the enhanced recovery protocols adopted by many hospitals. We sought to investigate the effect of the addition of metronidazole to the preoperative antibiotic regimen and the intraoperative pelvic irrigation with 0.05 % chlorhexidine gluconate (CHG) on the rate of SSI after a minimally invasive surgery in gynecologic oncology. <h3>Methods:</h3> After IRB approval, we collected data from June 2018 to January 2020 for patients who underwent minimally invasive gynecologic oncology surgery at Marshall University School of Medicine. Implementation of the infection control model (pre-operative Metronidazole + intraoperative CGH pelvic irrigation) started in July 2019. Demographic and medical data, as well as intraoperative and postoperative data, were collected. The rate of SSI was analyzed before and after adoption of the model. <h3>Results:</h3> A total of 508 patients underwent a minimally invasive gynecologic oncology procedure: 262 before the implementation of the infection control model and 318 afterward. The median age of the patients was 59 years old and the rate of comorbidities was equal between the groups. The rate of SSI before the implementation of the model (Group 1) was 2.29% (6/262) and the rate of SSI afterward (Group 2- post infection control model) was 0.94% (3/318). The most common bacteria isolated from the first group were gram-negative bacilli (Klebsiella and E. Coli) and anaerobes, while Group 2 had a single patient with Klebsiella infection, one Bacteroides species infection, and one MRSA infection. All of these infected patients required pelvic abscess drainage and hospital readmission for intravenous antibiotics, with an average of 2-day hospital stay. <h3>Conclusions:</h3> The addition of metronidazole to the preoperative antibiotics regimen and the intraoperative pelvic irrigation with 0.05 % CHG appears to decrease the rate of SSI after a minimally invasive gynecologic oncology surgery. This model merits further studying in order to validate these results.

Magnetic Resonance Imaging Artifact Elimination in the Diagnosis of Female Pelvic Abscess under Phase Correction Algorithm.

In order to explore the effect of magnetic resonance imaging (MRI) based on phase correction algorithm in diagnosing female pelvic abscess, firstly, the effect of phase correction algorithm on eliminating MRI image motion artifacts was studied, then it was applied to 71 female pelvic cases admitted to our hospital in the diagnosis of abscess patients with magnetic resonance imaging technology, and the results were compared with the results of multislice spiral CT and laparoscopy to explore the accuracy of MRI and CT. It was found that the results of MRI examination were close to those of laparoscopy, and the difference was not statistically significant (P > 0.05); the results of CT examination and laparoscopy were significantly different, and the difference was statistically significant (P < 0.05); in addition, the results of CT examination, the number of bacterial cysts (43 cases) and tuberculous cysts (12 cases), were significantly lower than the results of MRI (50 cases, 18 cases), and the difference was statistically significant (P < 0.05). The size of the mass shown by the MRI examination (4.1 cm × 4.2 cm × 3.9 cm～13.9 cm × 9.5 cm × 8.7 cm) was larger than the size of the mass revealed by the CT examination (5.2 cm × 4.3 cm × 4.1 cm～15.5 cm × 10.1 cm × 9.6 cm), the difference between the two was statistically significant (P < 0.05), and it was closer to the results of laparoscopic pathology (4.1 cm × 4.3 cm × 3.9 cm～14.1 cm × 9.3 cmP < 0.058.7 cm). In short, the phase correction algorithm could eliminate the motion artifacts of MRI images. In the imaging diagnosis of female pelvic abscess, the MRI diagnosis based on the phase correction algorithm is more ideal than the diagnosis of multislice spiral CT. It can be used as a reference basis for clinical disease treatment.

Influence of Covid -19 on the management of Appendicitis

Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic

THE EARLY RESULTS OF RADICAL SURGERY IN TREATMENT OF RECTAL CANCER

Objectives: To evaluate the early result of radical surgical treatment of rectal carcinoma. Subjects and methods: Longitudinal follow-up study on 109 patients diagnosed with rectal carcinoma who were surgically treated at Department of colorectal and perineal surgery, Viet Duchospital from October 2016 to May 2019. Results: Complications of anastomotic leakage (2.75%). Postoperative bleeding (1.83%). Abdominal wound infection (10.09%). Postoperative enteroplegia (5.50%). Urinary retention (4.59%). Intestinal obstruction (2.75%). Bladder leakage and psychosis both accounted for 1.83%. Intra-abdominal bleeding, pelvic abscess, acute pancreatitis all accounted for 0.92%. Parastomal hernia had a patient,accounting for 0.92%. There were 18.37% of patients relapse after surgery. There were 11.22% of patients with distant metastasis detected after surgery, the metastatic organs were liver and lung metastasises.Conclusion: Complications of radical surgery for rectal cancer were mainly anastomic leakage, wound infection, postoperative enteroplegia. The postoperative recurrence rate was 18.37% in allfollowing (11.22% of patients had distant metastases after surgery).

A meta-analysis of low Hartmann's procedure versus abdominoperineal resection for non-restorative treatment of rectal cancer.

Non-restorative surgery for rectal cancer is indicated in patients with comorbidities, advanced disease and poor continence. The aim of this meta-analysis was to compare the postoperative morbidity of Hartmann's procedure (HP) with that of extrasphincteric and intersphincteric abdominoperineal resection (APR) in the treatment of rectal cancer. The Medline, Embase and Cochrane databases were searched for publications comparing postoperative morbidity of HP and APR. The incidence of overall surgical complications, pelvic-perineal complications and pelvic abscess was analysed as primary endpoints. Readmissions requiring reintervention and postoperative mortality were also compared. A cumulative analysis showed a significantly higher rate of overall complications (odds ratio (OR) 0.553, 95% confidence interval (CI) 0.320 to 0.953 and P value 0.033) and pelvic-perineal complications (OR 0.464, 95% CI 0.250 to 0.861 and P value 0.015) after APR. The incidence of isolated pelvic abscess formation was significantly higher after HP (OR 2.523, 95% CI 1.383 to 4.602 and P value 0.003). A subgroup analysis of intersphincteric APR compared with HP did not show any significant difference in the incidence of overall complications, pelvic-perineal complications or pelvic abscess formation (P values of 0.452, 0.258 and 0.100, respectively). There was no significant difference in readmissions, reinterventions and mortality after HP and APR (P 0.992, 0.198 and 0.151). An extrasphincteric APR is associated with higher overall and pelvic-perineal complications and may be reserved for tumours invading the anal sphincter complex. In the absence of sphincter involvement, both HP and intersphincteric APR are better alternatives with comparable morbidity.

Experience with Percutaneous Drainage of Body Fluids in a Tertiary Center in Benin City

Background: Percutaneous drainage is the evacuation of body fluids either using needle aspiration or by catheter placement under imaging guidance. Abnormal collections in the body which may be idiopathic, postinfectious, posttraumatic, or postsurgical (iatrogenic) can be free (e.g., ascites) or loculated (e.g. cysts and abscesses). Most cases of significant fluid accumulation require evacuation. Interventional radiology offers treatment and even cure to such patients who may be too ill to withstand surgery or not able to afford the cost of open surgery. The aim of this article is to review the common percutaneous drainage procedures done in the Radiology department of the University of Benin teaching hospital. Materials and Methods: A retrospective analysis of percutaneous drainage requests to the department of radiology of the hospital from January 2017 to march 2020 was performed. Data on age, gender, clinical diagnosis, the radiologic findings, procedures, and instrumentation utilized were retrieved and analyzed using IBM SPSS version 23. Results: A total of 49 patients' data were recruited for this study; 40 (81.6%) were female. The most common indication for intervention was liver abscess (14.3%), followed by liver cyst, endometriosis, obstructive jaundice, and pelvic abscess. The IV cannula/sheath was the most widely used instrument, followed by the pigtail catheter. All patients had their procedures done under antibiotic cover and the cases of hepatic cysts had albendazole added to their drug regimen. Conclusion: Despite the limited availability of resources for interventional radiology, basic procedures like cyst and abscess drainages can be successfully carried out using available materials and catheters.