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A large variety of gastrointestinal and abdominal pathologic processes can be diagnosed or suspected by their direct effects on the chest. The chest radiograph, as often the first admission film, can aid the radiologist in recommending the appropriate follow-up examinations.
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Abscess formation associated with salmonella infections has long been recognized--but without implicating a particular serotype. The pathogenicity, invasiveness and increasingly frequent isolation of Salmonella virchow in the UK is well established. It's propensity to abscess formation is, however, less well recognised. We report 5 patients with abscesses due to S. virchow. This represents a disproportionate number of abscesses in relation to the salmonella isolations in North East Scotland during the 5-year period under scrutiny. We suggest that this organism should be considered as aetiologically relevant even where there is no history of preceding gastrointestinal infection.
A patient was admitted to the Internal Medicine Department after suffering from fever for 4 days. A splenic abscess was found in an ultrasound examination and was confirmed by an abdominal computerized tomography and galium scan. Antibiotic treatment was successful, however barium enema was performed due to the lack of a predisposing factor for this unusual abscess. A polypoid mass was found in the splenic flexure of the colon. Colonoscopy and histologic examination confirmed the mass to be colonic adenocarcinoma. Either an endoscopic examination or barium enema are recommended to exclude colonic lesions in cases of splenic abscess without an obvious cause.
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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.
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Our experience for the past four years with antireflux surgery has been reviewed. The Nissen fundoplication resulted in symptomatic improvement in 87.5 per cent of cases as compared with 64 per cent who were improved after the Belsey Mark IV procedure. Objective evaluation as measured by the standard acid reflux test (SART) revealed recurrent reflux in 9 per cent of those who underwent fundoplication and in 47 per cent of those treated with the Belsey repair. Mortality rates were similar. These results indicate that Nissen fundoplication is superior to the Belsey Mark IV procedure in the management of gastroesophageal reflux.
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43 specimens from a variety of sites were directly examined by indirect immunofluorescence assay (I.F.A.) with specific antisera against the capsular polysaccharide of Bacteroides fragilis and pooled antisera against a number of serotypes of Bacteroides sp. (all of the former B. fragilis subspecies). The findings were compared with those of routine anaerobic bacteriology and gas liquid chromatography for short chain fatty acids. Examination by I.F.A. was a sensitive (100%) and specific (90.3%) means of identifying B. fragilis. Use of the pooled serum was sensitive (100%) but less specific (64.3%) than the capsular antiserum (90.3%) although it had the advantage of detecting Bacteroides species other than B. fragilis. The capsular serum I.F.A. gave 9.7% false positives and no false negatives. The predictive value of a positive identification of B. fragilis in a clinical specimen using this anticapsular serum I.F.A. test was 80%; with the pooled Bacteroides group-serum it was 60%. The predictive value of a negative test was 100% for both sera, indicating that a negative I.F.A. test is a reliable index of the absence of Bacteroides from the culture I.F.A. of clinical material provides a rapid (less than 2 h) specific and sensitive means for the diagnosis of B. fragilis infections and would be of use in a clinical laboratory.
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Ultrasound is high frequency mechanical vibration. As far as is presently known, there are no harmful effects of ultrasound at the energy levels used in currently available commercial ultrasonic scanners. Ultrasonic studies are independent of organ function, are painless, and require nor special preparation. Ultrasonic scanning is useful in the diagnosis of pancreatic disease, especially in the detection of complications of pancreatitis such as pancreatic abscess or pseudocyst, and in diagnosing pancreatic carcinoma. Gallstones and dilation of the biliary tree can be detected ultrasonically even when the patient is jaundiced. Primary liver tumors and hepatic metastases can often be demonstrated. Intraabdominal abscesses are better investigated by ultrasound than by any other means currently available. Ultrasonic scanning also provides a sensitive means of detecting ascites. Ultrasonic control of needle placement has been suggested for pancreatic and liver biopsy, for aspiration of intraabdominal fluid collections, and for percutaneous transhepatic cholangiography. Ultrasonic B-mode scans provide undistorted images of cross sections through the abdomen which can be used in radiotherapy planning to localize tumor masses and to place kidney shields accurately. Organ volumes can be estimated from a set of ultrasonic B-mode scans without any assumptions being made as to the shape of the organ.
Pseudomonas like bacteria group Ve biotype I was isolated three times from the specimens taken by thorocenthessis from a patient with subdiaphragmatic abscess who was admitted to the Thoracic Diseases Clinic in the University of Ankara School of Medicine.
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From October 1982 to October 1984, a percutaneous drainage under realtime ultrasound guidance was performed in 53 patients with abdominal abscesses. The location of the abscesses was subphrenic (23), retroperitoneal (16), and intrahepatic (14). A safe access route was found by using ultrasound and fluoroscopy in 53 out of 55 patients (96 p. 100). Percutaneous drainage failed in 8 patients and 3 of these patients died. The causes of death were: cerebral abscess (1), renal failure after surgery for correction of a duodenal fistula (1), and pancreatic abscess (1). The other five patients were cured by surgical drainage. Two complications were observed: one case each of pneumothorax and purulent peritonitis. Forty-five patients were healed by percutaneous drainage without operation. The duration of the catheter drainage was 14 days +/- 13 (m +/- 1 SD). Our results suggest that percutaneous drainage under realtime ultrasound guidance is an efficient and safe way to treat abdominal abscesses.
We encountered 12 patients with psoas abscess in a two-year period. Of these, four were due to Crohn's disease making this the most important single cause of such abscesses in our series. Psoas abscess may be the presenting complaint in Crohn's disease and it should be considered as a possible cause of any psoas abscess from which enteric organisms are cultured.