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PubMed2002

Severe low back pain due to retroperitoneal abscess formation in diabetic patients.

We report two cases of diabetic patients with severe low back pain associated with retroperitoneal abscesses. In the first case, multiple retroperitoneal and spinal epidural abscesses were detected. Paraplegia due to the spinal epidural abscess was not relieved by drainage of the abscess and subsequent antibiotic therapy. In the second case, drainage of the retroperitoneal abscess and antibiotics were immediately started, resulting in successful recovery. Thus, we suggest that if a diabetic patient complains of low back pain, potential abscess formations should be considered and given appropriate treatment before administering epidural anesthetic injections for pain relief.

Abdominal Abscess↗
PubMed2003

[Puncture aspiration using ultrasound guidance in the treatment of abscesses and other purulent foci in the liver, pancreas and kidneys].

The authors deal with the problem of application of a therapeutic fine needle aspiration puncture in abscesses and other purulent foci in organs of abdominal cavity and retroperitoneum. The treatment using this method under continuing antibiotic therapy has been used in 60 patients (40 men, 20 women), 25 of them suffering from liver abscesses, 28 other from purulent foci of pancreas and seven patients from purulent foci of the kidney. In most patients there were solitary foci (43 persons). The total volume of the evacuated pus was higher than 20 ml in most patients (52), being even more than 100 ml in 2 patients. No relation ship was found among the number of foci, their volume and efficiency of the treatment. The average number of punctures until the abscesses and other purulent foci were healed up was 2.76 in the liver, 2.5 in pancreas and 1.1 in the kidney. The efficiency of therapy was higher in liver abscesses (96%), in purulent foci of pancreas (82%) and lower in the kidney abscesses (57%). The higher efficiency in the purulent foci of pancreas was probably influenced by predominant representation by infected pseudocysts in this group. The lower average number of punctures until the abscesses were healed up and the lower success in the kidney were influenced by a more radical approach of urologists who, having made the first evacuation puncture, performed a radical operation intervention. The complications were encountered in 9.5% of all punctures, being always insignificant. The results obtained demonstrated the contribution of aimed therapeutic aspiration puncture in the therapy of purulent foci of parenchymal organs of abdominal cavity and retroperitoneum as compared with surgical treatment. The advantage of the applied method in the therapy of purulent foci of the liver and pancreas may be seen in the higher success rate, low invasiveness and a low risk of complications together with a low financial cost and wide availability.

Abscess↗
PubMed1991

[Treatment of hepatic and juxta-hepatic abscesses by puncture-drainage].

The aim of this study was to show the result obtained by ultrasound-- or CT--guided puncture, possibly associated with transcutaneous drainage, for the treatment of hepatic and perihepatic abscesses. Preoperative imaging guides this treatment. It may reveal cavities as small as 1.5 cm in diameter. This nonsurgical treatment is based on single or multiple punctures, possibly followed by a long percutaneous drainage. The ideal indication is isolate liver abscesses located near the surface, as well as all juxtahepatic suppurative collections. Our experience is based on 73 patients, 32 of them presenting with an intrahepatic abscesses and 41 with a subphrenic or juxtahepatic abscess. For intrahepatic abscesses, healing was obtained with the surgical treatment in 75.3% of all cases: with a single puncture in 5 cases, two or more punctures in 4, and transcutaneous drainage in 11. Out of the 34 cases of perihepatic abscesses that underwent nonsurgical treatment, surgery was avoided in 25 cases, ie. 73.5% of all. Four of them were treated with a single puncture, 3 with repeated puncture, and 18 with transcutaneous drainage. The success of this procedure depends both on the indication and, most importantly, on the accurate application of the procedure.

Adult↗
PubMed1991

Percutaneous abscess drainage.

Literature published in the past year has focused on controversy over the indications for percutaneous abscess drainage, particularly drainage of hepatic, splenic, and renal abscesses. Percutaneous abscess drainage for intra-abdominal abscesses with enteric communication, perivascular abscesses, infected abdominal tumors, tuboovarian abscesses, and pancreatic collections is also reviewed.

Abscess↗
PubMedDate not supplied

[Hepatic abscess in children: analysis of 20 cases].

Between March 1986 and March 1989, 20 children were diagnosed as having liver abscesses at the Pediatric Department of the Central Hospital in Valencia. 10 were amebic and 10 pyogenic abscesses. 85% occurred in children and 15% in infants. 15 of them (75%) were located in the right lobe, 80% of amebic abscesses had positive serological tests. An etiologic agent was found in 50% of the pyogenic abscesses (3: E. coli, 2: S. Aureus). 80 to 90% of patients presented abnormal prothrombin time. Sedimentation rate was very high in both groups, even at the discharge time. Hepatomegaly, fever, anemia and abdominal pain were the main clinical features. The macroscopic aspect of the aspirate was not helpful in the diagnosis. 60% of amebic liver abscesses needed only medical treatment but 80% of pyogenic abscesses deserved medical treatment and needle aspiration.

Child, Preschool↗
PubMed1989

Brain abscess mimicking brain tumor.

We review our experience with brain abscesses presenting as primary brain tumor over a 5-year period (1983 to 1988). Four of 66 (6%) patients admitted with the diagnosis of primary brain tumor by computed tomographic scans were found at craniotomy to have brain abscesses. Periapical abscesses found after surgery were determined to be the cause of brain abscess in two of four patients. Our experience suggests that periapical abscess may be a more frequent cause of brain abscess than previously thought, and should be considered before surgery in patients with a suspected brain tumor.

Adolescent↗
PubMed1989

[Mycotic liver and spleen abscesses successfully treated by intraportal and intrahepatosplenic arterial administration of antimycotic drugs in two cases with acute leukemia].

Case 1. A 34-year-old male was admitted in July, 1986 with a diagnosis of AML (M2). Two courses of BHAC-DMP regimen induced complete remission in October, while marked pyrexia resistant to antibiotics remained. An ultrasonography (US) and computed tomography (CT) revealed multiple liver and spleen abscesses suspected of mycotic etiology. Administration of amphotericin B (AMPH-B) by intravenous injection was difficult owing to its severe side effect. Multiple abscesses increased in the size and number despite treatment with Miconazole (MCZ) and Ketoconazole. Exploratory laparotomy was performed with splenectomy, and splenic specimens were found to contain Candida organisms. Soon AMPH-B was administered through a catheter inserted into the portal vein at the same time. A side effect by AMPH-B was tolerable and his fever resolved to normal in 2 weeks after institution of this therapy, and the sizes of abscesses were markedly reduced. The patient remained in remission through 23 months, free of fungal infection. Case 2. A 23-year-old female was admitted for relapse of ALL (L2), in April, 1987. Reinduction therapy with BHAC-L-AVP achieved again in May but fever unresponsive to antibiotics occurred. Since multiple liver-spleen abscesses were showed by US and CT suspected mycotic etiology, antimycotic therapy with Miconazole and AMPH-B was performed but clinical findings were deteriorated. AMPH-B was administered through a catheter inserted into the hepatic artery for two weeks, following into the splenic artery for a week. Splenic abscesses were resolved in a week and liver abscesses were markedly reduced at three weeks after initiation of intra-arterial antifungal treatment. Through the analysis of these case studies we confirmed the usefulness of intraportal and intrahepatosplenic arterial administration of AMPH-B.

Abscess↗
PubMed1984

Successful antimicrobial therapy of hepatic, intra-abdominal and intrapelvic abscesses.

Antimicrobial therapy without surgical drainage or therapeutic aspiration was effective in the management of four patients with deep abscesses ranging in diameter from 1.3 to 10.0 cm. Two of the patients had multiple hepatic abscesses, one had hepatic, intra-abdominal and intrapelvic abscesses, and one had an intrapelvic abscess alone. Anaerobic bacteria were isolated from the blood or abscesses in all four patients, and an aerobic-anaerobic infection was present in one patient. The patients were treated with metronidazole, alone or in combination with other antibiotics, for 3 to 6 weeks. Therefore, in selected patients with deep abscesses, a therapeutic trial of antimicrobial agents instead of surgery may be justified.

Abdomen↗
PubMed1982

Reappraisal of the problems of intra-abdominal abscess.

During a ten year period, 69 patients underwent 100 operations for more than 147 intra-abdominal abscesses. The over-all mortality was 24.6 per cent and the redrainage rate, 30.4 per cent. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored two or more different organisms. Mortalities were low in patients less than 20 years of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients more than 40 years of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures, and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intra-abdominal abscess are confirmed.

Abdomen, Acute↗
PubMedDate not supplied

Aspiration cytology of liver abscesses. With an emphasis on diagnostic pitfalls.

Clinical and imaging features of liver abscesses are not specific. Necrotic hepatic neoplasms, primary or secondary, can mimic abscesses, and vice versa. Thirty-eight patients who had cytologic confirmed abscesses were analyzed. There was clinical, radiologic and cytologic concurrence in 27 patients. In six cases the clinically suspicious lesion turned out to be inflammatory. The remaining five were malignant. There were four amebic and three tuberculous cases in this series. Cytologically, pyogenic abscesses contained a heavy, neutrophilic, inflammatory exudate with nuclear debris. By comparison, amebic cases contained more necrotic debris, with degenerating hepatocytes and fewer inflammatory cells. Acid-fast bacilli were identified in two tuberculous abscesses; however, only one contained caseous necrotic material and epithelioid cells. A potential pitfall in the cytologic diagnosis of a case of inflammatory pseudotumor is emphasized. The diagnosis of liver abscess should be established by clinical and imaging findings in conjunction with needle aspiration.

Adult↗
PubMedDate not supplied

Postoperative intraabdominal abscesses: percutaneous versus surgical treatment.

The optimal treatment of postoperative intraabdominal abscesses has not yet been defined and mortality and morbidity remain high. In this retrospective study 2.310 laparotomies were reviewed. The records of 39 patients with postoperative intraabdominal abscesses (1.6%) are reported and the results obtained in percutaneous drainage (PD, n = 27) versus surgical drainage (SD, n = 10) are compared. The choice of drainage was made after consultation with the interventional radiologist, and PD was preferred in single, well-defined abscesses. Two patients had prompt spontaneous resolution of the abscess. The two groups were homogeneous for age, sex and postoperative day of abscess diagnosis. There was no difference in severity of illness assessed by Acute Physiologic Score (APS) between PD and SD groups (7.9 vs 9.3). No significant difference was found in mortality (11% vs 20%), morbidity (11% vs 40%) and duration of drain tube (14 vs 15 days) between PD group and SD group. This study confirms the data of recent retrospective stratified series: PD and SD are equally efficacious to cure postoperative intraabdominal abscesses. However, PD should be the treatment of choice because of its lower invasiveness and cost.

Abdominal Abscess↗
PubMed1997

Solitary and multiple pyogenic liver abscesses: characteristics of the patients and efficacy of percutaneous drainage.

OBJECTIVES: Although percutaneous drainage has emerged as one of the first line of therapies for pyogenic liver abscesses, the presence of multiple abscesses may warrant surgical drainage, which remains controversial in the literature. We studied whether the multiplicity of the lesions influences the outcome of the treatment. METHODS: Ultrasonography-guided percutaneous drainage was carried out in 48 patients with pyogenic liver abscesses. The abscesses were solitary in 38 patients and multiple (two to seven lesions) in 10 patients. Clinical characteristics and the efficacy of the treatment were compared between these two groups. RESULTS: Biliary diseases and malignancies were more frequently observed in the solitary cases than multiple cases. A past history of surgery for cholelithiasis was seen exclusively in the multiple cases. E. coli was more frequently cultured from the abscesses in the multiple cases. Three of the multiple cases required more than a single catheter. All of the multiple cases and 36 of the 38 solitary cases were successfully treated. Two patients died of biliary peritonitis as a complication of the procedure, and three died of other underlining diseases. CONCLUSION: Ultrasonography-guided percutaneous drainage is effective even in patients with multiple pyogenic liver abscesses by adding catheters to obtain sufficient drainage.

Adult↗
PubMed2005

[Anaerobic deep abscesses with unusual location: report of 5 cases].

OBJECTIVE: Anaerobic deep abscesses are rare and may have unusual location leading to severe outcome due to delayed diagnosis and treatment. In order to improve their diagnosis, we report and analyse 5 new cases. METHODS: Patients were seen from 1999 to 2003 in a single department of internal medicine of the university hospital of Marseille. RESULTS: Five new cases were diagnosed consisting in 3 females and 2 males with a medium age of 56,8 years, with unusual location in 4 cases: epidural (2), psoas (1) and sub-diaphragmatic (1) or circumstances in one case of pulmonary abscess unrelated to inhalation. Predisposing conditions thought to compromise resistance to infection were found in all cases: social poverty (4/5), alcoholism (3/5), smoking (4/5), teeth and periodontal disease (4/5), neoplasia (2/5), iatrogenic disease (2/5). Symptoms were insidious (5/5) and unspecific but were always related to the abscess location. Abscesses were frequently found distant from the initial focus of infection because of frequent hematogenous spread (4/5). Drainage of the collection led to bacterial identification in all cases (4/4), although blood cultures could be positive (3/5) and helpful in one case in which drainage was not possible (1/5). The isolated organisms always corresponded to the suspected initial focus (oropharynx 4/5 and digestive 1/5). Finally, combination of surgical drainage and double prolonged antibiotherapy (penicillin+metronidazole) was the elected treatment. CONCLUSION: Since hematogenous diffusion is frequent, anaerobic infection should be suspected in any case of deep abscess affecting patients with predisposing conditions such as poverty, severe teeth disease or iatrogenic procedure.

Abscess↗
PubMed2004

Brain abscess--diagnosis and management.

OBJECTIVE: To evaluate the clinical presentation, diagnosis, sources of infection, surgical management outcome and microorganisms involved in the brain abscess in our locality. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The department of Neurosurgery, Chandka Medical College Hospital, Larkana from July 1998 to June 2003. SUBJECTS AND METHODS: All patients who were confirmed cases of brain abscess were entered into the study. Data collected on proforma, contained categories of age, gender, clinical presentation, diagnostic laboratory findings, computed tomography scan reports, associated anomalies, surgical management, culture reports antibiotic therapy, microbiologic features and treatment out come. RESULTS: Out of 82 patients, 58 were males and 24 females. Mean age was 18 years (range 05 months to 55 years). Headache with papilloedema was the commonest presentation (82%). Neurological deficit was present in 46%. A source of infection was present in 89%. Otogenic source was the commonest (63%). CT scan was diagnostic in all (100%) cases. Solitary abscess was found in 79% of the cases while in 21% of the cases multiple abscess were found. Temporal lobe was the commonest site involved (55%). Cultures were found positive for microorganism in 82% of the cases. Bacteriodes (38%) and Streptococci (25%) were the commonest isolates. Burr hole aspiration was done in only 38% of the cases while excision of the capsule along with aspiration was carried out in 62% of the cases. Over all morality was 22% in this series; causes of death were septicemia, ventriculitis and pneumonia. CONCLUSION: Diagnosis with CT scan, appropriate antibiotic therapy and complete removal of abscess along with excision of capsule could reduce the mortality and neurological deficits from brain abscess.

Adolescent↗
PubMed2003

Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography.

OBJECTIVE: To determine the effectiveness of using intravenous antibiotics alone to treat clinically stable children with clearly defined deep neck abscesses diagnosed by contrast-enhanced computed tomography (CT). DESIGN: Retrospective chart and CT scan review. SETTING: Tertiary care children's hospital. PATIENTS: The study comprised clinically stable pediatric patients who presented with signs and symptoms of a deep neck infection and who had CT scans demonstrating an abscess in the parapharyngeal space, retropharyngeal space, or both that included (1) a well-formed ring enhancement around a nonenhancing density consistent with fluid and (2) a size greater than 1 cm in every dimension. MAIN OUTCOME MEASURES: Clinical resolution of the signs and symptoms of the deep neck abscess after treatment with intravenous antibiotics. RESULTS: Over a 22-month period (May 1999 to March 2001), 11 children ranging in age from 4 months to 16(1/2) years who had contrast-enhanced CT evidence of deep neck abscess and no clinical evidence of severe symptoms or significant airway compromise were initially treated with intravenous antibiotics. Ten (91%) of the 11 children responded to intravenous antibiotic therapy as their only treatment. All 10 responders began to improve clinically by 48 hours. The symptoms resolved in 5 children by treatment day 3. Five to 8 days of treatment were required to completely resolve the symptoms in the other 5 patients. The 1 child who did not respond to intravenous antibiotic therapy underwent surgical drainage of her deep neck abscess within 12 hours of admission, with purulence discovered at the time of surgery. CONCLUSION: In a select number of clinically stable children, deep neck abscesses diagnosed on contrast-enhanced CT scans using strict radiographic criteria can be effectively treated with intravenous antibiotics alone.

Abscess↗
PubMed1988

Needle aspiration of nonperitonsillar head and neck abscesses. A six-year experience.

Twenty-five patients with various head and neck abscesses have been managed with needle aspiration as the initial surgical modality over a six-year period. Twenty (83%) of 24 patients' abscesses resolved without formal surgical intervention. Patient 25 in the series whose abscess, though initially resolving, reaccumulated within two weeks requiring an incision and drainage. Recurrent cancer was then diagnosed. Eight of ten large-volume abscesses (over 10 mL) were controlled with needle aspiration. Fourteen patients required multiple aspirations, five of whom had indwelling catheters placed to facilitate abscess decompression. These data confirm that needle aspiration is an effective means of controlling nonperitonsillar abscesses of the head and neck.

Abscess↗
PubMed1993

Needle aspiration of peritonsillar abscess in children.

Needle aspiration for the treatment of peritonsillar abscess was assessed in 43 consecutive children aged 7 to 18 years (mean age, 13.9 +/- 2.5 years) during the 3-year period from 1988 through 1991. A positive aspirate was obtained in 31 (76%) of the 41 patients who cooperated for needle aspiration; a mean of 2.9 +/- 1.9 mL of pus was withdrawn. Of the 31 children with a positive aspirate, in 27 (87%) the abscess resolved, two (6%) required a second aspiration for resolution, and two (6%) underwent immediate tonsillectomy for persistent abscess. Of the 10 children (24%) with negative aspirations, in six (60%) the abscess resolved with antibiotic treatment alone, three (30%) underwent immediate (quinsy) tonsillectomy, and in one (10%) the abscess spontaneously drained. No bleeding, airway obstruction, or anesthetic complications occurred. Needle aspiration of peritonsillar abscess in children, with tonsillectomy reserved for nonresponders, appears to be an efficacious and safe method of treatment.

Adolescent↗
PubMed2002

Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess.

HYPOTHESIS: Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD). METHODS: We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome. RESULTS: The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. CONCLUSIONS: Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.

Abdominal Abscess↗