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PubMed1982

Amebic liver abscess.

Amebic liver abscess was seen in 35 patients over a ten-year period at Cook County and the University of Illinois hospitals, Chicago; 32 had immigrated from an area of endemic amebiasis, but three were natives of Chicago. Typically they had right upper-quadrant abdominal pain and fever of short duration (nine days); on physical examination, upper abdominal tenderness and hepatomegaly were usually present. The diagnosis was confirmed by liver scan, serologic studies, aspiration of "anchovy paste" from the abscess, and/or a favorable response to specific antiamebic therapy. Most were solitary abscesses in the right lobe of the liver. Metronidazole treatment alone was adequate in 24 of 29 patients (83%). Nine patients underwent percutaneous or surgical drainage of the abscess owing to incorrect diagnosis (three), persistent pain and fever after medical treatment (three), expanding left lobe abscess (two), and for diagnosis (one). Mortality was 5.7% (two patients). Owing to current immigration patterns amebic liver abscess should be considered in the differential diagnosis of patients with right upper-quadrant pain and fever. The diagnosis should be confirmed with a liver scan and serologic study for amebiasis.

Adolescent↗

PubMed1986

Effect of heparin and heparin fractions on experimental abscess formation.

To evaluate the effectiveness of heparin and heparin fractions in decreasing abscess formation, rats were divided into six groups. A fibrin clot containing 10(9) live Escherichia coli was placed in the peritoneal cavity of each rat. Group 1 (controls) received daily subcutaneous (SQ) injections of 0.1 mL of saline solution. Group 2 received daily intramuscular injections of gentamicin, 12.5 mg/kg. Group 3 received a daily SQ dose of 30 U of porcine heparin. In addition to gentamicin, group 4 received heparin, group 5 received heparin fraction PK10169, and group 6 received heparin fraction CY216, all in daily SQ doses of 30 U. Survivors were killed at ten days and examined for intra-abdominal abscesses. All group 1 animals developed abscesses. Abscess formation was significantly decreased in all groups receiving gentamicin. When used with gentamicin, neither heparin nor heparin fractions decreased the number of abscesses formed when compared with gentamicin alone. Heparin or heparin fractions in combination with gentamicin did decrease abscess size significantly when compared with controls.

Abscess↗

PubMed2002

Appendiceal abscesses: primary percutaneous drainage and selective interval appendicectomy.

OBJECTIVE: To present our results of non-surgical primary management of appendiceal abscesses using ultrasonic percutaneous drainage under local anaesthesia, and selective interval appendicectomy. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 24 patients with appendiceal abscesses 3-12 cm in size. INTERVENTIONS: Primary ultrasonic percutaneous drainage under local anaesthesia, antibiotic treatment, and selective surgical treatment. MAIN OUTCOME MEASURES: Long-term follow-up. RESULTS: All patients had their abscesses drained successfully without complications. One patient continued to have fever, but eventually responded to conservative treatment and in one the bowel was perforated by the drain but again this was treated conservatively. Four abscesses recurred. Seven patients underwent planned interval appendicectomy. Another three patients were also operated on-one for caecal adenocarcinoma, and two for persisting symptoms and enterocutaneous fistulas. CONCLUSIONS: Appendiceal abscesses can be effectively drained percutaneously using ultrasound-guided drainage under local anaesthesia, without complications. Recurrent appendicitis is common, and malignancy is a substantial risk in elderly patients. Modern laparoscopic appendicectomy and early postoperative discharge makes interval appendicectomy a valid treatment option after primary non-surgical management of appendiceal abscesses.

Abscess↗

PubMed2004

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

Adult↗

PubMed1981

Ultrasound gray-scale pattern and guided aspiration puncture of abdominal abscesses.

Various ultrasound gray-scale patterns of 45 consecutive abscesses were studied in 43 surgical and medical patients. Eleven abscess formations were unsuspected clinically, 27 had developed as a postoperative complication; 25 collections (55.6%) presented with an anechoic appearance, and 15 (33.3%) showed a mainly fluid pattern but contained a few nonreverberatory echoes. Five abscesses (11.1%) appeared with a complex solid-like pattern with large amounts of internal echoes. A total of 28 ultrasound guided diagnostic fine-needle aspirations of abscesses were performed on 26 patients without serious complications. All the aspirated samples yielded material sufficient for cytological or bacteriological examinations. Percutaneous fine-needle aspiration guided by sonography is recommended as a safe and useful diagnostic measure to confirm the nature of an ultrasonically displayed abdominal lesion suspected to be an abscess. Results from both sonography and confirmatory aspiration provide detailed topographic and diagnostic information for the choice of surgical or nonoperative management of abdominal abscess.

Abdomen↗

PubMed1986

Amebic liver abscess: sonographic diagnosis and management.

Over a period of 3 years, 68 intrahepatic abscesses in 48 patients were detected by ultrasonography at our institution in New Delhi, India. Our experiences with the sonography and management of this entity are presented. Multiple abscesses were present in 14 patients; the rest had a single abscess. The most common location was the right lobe of the liver. The sonographic morphology of the abscess was analyzed in terms of the echo pattern of the wall and contents of the abscess. These were later correlated with the duration of illness. An attempt was made to assess healing and thereby the age of the abscess. Follow-up ultrasound scans indicated that the change in sonographic appearance lags behind clinical improvement by a considerable period of time.

Adolescent↗

PubMed1994

Ultrasound detection of abscesses in the temporomandibular joint following surgical reconstruction.

The purpose of this investigation is to report the technique and assess the utility of ultrasound diagnosis of abscess in the postoperative temporomandibular joint (TMJ). Fourteen patients had 18 ultrasound examinations of the postoperative temporomandibular joint (TMJ) to detect a possible abscess. Ultrasound examinations were performed with either a 5-MHz linear array and/or a 7.5-MHz sector probe following placement of implants (16) and autogenous costochondral grafts (2). The TMJ was scanned in both coronal and axial planes. In 14 examinations, an abscess was not detected; there were no false-negatives. Soft-tissue edema was found in 1 of these 14 examinations; at surgery, there was no abscess. Four examinations were positive for an abscess; 3 of these were confirmed at surgery. One examination was false-positive. We conclude that ultrasonography can detect an abscess in the symptomatic postoperative TMJ. A negative examination is reliable.

Abscess↗

PubMed2005

Biological correlates of diffusivity in brain abscess.

Restricted diffusion in brain abscess is assumed to be due to a combination of inflammatory cells, necrotic debris, viscosity, and macromolecules present in the pus. We performed diffusion-weighted imaging (DWI) on 41 patients with proven brain abscesses (36 pyogenic and five tuberculous), and correlated the apparent diffusion coefficient (ADC) from the abscess cavity with viable cell density, viscosity, and extracellular-protein content quantified from the pus. On the basis of the correlation between cell density and ADC in animal tumor models and human tumors in the literature, we assumed that the restricted ADC represents the cellular portion in the abscess cavity. We calculated restricted and unrestricted lesion volumes, and modeled cell density over the restricted area with viable cell density per mm(3) obtained from the pus. The mean restricted ADC in the cavity (0.65 +/- 0.01 x 10(-3) mm(2)/s) correlated inversely with restricted cell density in both the pyogenic (r = -0.90, P = <0.05) and tuberculous (0.60 +/- 0.04 x 10(-3) mm(2)/s, r = -0.94, P = <0.05) abscesses. We conclude that viable cell density is the main biological parameter responsible for restricted diffusion in brain abscess, and it is not influenced by the etiological agents responsible for its causation.

Adolescent↗

PubMed1994

Effect of abscess fluid supernatants on the kinetics of Candida albicans growth.

Abscess fluid supernatants have been found to inhibit microbial growth, an effect that appears to be due to a protein originating in the cytoplasm of neutrophils. The antimicrobial activity of calprotectin, the responsible protein, is reversible by the addition of zinc to the culture medium. To more carefully analyze this type of antimicrobial activity supernatants of fluids from experimental subcutaneous Candida albicans abscesses in mice were studied to determine how they affect the in vitro growth kinetics of C. albicans. The abscess fluid supernatants inhibited growth in a dose-dependent fashion and more at early times than at later ones. Instability of the abscess fluid antimicrobial activity did not appear to explain the timing of the growth inhibition. A marked lengthening of the lag phase of growth was observed in cultures containing the supernatants (from approximately 6 hr in the control cultures to 15-20 hr in those with the supernatants). On the other hand, the abscess fluid supernatants had only minimal effects on the generation times of actively proliferating C. albicans yeast cells. In addition, these supernatants did not appear to significantly affect the percentage of inoculated organisms undergoing cell division, as determined by a limiting dilution assay. Therefore, these results indicate that abscess fluid supernatants extend the lag phase of C. albicans growth, an effect similar to that seen with zinc-deprived organisms.

Abscess↗

PubMed2001

Polyanionic polysaccharides reduce intra-abdominal adhesion and abscess formation in a rat peritonitis model.

BACKGROUND: Intra-abdominal infection is complicated by adhesion and abscess formation. We have assessed the adhesion- and abscess-reducing capacity of various solution volumes and concentrations of two polyanionic polysaccharides, hyaluronan (HA) and carboxymethylcellulose (CMC), in a rat peritonitis model. STUDY DESIGN: In 192 male Wistar rats a bacterial peritonitis was induced using cecal ligation and puncture. After 24 h the abdomen was reopened and the ligated cecum resected. Animals were randomized into three control groups, nine groups treated with various solution volumes (1 to 8 ml) containing different HA concentrations, and four groups treated with 1.7% CMC solution. Rats were killed at day 7, postoperatively, and adhesions were scored at five abdominal sites on a scale from 0 to 4. The presence and size of intra-abdominal abscesses were noted. RESULTS: Fifty-four rats (28%) prematurely died. There was no significant difference in mortality between treatment groups and controls. Treatment with CMC (P < 0.001) and low (0.2 and 0.4%) concentrations of HA (P < 0.005) significantly reduced intra-abdominal adhesion formation. High volumes of 0.2 and 0.4% HA were most effective (P = 0.01). The effect of CMC was volume independent. The incidence of abdominal abscesses was also significantly reduced by treatment with either CMC (P < 0.001) or low concentrations of HA (P < 0.001). With regard to abscess formation the effect was independent of the volume administered for HA, while low volumes of CMC were most effective (P < 0.005). CONCLUSION: Intraperitoneal treatment with either CMC or low-viscosity HA solution reduced intra-abdominal adhesion and abscess formation in a rat peritonitis model. The volume-induced reduction in adhesion formation suggests a hydroflotation effect of HA solution.

Abscess↗

PubMed1987

Ultrasound-guided brain abscess aspiration in neonates.

Four cases of brain abscess in neonates are described, diagnosed by ultrasonography and CT. All abscesses were confirmed surgically. One patient was operated on 5 weeks after diagnosis because of initial parental refusal. The etiology in all cases was meningitis superimposed on an hypoxic-ischemic insult. Two cases had a single abscess while the other two had multiple lesions. All cases were operated on with intraoperative ultrasound examination through the fontanelle. The case with delayed aspiration showed complete evolution from localized cerebritis to complete capsule formation with mass effect. One abscess was sterile, and in the others grew Klebsiella pneumoniae and Enterobacter aerogenes. The microorganism initially isolated from the lumbar CSF was also found in the abscess. Even after sterilization of the lumbar CSF, all abscesses were still present. Ultrasound examination and CT are compared.

Brain Abscess↗

PubMed1992

Brain abscess in infants.

Brain abscesses are rare in infants and their clinical presentation is specific for this age group. Seven cases of brain abscess in infants aged 2-11 months are reported. The underlying cause was meningitis in four, sepsis in two, and unknown in one. Gram-negative organisms were cultured in 6 patients. The abscess size was 5 cm or more in five cases; in four there were multiple lesions. Two abscesses were aspirated and irrigated; four particularly large lesions were drained and repeatedly aspirated and irrigated. One craniotomy was done. There were two deaths, one in the postoperative period and the other 6 months after discharge. Follow-up information is available for four children, showing a good result in only one of them. Formation of an abscess should be diagnosed early, and close ultrasound monitoring or CT scanning in infants with bacterial meningitis and sepsis is essential. The prognosis in cases in which large/multiple abscesses develop is poor.

Brain Abscess↗

PubMed1994

Brain abscess in infants and children.

Forty-four consecutive patients with brain abscesses, aged between 1 month and 16 years, were reviewed. The cause of abscess was meningitis in 36% of the cases, otitis in 27%, head injury in 16%, congenital heart disease in 9%, other in 5%, and undetected in 5%. Thirty patients had a single abscess and 12 had multiple abscesses. Multiloculated abscess was present in 2. Total excision was accomplished in 22 patients. Three patients underwent needle aspiration. Drainage of the abscess was performed in 13. Secondary excision was needed in 5 patients. One patient was treated nonsurgically. Streptococci, staphylococci and Proteus mirabilis were the microorganisms recovered in cultures. Overall mortality was 20% (9 patients). Mortality was significantly higher in patients under 2 years of age than in those older. Of 15 patients who were comatose at the time of admission, 6 died. Etiology, diagnostic method, and treatment modalities were not found to be significant factors in terms of predicting mortality.

Adolescent↗

PubMed1996

The serum neutralizing antibody response in cattle to Fusobacterium necrophorum leukotoxoid and possible protection against experimentally induced hepatic abscesses.

The serum antileukotoxin antibody response and protection against subsequent experimental challenge with Fusobacterium necrophorum were investigated in 30 steers vaccinated with crude F. necrophorum leukotoxoid. Culture supernatant of F. necrophorum, strain 25, containing leukotoxoid was concentrated. The steers were assigned randomly to six groups (n = 5): PBS control with Stimulon adjuvant; vaccinated with concentrated supernatant diluted to provide 2.5, 5.0, 10.0, or 20.0 ml with the water-soluble Stimulon adjuvant; and 5.0 ml with the Ribi oil-emulsion adjuvant. The steers were injected subcutaneously on days 0 and 21. Blood samples were collected at weekly intervals to monitor serum antileukotoxin antibody titres. On day 42, all the steers were challenged intraportally with F. necrophorum culture. Three weeks later (day 63), the steers were killed and necropsied for examination of their livers and assessment of protection. Steers vaccinated with crude leukotoxoid tended to have higher antileukotoxin titres than the controls, but the difference was not significant. Also, the antibody titre did not appear to be dose-dependent. In the control group, 3 out of 5 steers developed liver abscesses. The incidence of liver abscesses in steers vaccinated with Stimulon adjuvant was not dose related; however, only 8 of the 25 vaccinated steers developed abscesses. None of the steers vaccinated with the 5.0 ml dose with Ribi had any abscesses. Evidence for a relationship between antileukotoxin antibody and protection was shown by the lower titre in those steers that developed abscesses compared to those that did not. It was concluded that antileukotoxin antibody titres probably provided some degree of protection against experimentally induced liver abscesses, but further dose-titration studies using Ribi or possibly another more effective adjuvant will be needed to confirm this.

Adjuvants, Immunologic↗

PubMedDate not supplied

Intrahepatic abscess due to gallbladder perforation.

BACKGROUND: Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment. METHODS: The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis. RESULTS: Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions. CONCLUSION: Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.

Aged↗

PubMed1983

Experimental intraabdominal abscess formation by Escherichia coli and bacteroides fragilis.

An improved animal model of intraperitoneal abscess formation was developed in order to study the role of Bacteroides fragilis and Escherichia coli. Both microorganisms were found to independently cause abscesses, although Bacteroides fragilis-induced abscesses were invariably minute. The combined inoculation of these microorganisms resulted in the induction of intraabdominal abscesses larger than those formed by Bacteroides fragilis or Escherichia coli alone. However, the size difference between abscesses produced by Escherichia coli alone and by the combination of both organisms was not statistically significant. The animal model defined in this study differed from earlier models in that use of the complex sterile cecal contents can be avoided. This allows for a more precise evaluation of the contribution of each organism to the pathogenic process of intraabdominal abscess formation.

Abdomen↗

PubMed1994

Computerized tomographic scan-guided drainage of intra-abdominal abscesses. Preoperative and postoperative modalities in colon and rectal surgery.

PURPOSE: Computerized tomographic (CT) scan-guided percutaneous drainage of intra-abdominal abscesses has changed the colon and rectal surgeon's approach to preoperative and postoperative intra-abdominal infections. This study is an effort to prove the efficacy of CT scan-guided percutaneous drainage. METHODS: A retrospective study was performed on 133 patients who underwent CT scan drainage of intra-abdominal abscesses over a 6.3-year period. RESULTS: 67 patients had underlying lower gastrointestinal disease. Twenty-three of these patients (34 percent) had spontaneous abscesses and underwent drainage as a preoperative or final modality, whereas 44 patients (66 percent) were drained postoperatively. In 78 percent of patients, surgery was successfully avoided or delayed. Ten patients had acute diverticulitis associated with a large pelvic abscess. Eight patients underwent successful CT scan-guided percutaneous drainage, yielding an 80 percent success rate. Morbidity from the CT scan-guided percutaneous drainage procedure in spontaneous and postoperative groups was 0 percent and 9 percent, respectively. Mortality was 9 percent and 11 percent, respectively, and associated with an elevated Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSION: CT scan-guided percutaneous drainage of intra-abdominal abscesses is an important adjunct to colon and rectal surgery because roughly 80 percent of spontaneous and postoperative abscesses were successfully managed.

Abdominal Abscess↗

PubMed1993

Intrarectal ultrasound in the evaluation of perirectal abscesses.

Experience with intrarectal ultrasonography (IRUS) is limited for the evaluation of perianal sepsis. The purpose of this article is to report our experience with IRUS in evaluating 24 cases of suspected perianal abscess and fistula. IRUS was performed intraoperatively using a Brüel & Kjaer (Model #1846; Naerum, Denmark) endoanal ultrasound scanner with a 7-MHz transducer. After completion of the IRUS, careful anorectal examination and appropriate surgical therapy were performed. At surgery, 19/24 patients were found to have perirectal abscesses, with all 19 cases correctly identified preoperatively by IRUS. In 12 cases (63 percent), IRUS correctly defined the relationship between the abscesses and sphincters by Parks' classification. At surgery, internal openings of fistulous tracts were found in 14/19 cases, but IRUS identified only 4/14 (28 percent). In 6/24 cases, IRUS and clinical evaluation did not demonstrate a perirectal abscess. The role of IRUS in the evaluation of perirectal abscess is evolving. Certainly, uncomplicated abscesses can be managed without ultrasonography. However, IRUS can be an adjunct to careful evaluation of complex perianal suppurative disease.

Abscess↗