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PubMed2005

[Inhibition of abdominal abscess formation in rat: mortality by sepsis].

BACKGROUND: Intra-abdominal abscesses and adhesions play important roles on isolation of a septic process and on organism protection against bacteremia. On the other hand, such phenomenon difficults the afflux of immune factors and antibiotics to the septic site. The purpose of the present study was to evaluate the effect of abscess inhibition on survival of abdominal sepsis. METHODS: Thirty adult Wistar rats were submitted to intraperitoneal injection of 50% rat feces solution. The animals were divided into three groups (n = 10). Group 1: control - feces solution; group 2: feces solution plus 0.9% saline solution; and group 3: feces solution plus 1% carboxymethylcellulose to inhibit abdominal adhesions. The three groups were divided into two subgroups (n = 5). Subgroup A: relaparorotomy after 4 days and investigation of the abdominal cavity; and subgroup B: follow-up during 30 days to evaluate the mortality and its cause. The Fisher test was utilized for statistical analyses. RESULTS: The injection of 0.9% saline solution did not increase the mortality of the rats. However, the mortality enhanced in the group that received carboxymethylcellulose comparing with control group. That group developed less adhesions and abscesses. CONCLUSION: This study demonstrated that the reduction of abscess formation and of intraperitoneal adhesions increases the mortality due to abdominal septic disease.

Abdominal Abscess↗
PubMed1978

Evaluation of abdominal abscess with computed tomography.

Computed tomography (CT) is valuable in providing a specific diagnosis of abdominal abscess and in determining its site and extent. Computed tomography is also capable of excluding an abscess with a high degree of certainty. In 31 of 34 patients with proven abdominal abscess, CT suggested the correct diagnosis and accurately defined the extent of involvement. In nine patients, the CT findings were specific for abscess. The CT appearance of abscess is diverse, largely depending on its location. The most common appearance is a low density mass often with higher density at the periphery. The presence of gas distributed within the mass or an extraalimentary air--fluid level allows an extremely confident diagnosis of abscess. Differential diagnostic possibilities are reviewed with emphasis on interpretive problems.

Abscess↗
PubMed1976

[Ultrasonic aspects of abdominal abscesses and hematomas].

Abdominal ultrasonography often enables to display the fluid collection of an abcess or haematoma. This type of diagnostic procedure is most useful in a post-operative period. The intestinal gases which stop the ultrasonic beam may be responsible for diagnostic failures. Positive results, which are the most frequent, are never the less precious to assess and decide a treatment policy.

Abdomen↗
PubMed1980

Infections following gastrointestinal surgery: intra-abdominal abscess.

Intra-abdominal sepsis is frequently present after trauma, surgical resection, or intrinsic diseases of the gastrointestinal tract. Infection may be generalized or localized in intraperitoneal or extraperitoneal locations as well as in solid organs. The offending microflora is polymicrobial, consisting of both aerobes and anaerobes. Adequate, prompt surgical drainage and the appropriate choice of parenteral antibiotics aimed at both types of bacteria will result in a more favorable postoperative course and will reduce the possibility of local infection and secondary septicemia.

Abdomen↗
PubMed1985

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital.

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.

Abdomen↗
PubMed1986

[Percutaneous drainage of abdominal abscesses].

Percutaneous puncture with echographic guide was performed in 37 patients with suspected abdominal abscesses. The abscess has been confirmed in 31 cases and it has been related to previous surgery in 21. In 3 cases the 3 small cavities were evacuated by a single-stage aspiration; in the other cases different drainage catheters, in relation to the size and the content of the cavities have been employed. Benefits of proteolytic agents, irrigation with saline solution and permanent aspiration are stressed. Successful drainage avoiding surgery was achieved in 23/31 patients (74%), and positive results have been obtained in multiple abscesses, multilocular abscesses and infected haematomas as well. A partial success was achieved in 3 cases (10%): the patients were submitted to surgery after a clinical improvement. Two complications occurred (bowel perforation and small liver laceration). The percutaneous drainage turned out to be a technique of choice in the great majority of abdominal abscesses, and should be considered a good alternative to surgery, particularly in high risk patients.

Abdomen↗
PubMed1986

Murine neutrophil migration during the course of an intra-abdominal abscess.

Studies of neutrophil migration in heterogeneous groups of septic patients have reported elevated, normal, and depressed neutrophil mobility. This experiment, conducted in a standardized murine population, measured neutrophil migration under agarose during the course of a chronic intra-abdominal abscess initiated by cecal ligation. Compared with both control (unoperated) and sham celiotomy mice, those mice with an abdominal abscess showed elevations of 22% and 14% of directed and random migration, respectively, at 48 hours. They had 30% to 40% decreases in these functions at days 4 through 10. Murine neutrophil migratory response during the course of an intra-abdominal abscess consisted therefore of an early elevation followed by a prolonged depression. Such a biphasic response could underlie the variable findings of neutrophil studies in septic patients. This model could be further applied to the study of the effects of chemotherapy and immunologic adjuvants on abscess course and neutrophil function, as well as to the study of the mechanisms of neutrophil response to sepsis.

Abdomen↗
PubMed2006

Abdominal abscesses due to actinomycosis after laparoscopic cholecystectomy: case reports and review.

We describe 2 patients who presented to a health care facility with abdominal abscesses years after undergoing laparoscopic cholecystectomy that was complicated by gallstone spillage. In both patients, sample cultures yielded Actinomyces species and enteric organisms. In 1 patient, crystallographic analysis of abscess debris confirmed the presence of gallstones. Actinomyces species is a rare cause of abdominal abscesses that should be considered in this patient population.

Abdominal Abscess↗
PubMed1992

Abdominal abscesses associated with enteric fistulas: percutaneous management.

For many years, surgical dictum stated abdominal fistulas should be treated by means of surgical excision. Recent advances in percutaneous techniques have altered this. The authors reviewed 150 consecutive abdominal abscesses drained percutaneously over a 36-month period. Among these, 24 patients were found to have 26 fistulous communications to bowel, the pancreatic duct, or the biliary system. Initial drainage of their abscesses was performed in the hospital, but 17 of 24 patients were discharged with a tube in place and were followed up as outpatients. The duration of drainage ranged from 4 days to 3 months. Fistulas healed in 21 of 24 patients (88%) without surgical intervention. Complications were few and included inadvertent dislodgment requiring tube replacement (two patients) and inadvertent puncture of the transverse colon (one patient). Treatment of abdominal abscesses with fistulas by means of percutaneous methods is reliable and safe. Hospital stay may be minimized with outpatient management after drainage.

Abdomen↗
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

Diagnosis of postoperative intra-abdominal abscess.

Clinical, laboratory, radiologic, and radionuclide findings of 40 patients with operatively proven intra-abdominal abscesses were evaluated to determine their degree of diagnostic accuracy. Correct preoperative diagnosis was established by clinical, laboratory, and simple radiologic technics in 24 (60%) patients, whereas more sophisticated imaging procedures were used in 16. Gallium citrate Ga 67 scan was done in nine and was positive in six, ultrasonic scan was positive in seven of 16, and computerized tomography in six of eight patients. In 12, two consecutive imaging procedures were used. Concordant results were obtained in eight, of which five were accurate and three inaccurate. Of the four remaining patients with discordant results, the second imaging procedure was incorrect in three and correct in one instance. Accordingly, sophisticated imaging procedures were done in only 40% of patients and were accurate in 75% of less of cases. Furthermore, addition of a second imaging procedure did not increase diagnostic accuracy. Therefore, these technics, while improving the previously existing diagnostic means, should be still considered less than perfect and their negative result should not exclude the need for diagnostic celiotomy when clinical findings are highly suggestive of intra-abdominal abscess.

Abdomen↗
PubMed1993

Structural features of polysaccharides that induce intra-abdominal abscesses.

The capsular polysaccharide complex from Bacteroides fragilis promotes the formation of intra-abdominal abscesses--a pathologic host response to infecting microorganisms. This complex consists of two distinct polysaccharides, each with repeating units that have positively charged amino groups and negatively charged carboxyl or phosphate groups. Analysis of these polysaccharides as well as other charged carbohydrates before and after chemical modification revealed that these oppositely charged groups are required for the induction of intra-abdominal abscesses in a rat model.

Abdomen↗
PubMed1978

Computed tomography in the diagnosis and management of abdominal abscesses.

Computed tomography (CT) is effective in demonstrating abdominal abscesses and their relation to surrounding structures. The CT signs of abscess are not unlike those demonstrable radiographically and include an abnormal mass, obliteration and displacement of surrounding organs, inappropriate gas, and peripheral enhancement after intravenous contrast. Axial imaging permits selection of safe approaches through which percutaneous needle aspiration can be performed for diagnosis and therapy. When techniques similar to those employed in angiography are used, a catheter can be inserted, the abscess evacuated, and the catheter left in place as a drain. Combined with intravenous antibiotics, this method of abscess drainage has been successful in curing abscesses without surgery. Representative examples are shown.

Abscess↗
PubMed1992

Fistuloscopy for the management of postoperative intra-abdominal abscesses.

A new technique of fistuloscopy for evaluation and treatment of postoperative intra-abdominal abscesses is described which was used in 8 patients in whom drainage of abscesses following surgery was insufficient. A cholangiofiberscope was introduced into the fistula canal produced by the postoperative drainage. Fistuloscopy was combined with fistulography in all cases to delineate the extent of the inflammatory process. The guidewire was then placed under visual control through the endoscope followed by re-introduction of the drainage tube until a position most effective for pus drainage was achieved. Following this procedure, fever resolved in all 8 patients. Fistuloscopy is recommended to achieve sufficient drainage of intra-abdominal abscesses in those cases where percutaneous ultrasound- or CT-guided drainage fails to lead to significant clinical improvement.

Abscess↗
PubMed1994

Effect of recombinant tissue plasminogen activator on intra-abdominal abscess formation in rats with generalized peritonitis.

BACKGROUND: During generalized peritonitis, intraabdominal fibrin deposition is stimulated whereas fibrinolytic activity is reduced, which predisposes intra-abdominal abscess formation. We investigated the effects of increasing the intra-abdominal fibrinolytic activity on abscess formation by intra-abdominal administration of recombinant tissue plasminogen activator (rt-PA). Potential side effects, such as bacteremia and bleeding, were also assessed. STUDY DESIGN: A rat model of generalized peritonitis, induced by intraperitoneal injection of sterile feces contaminated with 10(4) cfu per mL Escherichia coli (E. coli) and 10(4) cfu per mL Bacteroides fragilis, was used. RESULTS: Rats treated with rt-PA dissolved in methyl hydroxy propyl cellulose (MHPC) gel (0.5 mg per mL), had significantly less intra-abdominal abscesses than rats in the control group, treated with either Ringer's lactate solution or MHPC gel alone (p < 0.01). Other than E. coli, cultures of abscesses revealed species originating from the intestine, demonstrating bacterial translocation. The mortality rate was significantly higher in the rats treated with rt-PA as compared with rats in the control group (p < 0.01), which was surprising considering the absence of bacteremia. By challenging the rats with a higher dose of E. coli, early bacteremia was observed in the rats treated with rt-PA, not related to increased mortality rates. Intraabdominal use of rt-PA was not associated with an increased incidence of bleeding events. CONCLUSIONS: Recombinant tissue plasminogen activator prevents abscess formation in rats with generalized peritonitis. However, early bacteremia and increased mortality rates are serious drawbacks of the intra-abdominal use of rt-PA in this rat model.

Abdominal Abscess↗
PubMed1987

Abdominal abscesses in adolescents with Crohn's disease.

Little information is available about the development of abdominal abscesses in adolescents with Crohn's disease. We report the clinical presentation of five adolescents with Crohn's disease who developed this complication. The mean time from diagnosis until development of an abdominal abscess was 1.7 years. The admitting diagnosis was an acute abdomen in two patients and recurrent Crohn's disease in the other three. No features of the clinical presentation or laboratory data distinguished this group from other adolescents with Crohn's disease. The use of ultrasound and CT scanning was helpful in making this diagnosis preoperatively. Those patients with active Crohn's disease who do not respond promptly to medical therapy should be evaluated for the development of this complication.

Abdomen↗
PubMed2006

Delayed recurrence of postoperative intra-abdominal abscess: an unusual case and review of the literature.

BACKGROUND: Although intra-abdominal abscess is one of the major complications of abdominal surgery, the literature documents only a few cases of recurrence after a long asymptomatic period. METHODS: Case report and literature review. RESULTS: A 66-year-old woman developed a primary subphrenic abscess secondary to anastomotic leakage after total gastrectomy. Percutaneous drainage succeeded in evacuating the abscess cavity, and broad-spectrum antibiotics apparently eradicated the infection. However, a recurrent subphrenic abscess appeared eight years later with no intervening signs or symptoms. CONCLUSIONS: The unexpected outcome in this case may call into question the appropriate follow-up period after treatment for subphrenic abscess. Our experience indicates that clinicians should be aware of the possibility of rare delayed recurrence of intra-abdominal abscess.

Aged↗
PubMed1983

Indium-111 tropolonate leucocyte scanning in the detection of intra-abdominal abscesses.

Indium-111 leucocyte scanning is established as an accurate method for localising intra-abdominal abscesses. With the currently available cell labelling techniques there is a variable and significant delay in localisation of abscesses which is a major disadvantage in comparison with ultrasound or computed tomography. We have examined the speed and accuracy of localisation of leucocytes labelled in plasma with a new chelating agent, indium-111 tropolonate, in 90 patients with suspected intra-abdominal abscess. In 50 patients a comparison with ultrasound was made. Nineteen patients had abscesses. The sensitivity and specificity of labelled leucocytes were 95% and 99%, respectively. Comparative results for ultrasound were 60% and 83%. In nine out of 10 patients with abscesses scanned sequentially from 40 min after return of the labelled cells, activity corresponding to the abscess was already visible on the 40 min scan. These results demonstrate that indium-111 plasma labelled leucocyte scanning is both rapid and an accurate method of detecting abscesses.

Abdomen↗