Surgery For Abscess Research Articles

Clinical and microbiological analysis of adult perianal abscess

In Taiwan, Klebsiella pneumoniae is the predominant pathogen causing pyogenic liver abscess in patients with diabetes mellitus (DM). The purpose of our hospital-based study was to determine the predominant bacterial species causing perianal abscess in hospitalized patients with and without DM in Taiwan. Data on patients admitted and then operated on for perianal abscess during the period of March 2001 to December 2008 were reviewed. Information extracted from medical records included clinical information and laboratory data as well as culture and antibiotic sensitivity results. A total of 183 patients underwent surgery for perianal abscess. The most common pathogen causing perianal abscess in non-DM patients was Escherichia coli (67.1%), and the most common pathogen isolated in DM patients was K pneumoniae (60%; p=0.009). Among the 25 patients with DM, incident DM was diagnosed in 24.0% (6 of 25). In addition, five patients had transient hyperglycemia. Escherichia coli was the predominant pathogen isolated from perianal abscesses in patients without DM. Klebsiella pneumoniae, however, was the predominant pathogen isolated in DM patients. In both DM and non-DM patients, more than 90% of K pneumoniae isolates showed in vitro sensitivity to first-generation cephalosporins.

Disentery and hepatic abscess in the colonial and republican Chile. Doctor Miguel Claro Vásquez

The frequency and severity of dysentery and hepatic abscess during the colonial and republican era in Chile are reviewed. The amebian etiology was confirmed in both clinical entities. Also, Miguel Claro Vásquez, physician and later priest and bishop of the Catholic Church, was distinguished for his contribution to hepatic abscess surgery.

Disentería y absceso hepático en el Chile colonial y republicano: El Doctor Miguel Claro Vásquez

The frequency and severity of dysentery and hepatic abscess during the colonial and republican era in Chile are reviewed. The amebian etiology was confirmed in both clinical entities. Also, Miguel Claro Vásquez, physician and later priest and bishop of the Catholic Church, was distinguished for his contribution to hepatic abscess surgery.

An Audit of Pilonidal Abscess Surgery and Complication Rates at Milton Keynes NHS Foundation Hospital

An Audit of Pilonidal Abscess Surgery and Complication Rates at Milton Keynes NHS Foundation Hospital

Salmonella infections in patients with systemic lupus erythematosus: a case series

Systemic lupus erythematosis (SLE) patients are highly susceptible to infections. We aim to present our experience regarding the manifestations and outcomes of Salmonella infections in a group of Filipino SLE patients. This study reviewed the medical records of Filipino SLE patients with documented Salmonella infection seen at the Rheumatology Clinics of the University of Santo Tomas (UST) Hospital, Manila, Philippines from 2002 to 2009. Included were 12 patients (11 female), with mean age of 25.75 years (range 11-53 years) and average SLE disease duration 4.45 years to Salmonella infection. Five had septic arthritis (knee in 4, hip in 1), one of whom had concomitant typhoid fever. Another two patients had typhoid fever only. Sepsis syndrome was noted in three. One patient each had soft tissue abscess and meningitis. Salmonella typhi was isolated in seven patients, Salmonella sp. in four, and S. enteritidis in one patient. Two patients developed acute respiratory distress syndrome (ARDS), another had mixed Salmonella and Klebsiella pneumonia. Eleven patients were on high-dose steroids for active disease, including one patient with antecedent first infusion of cyclophosphamide plus rituximab. Management consisted of antimicrobials and adjunct surgery for arthritis and abscess. Except for three patients with Salmonella sepsis, all other patients improved with appropriate therapy.

The management of pelvic abscess

The optimum treatment for pelvic abscess would be an approach that is safe, efficacious, cost-effective, minimally invasive, and which affects the woman's fertility potential as little as possible. In women of reproductive age tubo-ovarian abscess is one of the most common types of pelvic abscess. Tubo-ovarian abscesses are classically treated with broad-spectrum antibiotics. Frequently this approach fails and surgical intervention becomes necessary in about 25% of all cases. Surgical procedures include laparotomy or laparoscopy with drainage of abscess, unilateral or bilateral salpingo-ophorectomy, and hysterectomy. However, surgery for tubo-ovarian abscess is often technically difficult and associated with complications. An alternative approach is the use of imaging-guided drainage of abscess in combination with antibiotics. Combined data from several studies indicate that ultrasound-guided transvaginal drainage with concomitant antibiotics is especially safe and efficacious. This chapter discusses the management of pelvic abscess with a special focus on transvaginal ultrasound-guided drainage of tubo-ovarian abscess.

P131 - Induction and maintenance of clinical response and remission with certolizumab pegol in patients with inflammatory or fistulizing Crohn's disease: a referral center experience of compassionate use

P131 - Induction and maintenance of clinical response and remission with certolizumab pegol in patients with inflammatory or fistulizing Crohn's disease: a referral center experience of compassionate use

Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

硬膜下膿瘍術後に生じた医原性porencephalic cystの2例

硬膜下膿瘍術後に生じた医原性porencephalic cystの2例

Colouterine fistula complicating diverticulitis in elderly women

Dear Editor: Diverticulosis is a very common colonic pathology occurring in more than 65% of the population by the age of 80. The inflammatory process involving diverticulosis arises with an inflammatory response that may require surgery for hemorrhage, abscess, perforation, or fistula formation. The pathophysiology of colouterine fistulas includes destruction of two serosas of two epithelialized surfaces in close proximity. We describe the case of an elderly 76-year-old patient who presented within a period of 6 months with two episodes of acute diverticulitis that required endovenous treatment. The patient had already presented with fecal incontinence. At this time, the patient was taken to the emergency room because of the presence of a foul-smelling vaginal discharge with fecaloid flow. Abdominal examination revealed a low tenderness in the left lower quadrant, without palpable mass. The patient had no fever. Laboratory tests did not show any alteration in biological values. Antibiotic treatment was initiated and the patient was studied. A CT scan was performed that showed the presence of a uterus full of air and fecal content. Also, an inflammatory sigmoid colon with the presence of diverticles and a thick sigmoid wall could be seen. An image of malignancy could not be excluded. All these data confirmed the presence of a colouterine fistula. No colonoscopy had been yet performed because of the wish of the patient and their family. Surgery was performed and, at laparotomy, a chronic inflammatory mass was observed. This mass included the whole sigmoid colon and the posterior uterine wall. An en bloc resection was performed with a Hartman’s procedure. Colouterine fistulas were first reported by Lejemtel in 1909. At that time, three main etiologies were described: first, trauma or spontaneous rupture of a gravid uterus in which an intestinal loop impacted on the tear and a subsequent necrosis developed after constricting contractions of the myometrium; second, the presence of abscess rupture into the bowel and the uterus; third, a uterine or sigmoid carcinoma. In later years, radiotherapy has also been involved in colouterine fistula formation. Hawkes described obstetric trauma including curettage of the uterus with simultaneous perforation of the uterus and the colon. The first report of colouterine fistulas related to diverticulitis was by Noecker in 1929. This diagnosis is rare and even rarer is to observe colouterine fistulas related to diverticulitis. Among causes other than diverticulitis, endometriosis, gynecological cancer, and also apex abscesses have been described. Many reasons have been provided in order to explain colouterine fistula formation. Owing to the great thickness of the uterine wall, colouterine fistulas are very rare. The development of diverticulitis episodes may lead to a fistula formation, because of repeated inflammatory response in the tissues, such as in our patient. Repeated acute episodes of diverticulitis may lead to adhesions, local inflammation, with subsequent necrosis and fistula formation. It is usually the fundus of the uterus and the sigmoid colon that are linked. Also, a perforated sigmoid colon in the presence of an abscess may be the cause of the fistula formation, which was the case with our patient. Int J Colorectal Dis (2009) 24:599–600 DOI 10.1007/s00384-008-0630-x

Natural orifice translumenal endoscopic drainage for pancreatic abscesses

Few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis, peritonitis, or both. This report describes the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. This study reviewed 35 consecutively treated patients for the period 1994-2007. The approaches alone or in combination were transmural (transgastric or transduodenal) and transpapillary. The criteria for abscesses were two or more of the following: fever, abdominal pain, elevated white blood count (WBC), and positive fluid cultures. The 35 patients (19 men and 16 women) had a mean age of 49 years. The abscesses had idiopathic (37%), gallstone (32%), alcohol (20%), and divisum (11%) etiologies. The presenting signs were abdominal pain (80%), positive cultures (69%), fever (57%), elevated WBC (51%), and nausea/vomiting (39%). The approaches for abscess drainage were as follows: transgastric (n = 15, 43%), transduodenal (n = 4, 11%), transgastric combined with transpapillary (n = 8, 23%), transduodenal combined with transpapillary (n = 1, 3%), and transpapillary alone (n = 7, 20%). A total of 28 patients (80%) achieved successful endoscopic pancreatic abscess drainage, whereas 7 (20%) required surgery. Of these seven patients, two (6%) required emergent laparotomy to control bleeding, and the remaining five (14%) were explored after failure to demonstrate clinical improvement from endoscopic drainage. Three patients required internal drainage, and two patients required distal pancreatectomy. The mean follow-up period was 15 months, and the complication rate was 6%. No one died from the procedure. Endoscopic surgery for pancreatic abscess is feasible and effective. It is an alternative to surgery that currently can be considered a primary treatment option for selected pancreatic abscesses.

The eye in antiquity.

Interest in diseases of the eyes (probably rampant in antiquity) is evident in early medical writings from the Middle East; India and China. But real advance in the understanding of ophthalmology only followed on progressive comprehension of the anatomy of the eye during the Greek era (5th and 4th centuries BC). The Hippocratic Corpus contained the first reasonably accurate description of the structure of the eyeball (based on animal dissection) and the prognostic value of eye signs in clinical medicine. Aristotle was probably the first to give a convincing description of the optic nerve. Human dissection, initiated by the Alexandrians in Hellenistic times, established the correct structure of the eye and the course of the optic nerves. The anatomical descriptions of Herophilus in particular, were not improved on for 18 centuries. However, the physiology of vision largely remained a closed book, and the pathology of eye disease was not understood. Consequently, the treatment of abnormalities and illness of the eye remained, haphazard in the main. Eye surgery for trichiasis, abscesses, growths and small tumours of the eyelids were performed, and during the 1st century AD successful couching operations for eye cataracts were described. Demosthenes Philateles, Rufus of Ephesus and Susruta in India made some contributions, and Galen of Pergamon’s consolidation of knowledge remained dogma up to the Renaissance.

Endoscopic treatment of pituitary abscess: two case reports and literature review

Pituitary abscess is a rare entity and the correct diagnosis is still difficult before surgery. More than 210 cases have been reported in the medical literature, mostly in the form of isolated case reports. We report two cases of pituitary abscess treated endoscopically and we review the literature. A 30-year-old woman and a 35-year-old man were admitted with a history of pituitary dysfunction. Patient 1 presented with polyuria, polydipsia, amenorrhea, headache, and visual impairment. Magnetic resonance imaging showed a cystic intra- and supra-sellar lesion with ring enhancement after contrast injection. Patient 2 presented with frontal headache, proptosis, painful ophthalmoplegia, visual impairment, and fever. Eight years before the patient had undergone a transphenoidal surgery for Prolactinoma. Magnetic resonance imaging revealed a sellar lesion extending into the cavernous sinus and carotid artery bilaterally. Both patients underwent endoscopic transnasal-transsphenoidal exploration. Intraoperative diagnosis of pituitary abscess was made. The postoperative courses were uneventful. Antibiotic therapy was performed in both cases. Only three cases of endoscopic treatment of pituitary abscess have been reported in the literature. We recommend early management by endoscopic transphenoidal surgery for pituitary abscess: this technique is safe, with minimal blood loss, short operating time, low morbidity, and brief hospital stay.

Surgeons Say No to Surgery for Perianal Abscesses in Infants

Who would ever imagine surgeons stating the heretical view that an abscess does not need to be drained? Yet, that is the recommendation of the surgeons who wrote an article on the management of perianal abscesses for this month's Pediatrics Electronic Pages .1 Although this condition has generated controversy for a long time,2 perianal abscesses traditionally have been treated surgically by incision and drainage. On the basis of a 10-year retrospective analysis of hospital records, this provocative study contradicts that approach. The authors showed that medical management is superior to surgical treatment, because it takes care of the immediate … Address correspondence to Myles B. Abbott, MD, FAAP, East Bay Pediatrics, 2999 Regent St, Berkeley, CA 94705. E-mail: mabbottmd{at}aol.com

Management of intersphincteric abscesses

Intersphincteric abscesses are relatively rare, and in some cases of upward extensions in the supralevator plane, can be difficult to manage. The aim of this study was to analyse the type of treatment used in these abscesses. Twenty-one intersphincteric abscesses treated by endoanal drainage in our colorectal unit between 1992 and 2004 were reviewed from our database; location and extension of the abscess, type of treatment and recurrence rates and the use of endoanal ultrasound were studied. Ninety per cent of patients were male; 10 had a previous history of surgery for perianal abscess and suppuration (48%); 16 (76%) had a posterior location and five were anterolateral. Twelve patients had low intersphincteric abscesses and were treated by laying open the abscess and dividing the internal sphincter. Nine were found to have high extensions into the intermuscular planes and were treated by staged procedures: a temporary transanal mushroom catheter was used in seven patients. Endoanal ultrasound was used initially in seven patients (33.3%) and for the evaluation of definitive treatment in 11 (52%). Low intersphincteric abscesses should be treated by de-roofing of the abscess and division of the internal sphincter up to a level of the dentate line. High intersphincteric abscesses are relatively frequent and mostly require staged surgery with a temporary mushroom (de Pezzer) catheter. Accurate anatomical ultrasound localization and proper drainage become important to avoid recurrences or extrasphincteric fistulas.

85 Day surgery abscess pathway: Evaluation of efficiency and utilization in a university hospital day surgical unit

85 Day surgery abscess pathway: Evaluation of efficiency and utilization in a university hospital day surgical unit

Laparoscopic Splenectomy for Splenic Abscess

Splenic abscess is a rare clinical entity, and splenectomy remains the treatment of choice. We sought to determine the safety and efficacy of laparoscopic splenectomy in this setting. Using a prospective database of laparoscopic splenectomy, we identified 4 patients who underwent surgery for splenic abscess (3 male, 1 female). Mean age was 55.5 (range 42-78) years. Patient symptoms included: fever and abdominal pain in 4 patients, pleural effusions in 2, and nausea and leukocytosis in 1. Risk factors for splenic abscess included septic emboli from bacterial endocarditis in 2 patients and acquired immune deficiency syndrome in 1. All patients underwent successful laparoscopic splenectomy. Mean operative time was 200 (range 160-220) minutes, and blood loss was 220 (range 100-450) mL. There were no postoperative complications or deaths; postoperative length of stay averaged 14 (range 2-26) days. Despite the difficulty of the operation, the laparoscopic approach appears to be a safe and effective treatment of splenic abscess.

The direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano.

The recommended closure techniques for transsphincteric fistulas demonstrate divergent results for postoperative continence and recurrence rates. An incontinence rate of 35 percent and a recurrence rate of up to 54 percent has been reported after transanal advancement techniques. The authors hypothesize that a direct closure of the internal fistula opening without tissue mobilization is easier to facilitate and generally leads to better clinical and functional results. A prospective, observational study between 1995 and 1999 was undertaken in 90 patients with transsphincteric fistulas. A direct closure of the internal fistula opening without a flap was performed in all patients. A three-layer, nonstaggered closure of mucosa, submucosa, internal, and external anal sphincters was performed. The follow-up time periods ranged from one-half to six (median, 2.6) years and included assessment of fistula recurrence and continence using patients' histories, physical examinations, proctoscopy, and continence scores. Statistical analysis was performed using Student's t-test or chi-squared test. Data from 90 patients with a total of 106 operations were analyzed (65 males and 41 females; average age 46 (range, 22-78) years). Sixty-six patients had previous anorectal abscess surgery, and 41 had a previous fistula operation. The mean number of previous fistula operations was 1.7. All patients were continent before surgery. Mean elapsed operative time period was 37 +/- 11 minutes, and the mean anal retraction time was 20 +/- 7 minutes. Suture line dehiscence was the main postoperative complication. It was found to occur between the fourth and tenth postoperative days in 15 patients (14 percent). In 12 of 15 patients (80 percent), the fistula persisted and operative treatment was necessary. In three patients (20 percent), spontaneous closure took place. A recurrent fistula after wound healing was observed in seven patients (6.6 percent). The risk of developing a suture line dehiscence leading to a persistent fistula or a recurrent fistula was 22.5 percent. Ninety-four percent of the patients were continent (continence score 0), 6 percent had a minimal disorder of continence (score 4). A continence level for all patients was determined by the international classification of continence disorders. Direct closure for the treatment of transsphincteric fistulas is a safe and effective approach and achieves a good functional outcome; a small risk of suture line dehiscence, which may lead to a recurrent or persistent fistula, remains.

Surgery for lung abscess in immunocompetent and immunocompromised children

Purpose: The aim of this study was to evaluate the surgical management results of lung abscess in immunocompetent and immunocompromised children. Methods: Surgery was performed on 30 children with lung abscess or necrotizing pneumonia refractory to medical treatment in a 12-year period. Of them, 23 were immunocompetent, and 7 were immunocompromised. Pulmonary resection was performed including unilateral lung in 28, bilateral in 2, and 2 lobes in 6. Concomitant decortication was performed in 18 (78.2%) immunocompetent patients. Results: Increased incidence of surgery for lung abscess was caused mainly by drug-resistant and fungal infection. Surgery was performed commonly for bacterial lung abscess on patients less than 5 years old and fungal lung abscess on adolescence. A multiple small abscess was the predominant type of abscess in immunocompetent patients, whereas 2-lobe involvement tended to occur in immunocompromised patients. Fungal lung abscess tended to occur on left lung and in female patients. Left lower lobe was involved most commonly in both groups of patients in which majority need lobectomy. Immunocompromised patients required a more extensive pulmonary resection. There were 3 postoperative complications (morbidity of 10.2%) with no postoperative mortality. Length of postoperative hospital stay ranged from 6 to 85 days with average of 18.4 days. Conclusions: The incidence and pattern of lung abscess that required surgery between immunocompetent and immunocompromised children were different. A more aggressive, extensive surgical procedure is preferable for immunocompromised patients, and the surgical results were comparatively excellent to immunocompetent patients. However, the prognosis of immunocompromised children depends on their underlying disease process. J Pediatr Surg 36:470-473. Copyright © 2001 by W.B. Saunders Company.

Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess—11 year results

The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular abscess. The indications for surgery were congestive heart failure, systemic emboli and atrioventricular block III. The pre-operative evaluation was performed with transoesophageal echocardiography. Aortic valve replacement was performed with allografts in 47 cases, with mechanical valves in 15, and bioprosthetic valves in three cases. All patients with total ventricular-aortic dehiscence and prosthetic valve endocarditis were treated with allografts. The 30-day mortality rate was 23.5% in the prosthetic group, when compared with 8.5% in the patients treated with allografts. The rate of recurrent valve infections during the 11-year follow-up period was 27.1% in the prosthetic group and 3.2% in the allograft group. The actuarial 11-year survival rate was 82.1% in the allograft group and 64.7% in the prosthetic group. Aortic allografts are an effective treatment for infective aortic valve endocarditis with associated periannular abscess. The operative mortality and recurrent infection rates are lower than in the prosthetic group, resulting in a significantly higher survival rate. Diagnosis and surgical management of these cases should be based on pre-operative transoesophageal echocardiography.