Spontaneous Drainage Research Articles

Management of acute rectal problems in leukemic patients.

In the interval 1944-1983, 54 patients with leukemia and acute rectal pathology were seen at our institution, including: 25 patients with perirectal abscesses and/or fistulas (PF/F), 16 patients with acutely prolapsed or thrombosed hemorrhoids, 11 patients with anal fissures with or without hemorrhoids, and 2 patients with perianal excoriations. In the past, concerns have been raised about development of septicemia secondary to diagnostic or therapeutic instrumentation. In only 4 of 54 cases did the clinical course clearly suggest digital examination or instrumentation of the rectum may have caused bacteremia though 13 of 54 patients had positive blood cultures for gram negative organisms at some time during their course of which 7 were clearly coliform. Most (42/54) patients were treated initially by sitz baths, suppositories, and stool softeners and/or antibiotics. We observed five patients only and treated two by radiotherapy. Eleven patients required surgical intervention for thrombosed hemorrhoids and perirectal abscess and/or fistulas. Eight other patients with PA/F drained spontaneously. Poor healing after surgical or spontaneous drainage was documented in only one case. This study suggests that sitz baths, suppositories, antibiotics, and judicious surgical drainage (where needed) form the core of therapy for these patients.

Intrahepatic Biliary Tract Abnormalities in Children with Corrected Extrahepatic Biliary Atresia

SummaryThree children with surgically corrected extrahepatic biliary atresia developed recurrent cholangitis associated with bile lakes that failed to drain via the hepa‐toportoenterostomy. Surgical or percutaneous drainage of these cysts was followed by both resolution of the infection and spontaneous internal drainage. We postulate that the ongoing inflammatory process resulted in intrahepatic biliary obstruction, which caused cholangitis and bile cysts. Successful treatment required not only antibiotics but drainage of the bile lakes. Development of bile cysts is a new cause of recurrent cholangitis seen in extrahepatic biliary atresia.

Spontaneous regression of a dentigerous cyst in a middle-aged adult

Follicular cysts associated with impacted teeth in adults usually increase in size or remain static. A case is presented in which a typical dentigerous cyst decreased in size without any subjective or objective evidence of spontaneous drainage.

Perirectal infections in acute leukemia. Improved survival after incision and debridement.

During a 6-year period, 16 (7.9%) of 202 patients with acute leukemia of both the lymphocytic and nonlymphocytic types developed perirectal infections. All patients were febrile and severely neutropenic (14 patients had absolute neutrophil counts of less than 100/mm3). Lesions were painful and indurated but lacked fluctuance. Urinary retention, peritoneal signs, and extension of the infection to the genitalia were common. Eleven patients had bacteremia, and an average of 2.1 enteric bacteria were recovered from samples of abscess fluid or blood. Perirectal lesions were operatively incised and debrided (10 patients), unless spontaneous drainage occurred (5 patients). These 15 patients became pain-free in less than 48 hours and afebrile in 2 to 8 days. Drained lesions healed in all. Thirteen of fifteen patients left the hospital, whereas 2 died in the hospital of unrelated causes. The only patient whose lesion was not drained died of continuous bacteremia. Early incision and debridement contributed to our patients' improved survival.

Proctocolectomy without ileostomy: ileo-anal anastomosis with an ileal reservoir.

Six patients with polyposis coli and five with chronic ulcerative colitis underwent total colectomy and mucosal proctectomy with preservation of the anal sphincter and levator ani muscle. An ileal reservoir, constructed from the terminal ileum, is brought out through the anal sphincter for anastomosis to to the anus at the dentate line. Two patients in the series had a three-limb reservoir with anastomosis of a short efferent ileal limb to the anus (Parks technique). Nine patients had a two-limb J-shaped reservoir with the apex of the reservoir anastomosed to the anus (Utsunomiya technique). All patients had a temporary defunctioning ileostomy. There were no deaths. Two patients suffered from severe infection within the rectal muscle cuff. One resolved completely with spontaneous drainage into the reservoir; the other had continuing sepsis and eventually required excision of the anus and conversion to a continent ileostomy. All patients remain in good general condition with no disturbance of urinary or sexual function. Continence is satisfactory in all patients but two wear a pad at night. All evacuate their reservoirs spontaneously: none requires the use of a catheter. For most patients stool frequency varies from four to eight times daily but two patients have more frequent bowel motions. Colitis patients have more frequent bowel activity than those with polyposis. Three patients take Imodium tablets to lessen bowel frequency. The operation should be reserved for specialized centres and is still under trial; however, it appears likely to become the operation of choice for all patients with polyposis coli and for many patients with chronic ulcerative colitis.

Spontaneous drainage of cardiac tamponade

The case of a 23-year-old man with life-threatening pericardial tamponade resulting from a cardiac stab wound is presented. After initial attempts at stabilization failed to reverse the progressively worsening status of the patient, he was prepared for surgery. Just prior to induction of anesthesia, blood began to flow from the patient's chest tube, resulting in a return to a near normal hemodynamic status. This was believed to be the result of spontaneous drainage of cardiac tamponade prior to cardiorrhaphy. The patient was discharged ten days post admission in excellent health and was doing well at a one-month follow-up visit. The discussion includes what comprises definitive care for cardiac tamponade, and the controversy in the timing and appropriateness of pericardiocentesis.

CT Demonstration of spontaneous internal drainage of a Pancreatic Pseudocyst

Using CT, we recently studied a patient with a pancreatic pseudocyst. On subsequent examinations, this patient was shown to have undergone spontaneous drainage of the pseudocyst by way of the gastrointestinal tract. Such drainage is probably more frequent than previously realized. With the continued use of CT in the evaluation of pancreatic disease, we should see this phenomenon with increasing frequency.

Aspiration of Intrathoracic Abscess

Three cases illustrate that acute respiratory failure may be precipitated by spontaneous drainage of lung abscess or pleural empyema intrabronchially with diffuse aspiration of the contents bilaterally. This condition is especially hazardous if the cavity is large and the patient is debilitated or obtunded. The acute onset may mimic aspiration of gastric contents. Immediate studies of tracheal aspirate and roentgenograms of the chest should define the aspiration of intrathoracic abscess contents as the cause of acute respiratory failure.

Ultrasonic distinction of abscesses from other intra-abdominal fluid collections.

The nature of 103 intra-abdominal fluid collections examined by ultrasound was determined by autopsy, needle aspiration, spontaneous drainage or surgical exploration. Abscesses, chronic hematomas, lymphoceles, urinomas, cysts and fluid-filled bowel loops are all approximately elliptical or circular in cross section. Collections of ascites have a very irregular outline. Bowel loops appear as multiple circles, all of similar size. Chronic hematomas contain strongly echoing material, while lymphoceles, urinomas, renal and hepatic cysts and collections of ascites are echo-free. Ovarian cysts into which there has been bleeding may contain echoes. The walls of abscesses, chronic hematomas, and bowel loops are less sharp than the walls of other collections. Intrahepatic abscesses may have more ragged walls than abscesses elsewhere. Ultrasonic characteristics of abscesses and hematomas overlap. It is sometimes possible to distinguish the nature of the fluid by its ultrasonic properties, but atypical appearances are not rare.

A retroperitoneal cystic leiomyosarcoma spontaneously draining into the stomach

An unusual case of a retroperitoneal cystic leiomyosarcoma clinically resembling a pancreatic pseudocyst with subsequent spontaneous cystgastrostomy drainage is presented.

Spontaneous internal drainage of pancreatic pseudocysts

Six cases are reported in which spontaneous internal drainage between a pancreatic pseudocyst and the alimentary tract became established. In each instance the communication was demonstrated radiologically. The clinical circumstances and radiographic features of these cases are described, and the existing literature pertaining to this phenomenon is reviewed.

Effects of 5 juvenile hormone analogues applied topically to cattle naturally infested with Hypoderma larvae (Diptera: Oestridae).

Three yearlings in each of 5 groups were sprayed twice (36 days apart) with 0.1% concentration of juvenile hormone analogues. Some yearlings sprayed with (E)-4-[(6,7-epoxy-3,7-dimethyl-2-nonenyl)oxy]-1,2-(methylenedioxy) benzrne (Hoffman La Roche RO 20-3600); ethyl 10,11-epoxy-3,7,10,11-tetramethyl-2,6-dodecadienoate (Hoffman La Roche RO 8-4314); isopropyl (E,E)-11-methoxy-3,7,11-trimethyl-2,4-dodecadienoate (Zoecon ZR-515, methoprene); or (E)-6,7-epoxy-1-(p-ethylphenoxy)-3,7-dimethyl-2-octene (Stauffrr R-204158) developed enlarged warbles about 13 to 20 days after each dermal application. Warbles distended until their contents were discharged by spontaneous drainage. Exudates from these warbles varied from a thin, yellow fluid to a viscous, yellow semifluid. Skin lesions healed externally about 14 to 21 days after exudation ceased. Yearlings sprayed with methyl 10,11-cpoxy-7-ethyl-3,11-dimethyl-2,6-tridecadienoate (Hoffman La Roche RO 6-9550) did not develop enlarged warbles after the 1st or 2nd dermal application. No definitive changes developed in the biochemical or hematological values that were measured. Acute toxic effects were not observed in the cattle.

An unusual cause of recurrent chest pain

BY FAR the most common cause of pleural effusion in children is pulmonary infection. When infection is excluded as a cause of pleural effusion in a child, an uncommon or even rare cause must be sought. The case reported here was characterized by recurrent episodes of chest pain and pleural effusion. Bacterial infection was not present, and only after extensive studies did it become evident that the pleural effusion was caused by spontaneous drainage of pericardial effusion into the left pleural cavity through a congenital defect in the pericardium. Report of a Case A 12-year-old boy was transferred to Children's Medical Center with a four-day history of chest pain and orthopnea. He had not had any recent respiratory infection, fever, or chest trauma. Symptoms similar to current ones had occurred both 36 and 14 months earlier. During the latter illness, the boy had been hospitalized because of massive left pleural

An Unusual Cause of Recurrent Chest Pain

BY FAR the most common cause of pleural effusion in children is pulmonary infection. When infection is excluded as a cause of pleural effusion in a child, an uncommon or even rare cause must be sought. The case reported here was characterized by recurrent episodes of chest pain and pleural effusion. Bacterial infection was not present, and only after extensive studies did it become evident that the pleural effusion was caused by spontaneous drainage of pericardial effusion into the left pleural cavity through a congenital defect in the pericardium. Report of a Case A 12-year-old boy was transferred to Children's Medical Center with a four-day history of chest pain and orthopnea. He had not had any recent respiratory infection, fever, or chest trauma. Symptoms similar to current ones had occurred both 36 and 14 months earlier. During the latter illness, the boy had been hospitalized because of massive left pleural

Release of toxic agents in septic shock.

The presence of toxic factors in various forms of injury must have been obvious to prehistoric man when he first experienced the relief following spontaneous drainage of an abscess. Within a few hours, the tachycardia, sweating, feeling of weakness, and malaise disappeared, and he could not help but speculate on the toxic effects of pus, the subject that concerns us now. This dramatic systemic response to the drainage of an abscess is, I think, one of the most solid indicators of the possibility that a toxic agent emanating from an area of injured tissue is responsible for many of the systemic effects of sepsis. To this day, the most striking response seen in septic patients follows the drainage of an abscess, the removal of a septic uterus, or the amputation of a septic gangrenous leg.

Scalp abscess: A rare complication of fetal monitoring

Seven instances of scalp abscesses in newborninfants are described which seemed to be associated with the application of scalp electrodes for fetal monitoring during labor. The incidence of these abscesses is extremely low, occurring in 7 neonates out of a total of 2,003 who were monitored. One patient had 2 small pustules from which β-hemolytic streptococcus was isolated; the other 6 large abscesses must be considered sterile in light of the repeatedly negative bacteriologic cultures. The large, mostly bilateral abscesses were noted by the end of the first week of life and responded promptly to spontaneous or surgical drainage. The general condition of the neonates was always remarkably good. Maternal complications of labor, caput succedaneum, cephalhematoma, and lacerations of the scalp did not seem to play a role in predisposing to the formation of the abscesses. The pathogenesis of the scalp abscesses remains obscure. Seven instances of scalp abscesses in newborninfants are described which seemed to be associated with the application of scalp electrodes for fetal monitoring during labor. The incidence of these abscesses is extremely low, occurring in 7 neonates out of a total of 2,003 who were monitored. One patient had 2 small pustules from which β-hemolytic streptococcus was isolated; the other 6 large abscesses must be considered sterile in light of the repeatedly negative bacteriologic cultures. The large, mostly bilateral abscesses were noted by the end of the first week of life and responded promptly to spontaneous or surgical drainage. The general condition of the neonates was always remarkably good. Maternal complications of labor, caput succedaneum, cephalhematoma, and lacerations of the scalp did not seem to play a role in predisposing to the formation of the abscesses. The pathogenesis of the scalp abscesses remains obscure.

Noninstrumental Perforations of the Esophagus

While instrumental perforations of the esophagus are usually amenable to early diagnosis and treatment, noninstrumental perforations occur under such heterogeneous circumstances that late recognition and treatment often leads to a high morbidity and mortality. In this study, noninstrumental perforations of the esophagus resulted in a 30 percent mortality. Postemetic perforations proved to be particularly lethal, especially when definitive treatment was delayed more than 24 hours and when complicating esophageal disease was present. Perforations due to the ingestion of a sharp foreign body responded well to treatment even when seen late after perforation. A group of esophageal perforations that occurred late after operations on structures adjacent to the esophagus were thought to be due to periesophageal infection. The rupture developed with spontaneous drainage into the esophagus. Because of the chronic nature of these postoperative perforations, delayed treatment was well tolerated.

Chronic spontaneous cerebrospinal rhinorrhea.

Introduction The drainage of cerebrospinal fluid from the nose or the ear after certain kinds of fractures of the skull is a well-known, but fortunately not-too-common problem of head trauma. On the other hand, the development of spontaneous drainage of cerebrospinal fluid from the nose is unusual. Intracranial tumors which have eroded into the paranasal sinuses and formed a pathway from the nasopharynx to the subarachnoid space of the pituitary fossa may cause spontaneous cerebrospinal rhinorrhea, often complicated by a purulent leptomeningitis. That this is a rare feature of pituitary tumors, or for that matter of any tumor mass in either the paranasal sinuses or the sella turcica, is shown by the low incidence of nasopharyngeal extension in Cushing's cases as followed by Henderson.1In this series, which dealt solely with pituitary adenomata and adenocarcinomata, only 8 cases out of a total of 339 developed nasopharyngeal extensions which might

Inflammatory bronchial obstruction with unusual clinical manifestations: report of a case.

The lumen of the posterior or posterolateral division of the bronchus to the lower lobe of the lung is normally quite small. This fact, combined with the dependent location of this bronchus and the angle at which junction is made with the main division of the lower lobe bronchus, impairs drainage from this portion of the lung and predisposes to infection. Abscess not infrequently occurs in this locality, and intermittent partial bronchial obstruction with varying degrees of infection is commonly encountered. Recurring attacks of acute infection in the lower lobe of the lung almost always result from impaired drainage from this bronchus. Spontaneous drainage of the area of infection is followed by prompt recession of symptoms, but recurrence is frequent. Physical signs of localized pulmonary disease may be minimal or absent. If the lesion is located on the right side there may be roentgenographic evidence of pulmonary infiltration, but when

Urethral calculus: its roentgen evaluation.

The case of urethral calculus to be reported here is of interest because of the absence of symptoms in spite of the large size of the stone and because it demonstrates the value of urethrography for localization and evaluation. Case Report A 53-year-old white male was referred for roentgen examination of the perineal region because of his accidental palpation of a perineal mass during bathing. His past history was entirely non-contributory, revealing no urinary tract abnormality or infection. Physical examination disclosed the presence of a fixed, stony hard perineal mass, immediately posterior to the scrotum; its precise dimensions could not be determined. Otherwise the physical findings were normal. Digital rectal examination demonstrated a prostate of normal size and consistency. Except for the presence of small numbers of polymorphonuclear leukocytes in the urine, laboratory studies were also normal. Radiographic examination of the pelvic region revealed a large, oval, lamellated calculus in the subpubic region (Fig. 1). Study in the lateral and oblique planes confirmed its anterior and subpubic location. It was believed to be a calculus located in a urethral diverticulum. Urethrography was recommended, both to confirm the location of the stone and to determine whether or not urethral stricture was present. Urethrography was performed on Feb. 7, 1951, under fluoroscopic guidance. Rayopake, injected intra-urethrally, through an attached Brodny clamp, passed through the urethra adjacent to the calculus into the bladder. Film study confirmed its apposition to the membranous urethra. No stricture was demonstrable. There was minimal elongation of the prostatic urethra (Figs. 2 and 3). Immediate operation was recommended, but was postponed by the patient. On March 14, 1951, he reported with perineal induration and inflammation, with fluctuation superficial to the calculus. He was hospitalized on March 16, and on March 17 spontaneous superficial drainage occurred. Under spinal anesthesia, the area of spontaneous perforation was enlarged and explored by Dr. James Lehman. The calculus could not be palpated and it was believed to have passed spontaneously. Iodoform packing was inserted. Postoperative roentgen examination, however, again revealed the calculus. On March 27, under spinal anesthesia, with an intra-urethral catheter present, a transverse perineal incision was made. The transverse perinei muscles were divided, and the calculus was palpated in the membranous urethra just distal to the prostate. A longitudinal incision was made in the urethra and the calculus removed. The urethra was sutured around the indwelling catheter, an iodoform pack drain was inserted, and several interrupted silk sutures were introduced in the skin. The calculus was 4.2 cm. long, 3.0 cm. wide, and 2.5 cm. in anteroposterior diameter (Fig. 4). Penicillin was given preoperatively and postoperatively.