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PubMed2005

Effective laparoscopic drainage for intra-abdominal abscess not amenable to percutaneous approach: report of two cases.

PURPOSE: The usefulness of the laparoscopic approach for massive intra-abdominal abscesses is controversial. We report two patients who underwent laparoscopic abscess drainage for massive intra-abdominal abscesses not amenable to the percutaneous approach that were suspected to be caused by acute appendicitis. METHODS: In both patients, four ports were placed at their abdominal walls under general anesthesia. Intra-abdominal abscess cavities were punched out, and the purulent exudates that spilled out from the cavities were aspirated completely. Copious irrigation was performed under direct vision. These procedures were completed laparoscopically. RESULTS: The postoperative clinical courses of the patients were uneventful. The intra-abdominal abscesses did not recur, and no wound complications were recognized. The patients were discharged from our hospital in excellent condition within two weeks. CONCLUSIONS: Laparoscopic drainage for massive intra-abdominal abscess is a minimally invasive and useful procedure compared with the open method or the percutaneous approach. It offers the advantage of being able to explore of the abdominal cavity without an unnecessary wide incision, and aspiration of a purulent exudate is possible under direct vision.

Abdominal Abscess↗
PubMed2006

Immediate percutaneous drainage compared with surgical drainage of renal abscess.

PURPOSE: To compare immediate percutaneous drainage of renal abscess via ultrasonographic guidance to surgical drainage. PROCEDURES: This was a retrospective cross-sectional study of 27 patients (mean age of 59.37 +/- 12.25 years) with renal abscesses. Immediate percutaneous catheter drainage was performed in patients with pus-containing cavities greater than 3 cm who consented in the emergency section (n = 12). Other patients underwent surgical drainage (n = 11). Both groups were also treated with empirical antibiotic therapy. Four patients were treated exclusively with antibiotics and were excluded from the analysis. FINDINGS: Abscess size on computer tomography (CT) was similar between the percutaneous catheter drainage (PCD) patients and open surgical drainage patients (7.47 +/- 1.75 cm vs. 8.67 +/- 1.87 cm; P = 0.13). There was no significant difference in mean duration of hospitalization (PCD, 19.5 +/- 10.5 days; surgical drainage, 14.55 +/- 4.52 days. P = 0.15). Larger abscess size and higher C-reactive protein levels were important prognostic factors in both groups. Microbiological analysis revealed Escherichia coli and Klebsiella pneumoniae in most abscesses. CONCLUSIONS: Patients treated with percutaneous drainage for renal abscess had outcomes comparable to those treated with surgical drainage.

Abscess↗
PubMed2006

Postneurosurgical nosocomial bacterial brain abscess in adults.

BACKGROUND: Bacterial brain abscess after a neurosurgical procedure has become an important occurrence in the hospital setting. However, no information about the frequency, clinical relevance, and the outcome has been reported. PATIENTS AND METHODS: Over a period of 19 years (1986- 2004), a total of 31 patients were retrospectively identified as having brain abscesses after neurosurgical procedures and were enrolled in this study. RESULTS: Those included in this study accounted for 0.17% (31/18600) of all neurosurgical procedures in the same period. There was an increased percentage of adult postneurological nosocomial brain abscess compared to all adult bacterial brain abscesses in recent years. The majority of cases were due to Gram-negative bacilli and polymicrobial infections, including both Gram-negative bacilli and Staphylococcus species. Furthermore, the appearance of multi-antibiotic resistant strains was also noted during the study period. The overall fatality rate was 16%. CONCLUSION: Post-neurosurgical states have become important predisposing factor for bacterial brain abscess. In patients that undergo neurosurgical procedures and develop smoldering fever, progressively disturbed consciousness, headache, and new onset focal neurologic signs, immediate neuro-imaging studies should be undertaken to determine whether bacterial brain abscess is present. Although mortality may be related to the primary brain pathology, early diagnosis and timely use of appropriate antibiotics based on antimicrobial susceptibility testing are also essential for survival.

Adolescent↗
PubMed1984

Experimental aspects of intraabdominal abscess.

Two animal models were used to examine the bacteriologic aspects and antibiotic treatment of intraabdominal abscess. The first model was designed to simulate the septic complications of colonic perforation using an inoculum of stool implanted intraperitoneally in rats. The results showed that coliforms were responsible for early lethality, Bacteroides fragilis appeared to play a particularly important role in abscess formation, and optimal treatment required antimicrobial regimens directed against both coliforms and anaerobes. The second model was designed to examine the pharmacokinetic properties of antibiotics and therapeutic efficacy of various antimicrobials in a subcutaneous abscess involving B. fragilis in mice. This work showed all drugs penetrated abscesses, although there was a diminishing antimicrobial effect with progressive delays in the time that treatment was initiated. It is suggested that bacteria within an abscess are in a stationary phase of growth so that early institution of treatment is critical for optimal in vivo activity, and bactericidal drugs may be preferred once an abscess has formed.

Abdomen↗
PubMed1986

Induction of subcutaneous and intraperitoneal abscesses in mice by Neisseria gonorrhoeae and Bacteroides species.

The pathogenicity in relation to encapsulation and potential for synergy between Neisseria gonorrhoeae and Bacteroides spp. was studied by subcutaneous and intraperitoneal inoculation of single organisms or mixtures of these organisms into mice. Ten isolates of N. gonorrhoeae and 12 isolates of Bacteroides spp. were studied. When injected alone, only heavily encapsulated organisms induced subcutaneous and intraperitoneal abscesses. However, N. gonorrhoeae did not induce intraperitoneal abscesses and did not survive in intraperitoneal abscesses even when inoculated with Bacteroides spp. Abscesses developed after subcutaneous inoculation of mixtures of heavily encapsulated Bacteroides and heavily or slightly encapsulated N. gonorrhoeae or of slightly encapsulated Bacteroides and heavily encapsulated N. gonorrhoeae. Heavily encapsulated N. gonorrhoeae did not survive in subcutaneous abscesses longer than 3 days after being inoculated alone and survived no longer than 7 days after inoculation with heavily encapsulated Bacteroides spp. An increase in the colony-forming units of Bacteroides spp. per abscess was observed when they were inoculated with N. gonorrhoeae. When mixed with heavily encapsulated isolates, slightly encapsulated N. gonorrhoeae or Bacteroides isolates became heavily encapsulated. These data demonstrate the effect of encapsulation on the relationship between N. gonorrhoeae and Bacteroides spp. and the potential for synergy between these organisms.

Abscess↗
PubMed1981

Use of indium-111-labeled autologous leukocytes in differentiating pancreatic abscess from pseudocyst.

Pancreatic abscess is very difficult to diagnose and the differentiate from pancreatic pseudocyst based on clinical findings, laboratory studies and roentgenographic examinations. Eight patients diagnosed as having a pancreatic mass by ultrasonography or computed tomography also underwent indium-111-labeled autologous leukocyte scanning (10 scans) for suspected intraabdominal sepsis. This scan detects migration of labeled leukocytes into abscesses or areas of inflammation. Four patients had abscess and positive scans, and four patients had pseudocyst and negative scans. There was one false-positive scan in a patient with a recurrent pancreatic mass after drainage of an abscess. Since pancreatic abscess requires prompt drainage, and since it may be preferable to delay drainage of a pseudocyst, the differentiation of these two conditions is important. This test appears very effective in diagnosing pancreatic abscess and differentiating it from a pseudocyst.

Abscess↗
PubMed1983

Amebic liver abscess. Differential diagnosis of cholecystitis.

Among patients presenting with pain and tenderness in the right upper quadrant were 75 with cholelithiasis (13 male, 2 under age 50) and 9 with amebic hepatic abscess (6 male, all under age 45). The differential diagnosis of cholelithiasis versus liver abscess was accurately made by prompt sonography and hepatobiliary scintigraphy. Amebic abscess was confirmed by positive serum ameba titers. Presenting symptoms and results of laboratory studies of patients with amebic abscess were indistinguishable from those of patients with cholecystitis. It is concluded that an accurate diagnosis of amebic liver abscess in the differential diagnosis of cholecystitis can be made by sonography and hepatobiliary imaging. Also, in endemic areas of the southwestern United States, amebic abscess should be strongly considered in the differential diagnosis of patients presenting with pain and tenderness in the right upper quadrant and is more common than cholecystitis in young men.

Cholecystitis↗
PubMed1987

Changing clinical spectrum of splenic abscess. A multicenter study and review of the literature.

The changing demographics of splenic abscess in regard to predisposition, clinical setting, diagnosis, bacteriologic findings, and treatment have been presented based on 19 patients from five institutions and 170 patients reported in the literature since 1978. These data, in turn, have been compared with a previously published retrospective review of the world literature from 1900 to 1977. It has become clear that since 1978, splenic abscess is diagnosed earlier in its presentation due to the widespread use of improved imaging techniques, immunocompromised patients comprise a much larger proportion of patients (24 percent) than previously due to increasing use of steroids and chemotherapeutic agents, and the diagnosis of fungal splenic abscess, almost unheard of before 1978, has increased to 26 percent of patients. The diagnostic sensitivity of computerized tomography (96 percent) has clearly been shown to be superior to ultrasonography, and gallium, indium, and technetium-99m liver and spleen scanning. The diagnosis of splenic abscess, however, is still often not considered due to its rarity and the presence of predisposing conditions which obscure its clinical presentation. Untreated splenic abscess is still fatal, and although splenectomy is the mainstay of treatment, it appears that antifungal treatment without splenectomy can be recommended for patients with disseminated fungal disease as long as bacterial abscess has been ruled out by invasive culture techniques. Scattered reports of percutaneous drainage exist and are increasing in the literature, although the results are as yet inconclusive. Eventual recovery depends on early diagnosis and successful treatment of the underlying condition.

Abscess↗
PubMed1993

Management of splenic abscess in immunocompromised children.

Splenic abscess is an infrequent complication in the immunocompromised patient. Six patients underwent splenectomy for presumed splenic abscess from 1987 to 1991. Chemotherapy altered the immune system of four patients; the human immunodeficiency virus (HIV) rendered the other two vulnerable to infection. Five presented with fever but none had leukocytosis; only one exhibited palpable splenomegaly; three had abdominal pain. Cultures documented systemic infection in all but one, an HIV-positive individual. Respiratory embarrassment was the indication for surgery in one patient. In five cases the decision for surgical intervention was made after computed tomography (CT) indicated the presence of multiple splenic lesions and systemic antibiotics failed to resolve the fevers. CT additionally showed hepatic and/or renal microabscesses in four patients. Signs and symptoms experienced preoperatively resolved with splenectomy in all six patients. No additional surgery was required for the patients with extrasplenic abscesses. Surgical pathology determined that three spleens had fungal and two had mycobacterial abscesses. The other was shown to be a spindle cell sarcoma; no abscess was present. This patient had preoperative blood cultures positive for mycobacteria, and the same organism was recovered from retroperitoneal nodes sampled at the time of splenectomy for the sarcoma. Follow-up indicates that no patients experienced surgical complications or sequelae related to their splenic pathology. Splenectomy is necessary and effective in treating splenic abscesses in immunocompromised patients and is appropriate for diagnosis as well as therapy.

Abscess↗
PubMed1995

Amebic hepatic abscess in children.

The authors retrospectively reviewed all case histories of children with amebic hepatic abscess treated from 1975 to 1993 at their hospital. Twenty boys and 12 girls were diagnosed. Their ages ranged from 10 months to 12 years, with a mode of 1 and 2 years. In 17 (53%) of the patients, the abscess remained confined to the liver and was treated medically with dehydroemetine and metronidazole. Imminence of complication was present in 9 patients (52%), and required percutaneous needle aspiration. Imminence of complication was evidenced by: (1) clinical worsening of the patient despite adequate medical treatment, (2) presence of an abscess of 6 cm or more in a septic patient, or (3) clinical or ultrasonographic findings of an abscess on the verge of rupture. All 9 patients did satisfactorily. Fifteen cases (47%) were complicated by rupture and required surgical treatment. One of these patients died of sepsis. Medical treatment alone was excellent for small abscesses. Percutaneous needle aspiration was a successful approach in patients with imminence of complication. Surgery was reserved for ruptured abscesses.

Algorithms↗
PubMed1989

Enhancement of survival from murine polymicrobial peritonitis with increased abdominal abscess formation.

Muramyl dipeptide (MDP), a purified synthetic immune adjuvant, has been shown to increase murine intraabdominal abscess formation in a monomicrobial model using Bacteroides fragilis. This effect required live bacteria and was abolished by appropriate antibiotics. A polymicrobial model of peritonitis and abdominal abscess formation using Streptococcus fecalis, Escherichia coli, and B. fragilis was initially used to determine mortality rates at various concentrations and obtain an appropriate LD50. Animals were then pretreated with MDP or its inert buffer and underwent intraperitoneal injection of the appropriate bacterial suspension. Mortality and abdominal abscess formation were then assessed at 2 weeks after injection. There was a significant reduction in mortality (P less than 0.03) in mice treated with MDP compared to the controls. In surviving animals, there was also a significant increase in the number of animals forming abscesses (P less than 0.05) following treatment with MDP. This study has shown that nonspecific immune stimulation by MDP provided enhanced protection against a polymicrobial intraperitoneal challenge and paradoxically increased the formation of abdominal abscesses at the same time. This may be regarded as enhancement of the natural history of survival from peritonitis via bacterial containment through intraabdominal abscess formation, a manifestation of beneficial outcome in experimental peritonitis.

Abdomen↗
PubMed1981

Kinetics of lymphocyte subpopulations and their functions in cases of amoebic liver abscess.

This study shows the relationship between lymphocyte subpopulations and their response to non-specific stimulant phytohaemagglutinin (PHA) and specific stimulant (amoebic antigen) in cases of amoebic liver abscess in relation to the duration of disease, based on the first appearance of symptoms and/or signs, 26 patients with amoebic liver abscess and 20 normal, healthy controls were studied. Five of the patients gave a history of alcohol intake for the last 10 to 15 years. Eight had a solitary abscess and five had multiple abscesses, as seen on liver scan. No change in the B cell count was noticed in any of the patients. Depression of the T cell number and function was noticed from two weeks onwards. A history of alcohol intake made no difference. Cases with multiple liver abscesses were more immunologically depressed than were those with a solitary abscess.

Alcoholism↗
PubMed1989

Brain abscess associated with congenital heart disease.

Between 1952 and 1985, 25 cases of brain abscess with congenital heart disease were treated at the Department of Neurosurgery, Tianjin Medical College Hospital. Patients' ages ranged from 5 to 38 years. The most common form of congenital heart disease was tetralogy of Fallot, occurring in 13 cases. The abscesses were located in the parietal, frontal, and temporal lobes. The pus from the abscesses was sterile in 13 of 19 cases. In the rest, Streptococcus was the predominant organism. Twenty-three cases were treated by aspiration of the abscess through a burr hole. In two cases, initial aspiration was followed by excision of the abscess. The mortality rate of the whole group was 32%. The etiology of brain abscess in patients with congenital heart disease is discussed.

Adolescent↗
PubMed1986

Efficacy of abdominal computed tomography in evaluation of possible abdominal abscess.

A retrospective analysis was made of all abdominal computed tomography scans performed because of clinical suspicion of an abscess at our institution over a 12-month period. Of 130 patients examined, 45 patients had had abdominal surgery within the previous 2-week period. Of these patients, 14 were found to have abscesses on computed tomography, with three known false-negative studies. An additional nine patients had sterile postoperative collections. Nine patients had had an abdominal abscess previously diagnosed, and five of these had a residual abscess. A total of seven abscesses were found by computed tomography in 76 patients who had had no surgery in the previous 2 weeks, with one known false-negative study. High-risk categories of nonoperative patients were identified. Only one positive study occurred in a patient without a high clinical index of suspicion for an intraabdominal abscess, although a total of 50 patients fell into this low-risk, nonoperative category. The cost-effectiveness of computed tomography studies in such low-risk patients is questioned.

Abdomen↗
PubMed1985

Abscess incision and drainage in the emergency department--Part I.

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. Incision is generally performed using local anesthesia, with intraoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary. Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage. The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.

Abscess↗
PubMed2006

Nasal septal abscess complicated with acute sinusitis and facial cellulitis in a child.

Non-traumatic nasal septal abscess is rare, commonly seen in patients with poor immunity, and presents as isolated nasal septal abscess. Further, nasal septal abscess complicated with acute sinusitis is rather rare. Very little literature has been generated for non-traumatic nasal septal abscess complicated with acute sinusitis in healthy patients. Prompt diagnosis and adequate treatment will help to prevent the complications associated with nasal septal abscess such as saddle nose and intracranial involvement. Herein, to our knowledge, we present the first case involving an otherwise healthy little girl with nasal septal abscess complicated with acute sinusitis and facial cellulitis.

Abscess↗
PubMed2005

Risk factors for spontaneous rupture of liver abscess caused by Klebsiella pneumoniae.

To identify risk factors for spontaneous rupture of liver abscess (SRLA), a retrospective study on patients with liver abscess caused by Klebsiella pneumoniae was performed. Of the 140 enrolled patients with liver abscess caused by K. pneumoniae, 8 (5.7%) experienced SRLA. In comparison to those with nonruptured liver abscess (NRLA), patients with SRLA were found to have significantly higher proportions of diabetic mellitus (100% versus 62.1%, P = 0.003), larger abscess size (mean of maximal diameter 7.8 versus 6.1 cm, P = 0.043), gas formation in abscess (87.5% versus 23.5%, P < 0.001), and left hepatic lobe involvement (50.0% versus 16.5%, P = 0.018). K. pneumoniae serotypes K1 and K2 were the predominant microorganisms isolated in both patients with NRLA and SRLA. Pulsed-field gel electrophoresis-generated fingerprinting of K. pneumoniae isolates from patients with SRLA revealed that these pathogens were nongenetically related.

Aged↗
PubMed2006

Nonsurgical treatment of abdominal or pelvic abscess in consecutive patients with Crohn's disease.

BACKGROUND: There is little agreement about the efficacy of nonsurgical treatment for abscess associated with Crohn's disease. Furthermore, there is no study on characteristics of abscess or patient that nonsurgical treatment could be worth trying as initial treatment. AIMS: To evaluate the outcome of nonsurgical treatment in Crohn's disease-related abscess and identify factor leading to failure of nonsurgical treatment of this complication. PATIENTS: Twenty-four patients, who consecutively admitted for Crohn's disease-related abscess to our institution during a 7-year period, underwent nonsurgical treatment as initial therapy. METHODS: Outcome data such as recurrence and intractability, and clinical features were retrospectively analysed. Univariate analysis with patient-related factors and abscess-related factors was performed for risk factor identification. RESULTS: Median follow-up period was 47.5 months. Of the eligible patients, 19 patients were treated medically and 5 patients underwent percutaneous catheter drainage with medical treatment. Overall success rate of nonsurgical treatment in our centre was 66.7%. The cumulative recurrence rate at 7 months was 12.5%. All recurrences occurred within 7 months from complete resolution on follow-up imaging. Univariate analysis showed that the significant factors which lead to failure of nonsurgical treatment were presence of associated fistula and concurrent steroid use (P=0.019 and P=0.019, respectively). CONCLUSION: Nonsurgical treatment can be considered as initial treatment modality for the Crohn's disease-related abscess without concurrent steroid therapy or relevant fistula.

Abdominal Abscess↗