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PubMed1994

[CT-guided percutaneous drainage in the management of psoas abscesses].

The authors review their first experiences in Hungary with the CT guided percutaneous catheter treatment of psoas abscesses. Diagnostic aspiration from abscess was performed in one patient. Percutaneous catheter drainage of psoas abscess were performed in 4 patients. There were 4 patients with unilateral and 1 patient with bilateral psoas abscess. 4 patients had tuberculous spondylodiscitis, 1 patient had staphylococcal vertebral osteomyelitis. One patient following diagnostic aspiration was successfully treated with antituberculoutic drugs. All patient treated with percutaneous catheter drainage received medical antituberculoutic or antibiotic therapy and showed excellent clinical and radiological results. There was no complication and there was no need to open surgical drainage in this series. CT guided aspiration is a valuable tool in the diagnosis of psoas abscesses as well as in the identification of the exact abscess etiology. Percutaneous drainage represents an efficient and attractive alternative to open surgical drainage in the treatment of psoas abscesses.

Aged↗
PubMed1994

Sterile epidural and bilateral psoas abscesses in a patient with Crohn's disease.

Crohn's disease primarily affects the distal gastrointestinal tract, yet it is a systemic disease that can involve nearly any organ. A psoas abscess complicating Crohn's disease is uncommon and usually originates from a fistulous communication with an adherent bowel. Spinal epidural abscess, an extremely rare complication, also appears to arise by fistulization from another organ involved with Crohn's disease. Previous reports indicate that abscesses in these two areas usually contain bacterial organisms, often mixed flora, consistent with seeding from a diseased bowel. This report represents the first case of Crohn's disease complicated by both bilateral sterile psoas abscesses and a coexistent sterile epidural abscess without evidence of a fistulous communication from the bowel. We report this case because psoas and epidural abscesses can present without typical signs and symptoms. Once suspected, aggressive diagnostic workup and definitive operative intervention is indicated. Failure to promptly diagnose and treat these abscesses may result in considerable morbidity.

Adult↗
PubMed1993

[Subdiaphragmatic abscesses in children].

At the clinic of pediatric surgery of the Sverdlovsk Medical Institute 30 children aged from 3 to 14 years were treated for subdiaphragmatic abscesses in 1979-1989. In 27 of them the abscesses occurred in 6 days to 6 months after an emergency operation. The largest group (19 children) was formed of patients who underwent operation for destructive appendicitis and peritonitis. The subdiaphragmatic abscess was found on the left side in 16 (53.3%) and on the right side in 14 (46.6%) cases. In 11 (36.6%) patients in was combined with abscesses of other localization. X-ray and ultrasonic studies and, occasionally, computed tomography were used along with clinico-laboratory methods in establishing the diagnosis of subdiaphragmatic abscesses. Operations were performed on 29 patients. One patient was treated by puncture followed by drainage of the abscess after Seldinger. The choice of the approach was determined by the localization of the abscess. The intraperitoneal approach was used in 11 cases (36.6%), Klermon's extraperitoneal approach in 16 (53.3%), Melnikov's extrapleural approach in 2, and the posterior retropleural approach in one case. Complex intensive therapy was applied in the postoperative period. Among the 30 patients one died from sepsis and developed polyorganic insufficiency.

Adolescent↗
PubMed1996

Management of intra-abdominal abscesses in Crohn's disease.

Over a 5-year period, 54 intra-abdominal abscesses were observed in 40 (20.8%) of 192 patients with Crohn's disease. The median age was 39 years (range 17-76 years); median interval from diagnosis, 7.5 years (range 0-24 years) and the median number of surgical operations was 2 (range 0-7). Forty abscesses (74.1%) were spontaneous and 14 (25.9%) were postoperative. Thirty abscesses were initially managed by laparotomy, 14 by percutaneous drainage, nine by incision and drainage and in one case the abscess drained spontaneously. Intra-abdominal abscesses were managed successfully by laparotomy in 23 (76.7%) of 30 patients, with a 93% success rate (13 of 14) for spontaneous abscesses managed by resection and primary anastomosis. Three of 8 (37.5%) spontaneous abscesses were managed successfully by percutaneous drainage, a temporising effect being achieved in a further two cases. There was no significant difference in sepsis score or duration of hospital stay for patients managed initially by laparotomy and those managed by drainage. However, patients with stricturing or fistulating Crohn's disease were much more likely to have initial management by laparotomy and in these patients surgical intervention was found to be an effective initial strategy.

Abdominal Abscess↗
PubMedDate not supplied

[Perforation in Crohn's ileitis and its consequences in the natural history of disease. 2. Consequences of perforation in the peritoneal cavity: diffuse septic peritonitis, abscesses, external and internal fistulas].

Perforation of Crohn's ileitis occurring in the peritoneal cavity is always free perforation, but it causes usually a localized peritonitis, i.e. an abscess, and only in rare cases a diffuse septic peritonitis for the reasons expounded in the Part 1. Diffuse septic peritonitis has the common features of all perforative peritonitis; its surgical treatment must be ileocolic resection, simple suture of perforation being a serious mistake. Abscesses develop: as regards the ileum, about 30-45 cm from the ileo-caecal valve; as regards the abdominal cavity, in the right iliac fossa or in the pelvis, at a site where the ileum, weighed down by its chronic inflammation, rests. These abscesses have a wall like that of all abscesses, with no specific crohnian features. On operation, if technical considerations so require, part of the abscess wall may be left in place with no fear of recurrences or fistulas. Nowadays, most abscesses of the right iliac fossa are opened surgically; an enterocutaneous fistula follows. Most abscesses of the pelvis still open spontaneously into a hollow organ (sigma-rectum, urinary bladder), and rarely into the vagina or onto the perineum after penetrating through the levator any muscle and causing suppuration of the ischiorectal fossa.

Abdominal Abscess↗
PubMed1996

[X-ray computed tomographic tests in the diagnosis and treatment of amebic liver abscesses].

PURPOSE: The aim of this study was to evaluate the CT findings of amebic liver abscesses and its usefulness for treatment. METHODS: CT was performed in 51 patients with proved amebic liver abscess. CT studies were made before and after contrast injection. RESULTS: Among the 98 abscesses, 66% occurred in the right lobe. 66% of the patients presented a solitary abscess. The diameters were found between 2 cms to 15 cms. The mean was 7 cms. An enhancing wall was present in 84%; the margins were festooned in 75%, smooth in the other cases; internal septations were noted in 57%. High density material within the abscess, before injection of contrast was seen in 50%. 30% of patients had focal intra-hepatic biliary dilatation, 27% right pleural effusion, 23% peri-hepatic fluid collection. One hepatic-colic fistula and one hepato-pulmonary fistula were not suspected on U.S. examination. Percutaneous aspiration was done in 31% of the patients, when the diameter of the abscesses were more than 10 cms or when they were seen in the left lobe or when fever or pain did not disappear after treatment. CONCLUSION: CT scan may be helpful in diagnosis of amebic liver abscess at an early stage or later when a complication is suspected. CT scan can also help to indicate and safely perform a percutaneous therapeutic aspiration.

Adolescent↗
PubMed1996

Nerve abscess in children and adults leprosy patients: analysis of 145 cases and review of the literature.

The authors report on their experience of nerve abscess in leprosy. They have found that in the last 5 years there is a significant increase in this type of pathology, at a time when the total number of patients has decreased in adults. Nerve abscesses are, recently, noticed in a large number of children and teenagers. This was not the case 7-9 years ago. Abscesses were excised from one hundred forty-five nerves in one hundred and sixteen patients between May 1985 and May 1994, out of which, 14 patients (12.6%) were operated during the period May 1985 to December 1989 and 102 (87.93%) in the period January 1990 to May 1994. Children and teenagers account for 47% of all cases of nerve abscess in this series. The incidence of abscess in multiple nerves is high too in these groups. Abscess of cutaneous nerves is very common too (35% of cases) though rarely reported in the literature. There is a higher incidence of nerve abscess in male adults as compared to females. The authors believe that this sudden increase in neural pathology can be attributed, in part, to the extension of multidrug therapy (MDT) programmes without adequate infrastructure to detect and treat early neuritis.

Abscess↗
PubMed1997

Percutaneous drainage of intra-abdominal abscesses in Crohn's disease: short and long-term outcome.

OBJECTIVE: To determine whether percutaneous drainage of Crohn's abscesses obviates the need for early surgical drainage. METHODS: All cases of percutaneous drainage of Crohn's abscesses between 1990 and 1995 were reviewed and classified as a success or failure on the basis of the need for surgery within < 30 days of catheter removal. RESULTS: Twenty-seven drainage procedures were performed in 24 patients; 15 (56%) were classified as successes, and 12 (44%) were classified as failures. Successes and failures did not significantly differ with respect to patient demographics and Crohn's disease characteristics. Patients whose abscesses were successfully drained had significantly fewer associated fistulae (46.6 vs 92.0%, p = 0.037), and their abscesses tended more often to be first (vs recurrent), spontaneous (vs postoperative), located in the right lower quadrant, and smaller. Patients whose abscesses were successfully drained also tended to spend more time with the catheter in place and to require more imaging procedures. Complications were noted in four cases (15%), enterocutaneous fistula at the site of catheter insertion in three cases and postprocedure fever in one case. Hospital stay was significantly shorter after successful drainage (16.3 +/- 6.9 vs 31.7 +/- 22.1 days, p = 0.017). After a total of 543.5 patient-months of follow-up, subsequent intra-abdominal Crohn's-related surgery was required in only two of the successes and one failure. CONCLUSIONS: 1) Percutaneous drainage of Crohn's abscess successfully obviates the need for early surgery in approximately 50% of cases, and this benefit is maintained on long term follow-up. 2) Percutaneous drainage shortens hospital stay. 3) Crohn's abscesses in various locations, single or multiple, with or without an associated fistula may be successfully drained percutaneously. 4) Presence of an associated fistula may be a risk factor for failure.

Abdominal Abscess↗
PubMedDate not supplied

Surgical management of aortic root abscess.

BACKGROUND: The mortality and morbidity associated with surgery for aortic root abscess is reportedly high. This is a review of our experience with radical resection of the abscess and reconstruction of the left ventricular outflow tract with pericardium. METHODS: Sixty-three consecutive patients with aortic root abscess were operated on since 1980. Their mean age was 47 years, range 16 to 75; 53 patients were men. Thirty-one patients had native and 32 had prosthetic valve endocarditis; of these 32, 13 had previous composite replacement of the aortic valve and ascending aorta. The most common offending microorganisms were staphylococci, which were cultured in 31 patients. The abscess was confined to the aortic annulus in 22 patients and had extended into surrounding structures in 41. The abscess involved the mitral valve in 13, the tricuspid valve in 2, and the pulmonary valve in 1. Radical resection of the abscess and reconstruction of the left ventricular outflow tract and other valve annull was accomplished with autologous or glutaraldehyde-fixed bovine pericardium. Aortic valve homograft was used in only three patients; prosthetic heart valves in 60. RESULTS: There were eight deaths; 26 patients experienced one or more non-fatal perioperative complication. Patients were followed up for a mean of 58 +/- 39 months. There were ten late deaths; the actuarial survival at 10 years was 55% +/- 10%. Nine patients developed late recurrent endocarditis 10 to 108 months postoperatively. The freedom from recurrent endocarditis at 10 years was 75% +/- 8%. CONCLUSIONS: Radical resection of aortic root abscess and reconstruction of the left ventricular outflow tract with pericardium is an effective method to eradicate the infection. These patients appear to have a relatively high risk of recurrent endocarditis.

Abscess↗
PubMed1997

Epidural abscess presented with psychiatric symptoms.

Cranial epidural abscesses are unusual in neurosurgical practice. Mostly they are secondary to skull bone osteomyelitis of foreign body implantation as a result of trauma, or infection of paranasal sinus, otitis, and mastoiditis in adults or late adolescents. The purulent inflammatory process of the epidural abscess, thrombophlebitis of the venous drainage, septic thrombosis, direct extension into the orbit, carvenous sinus, superior orbital fissure give the epidural abscess a high mortality and morbidity. We present an interesting case, who has had psychiatric symptoms such as bizarre behavior, auditory and visual hallucination for about two years. Incidental brain computed tomograms, to exclude the organic-somatic disorder, revealed a huge brain abscess. Emergent surgical intervention was carried out and the episodes of talking to himself and auditory hallucination subsided. The removal of the epidural abscess eliminated the symptoms and cured the patient. All the right amygdata, entorhinal area, cingulate gyrus, hippocampus and parahippocampal gyrus of this patient were compressed by the huge abscess. All these structures belonged to limbic system. Diseases involving the limb system may cause emotional disturbances, such as delusions, illusions and hallucinations, emotional lability, pathological laughing and crying, rage reaction and aggression, apathy and placidity, even endogenous fear, anxiety, depression and euphoria. Dramatic improvement of the patient was found after surgical removal of the abscess. We highlight this interesting case for it will undoubtedly bring together a large cooperation of psychiatrists, neurologists and neurosurgeons.

Abscess↗
PubMed1997

Clinical and microbiological features of liver abscess after transarterial embolization for hepatocellular carcinoma.

OBJECTIVES: To present the clinical and microbiological features of liver abscess after transarterial embolization (TAE) for hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed records of 452 TAE procedures in 289 patients with HCC over a 2-yr period. RESULTS: Four men and one woman with a mean age of 68.4 yr were diagnosed with liver abscess 1-8 wk (mean 4.6 wk) after the embolization. The incidence was 1.1% (5/452). Common symptoms included fever, chills, and right upper quadrant pain. Serum aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase levels and leukocyte count were frequently elevated. All the abscesses appeared as areas of hypodensity on CT scan and hypoechogenicity on ultrasonogram. The areas contained gas in the embolized tumor, which led to the suspicion and finally the diagnosis of abscess. In contrast to predominance of gram-negative aerobes in sporadic pyogenic liver abscesses, the causative microorganism was predominantly gram positive (60%). All patients were treated with parenteral antibiotics plus percutaneous aspiration, drainage, or operation, but one patient died from the abscess. CONCLUSIONS: For patients receiving TAE for HCC, few specific clinical or radiological features could readily differentiate patients complicated with liver abscess from those without. This may delay a timely diagnosis and lead to significant morbidity. Hence, in patients with risk factors, including old age, previous biliary tract disease, large tumor size (>5 cm), and gas forming in the embolized tumor, aspiration of the suspected focal hepatic lesion should be performed as soon as possible.

Abdominal Pain↗
PubMed1997

[Successful meropenem therapy of recurrent multiple brain abscess].

Authors describe the history of a 37-year-old man suffering from multiple purulent brain abscess. The multiple brain abscess evolved primarily from a gluteal abscess to the lung, and secondarily from the lung to the brain by hematogenous spreading of the bacteria. The identification of the pathogene/s was unsuccessful despite numerous bacteriological examination. Despite many regimens of empiric antibacterial therapy the brain abscesses progressed, neurologic state of the patient deteriorated. At long last, the patient was given chloramphenicol. After that, he had no more fever, his consciousness cleared, no more epileptic convulsion occurred and the cell number of the cerebrospinal fluid became normal. The patient was thought to be cured and was sent home. Two months later fever occurred again and it was accompanied by excrutiating headache, increasing disorientation, so the patient was admitted to the hospital. The occurrence of a new brain abscess and purulent meningitis indicated the relapse of the disease. It was again unsuccessful to identify the pathogene/s therefore the authors treated the patient with many empiric antibiotic regimen, all of which-including chloramphenicol too--proved to be uneffective. As all the therapeutic regimens usually used in the treatment of purulent brain abscess were uneffective--including the combinations which have the widest antibacterial spectrum, authors gave meropenem as ultimum refugium. Some days later the fever came to an end, his consciousness cleared, the brain pressure and the cerebrospinal fluid became normal. The patient had no serious complaints in the course of the four years follow up, his residual neurologic symptoms regressed. On the base of this case history, authors suppose that meropenem--which has already proved to have a very wide antibacterial spectrum and to be very effective in the therapy of many kinds of serious bacterial infections--could also become a promising new therapeutic alternative in the treatment of purulent brain abscess.

Adult↗
PubMedDate not supplied

Pyogenic liver abscess in children: some observations in the Espírito Santo State, Brazil.

Pyogenic liver abscess in children is uncommon in developed countries and there are few reports about the disease in developing countries including Brazil. As pyogenic liver abscesses in children are frequently diagnosed in Vitória (E. Santo State, Brazil), the records of admissions at the Children's Hospital (Hospital Infantil N.S. da Glória) were surveyed. Sixty-five cases of pyogenic liver abscess were observed over a period of three years, from May 1991 through April 1994 (mean of admissions of 2800 children/year). Fourty-seven cases occurred in boys (mean of ages 8.1 +/- 3.5 yr, median 8 yr) and 18 in girls (mean of ages 6.1 +/- 3.3 yr, median 7 yr) with a 2.7:1 male/female ratio. Predisposing factors were skin infections (23 cases), bile duct ascariasis (six cases), trauma (two cases) but in 30 cases a predisposing factor was not evident. Staphylococcus aureus was the bacteria most frequently isolated (16/29 examined). Entamoeba histolytica trophozoites were never found in the exudate of abscesses and cysts were found once in fecal examination. Clinical manifestations were similar to those observed in other reports about pyogenic liver abscess in children. There was a high frequency of intestinal helminth infection (80.6% of 36 cases in which a fecal examination was recorded) and eosinophilia in the peripheral blood (36.2% of 61 cases). In addition most cases came from the urban periphery of Vitória, where intestinal parasites are frequent. These data showed that the frequency of pyogenic liver abscess is higher in Vitória (one case/138 admissions) than in developed countries (25 cases or less/10,000 admissions in USA). We hypothesyse that the helminth infection (mainly with ascaris and toxocara), whose larvae migrate through the liver inducing granulomas, could enhance the localization of bacteria, increasing the risk for pyogenic liver abscess.

Brazil↗
PubMed1998

[Prevertebral abscesses with a protracted insidious clinical course and subsequent lethal, acute pyogenic meningitis and septic shock].

This report concerns a 66-year-old man suffering from prevertebral abscesses with a protracted insidious clinical course and subsequent lethal and acute pyogenic meningitis. The patient had a three-month history of mild neck pain, and died as a result of septic shock due to staphylococcus aureus (methicillin susceptible) infection two days after admission to the hospital. At autopsy, abscesses encapsulated by fibrous connective tissue were found on the ventral surfaces of the cervical and thoracic regions of the spine. The prevertebral abscess on the upper cervical region was organized with dense fibrous tissue and contained a small number of inflammatory cells. On the other hand, the prevertebral abscess on the thoracic region was purulent and contained numerous inflammatory cells, macrophages and gram-positive cocci. Pyogenic spondylitis and discitis accompanying the prevertebral abscesses were multiple and widespread. These features suggested that the abscesses developed initially on the cervical region, extended caudally through the prevertebral space, directly involving the corpus vertebrae and discs, and ultimately caused sepsis. It is important to note that prevertebral abscesses can exhibit a protracted clinical course with only mild symptom such as minor neck pain and then manifest abruptly as acute meningitis and sepsis.

Abscess↗
PubMed1994

The prevalence of periodontal abscess.

The records of 5,467 periodontal patients in a military practice were reviewed for ADA case type 3 or 4, resulting in 203 patients (3.71 percent) in the two categories. These records were then examined for 1) sex of the patient; 2) occurrence of a periodontal abscess; 3) whether or not the patient was in active periodontal treatment at the time of the abscess; and 4) which tooth or teeth were involved. Periodontal treatment was shown to greatly reduce the incidence of periodontal abscesses among case type 3 patients. ADA case type 4 patients were much more likely to develop an abscess than case type 3 patients, and treatment had no effect on the rate of abscess formation in these patients. In those patients who developed an abscess while undergoing periodontal treatment, women showed a greater tendency toward abscess formation. Maxillary incisors and first premolars had the lowest rates of involvement.

Adult↗
PubMed1998

Randomized double-blind trial of metronidazole versus secnidazole in amebic liver abscess.

OBJECTIVE: To compare the efficacy of secnidazole with metronidazole in the treatment of amebic liver abscess. METHODS: Thirty two patients with uncomplicated liver abscesses were studied in a randomized, double-blind trial. Fifteen received metronidazole (400 mg t.i.d. for 7 days) and 17 secnidazole (500 mg t.i.d. for 5 days). All abscesses were aspirated on day 1 and laboratory tests and ultrasonographic examination were done on days 1 and 10. RESULTS: One patient in the metronidazole group developed intraperitoneal rupture. The other 31 patients had 40 abscesses (19 in metronidazole group, 21 in secnidazole group). Complete resolution of signs occurred by day 10 in 10 patients on metronidazole and 12 on secnidazole, and in all others by day 28. On day 10 ultrasonography in the metronidazole group showed complete disappearance of abscess in one patient, decrease in 8 and increase in 5 (versus 2, 12 and 3, respectively in the secnidazole group). After 6 months, four asymptomatic patients (two from each group) had small abscess cavities on ultrasonography; there were no recurrences. CONCLUSIONS: Secnidazole is as effective in the treatment of amebic liver abscess as metronidazole; it is equally well tolerated.

Adult↗
PubMed1998

[CT-controlled percutaneous drainage of intra-abdominal abscesses with basket catheters].

Today, CT-guided percutaneous drainage for intraabdominal abscesses of various origin and location is well accepted. With this method open surgery and its complications can be often avoided. We report results of such treatment in 47 patients with intraabdominal abscess formation. 66 "basket" catheters were placed into abscess formations of differing sizes and locations. 27 patients had developed abscess formation after surgery, in 2 patients abscesses after tumorembolisation were drained. In 18 cases there was no previous surgery. No complications occurred. Mean drainage time was 8.5 days. Surgical intervention was avoided in 34/47 patients. 9 of 47 patients received only percutaneous drainage. 25 of 47 patients required concomitant antibiotics for successful treatment. Antibiotics were selected according to bacterial culture with resistance determination. 13/47 cases required secondary surgery. About 80% of intraabdominal abscesses are curable with CT guided percutaneous drainage and systemic antibiotic medication. If a percutaneous drainage fails and signs of infection still remain, the procedure can be repeated. If secondary surgery after failing of percutaneous drainage should become necessary, the extent of the surgical intervention can be reduced. Surgery is necessary, if CT guided percutaneous drainage could not reach the abscess formation, if drainage failed or if an additional illness exists, which requires an operation.

Abdominal Abscess↗
PubMed1998

Intramyometrial abscess complicating pregnancy. A report of two cases.

BACKGROUND: Intramyometrial abscess in pregnancy is a rare event. Little information is available on the presentations and potential complications. CASES: Two asymptomatic patients underwent complications with failed instrumental delivery in the second stage of labor. Intramyometrial abscesses were found during lower segment cesarean section. In the first case, incision and drainage was done, and the culture of the pus revealed multiple organisms, including Escherichia coli, group B Streptococcus and Klebsiella species. The patient was successfully treated with antibiotics, while the infant did not show any evidence of infection. In the second case, removal of the abscess was performed, and pathology showed evidence of chronic abscess, but the culture did not reveal any organisms. The patient was treated with prophylactic antibiotics. The infant was treated with antibiotics for clinical sepsis, but no organism was revealed. CONCLUSION: Intramyometrial abscess complicating pregnancy can be asymptomatic. Obstructed labor can be a potential complication when the abscesses are located in the lower uterine segment. Antibiotics, together with incision and drainage or removal of the abscess, is the first choice for treatment.

Abscess↗