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PubMed1982

[Echo morphology and puncture diagnosis of intraabdominal abscesses].

In this article it is reported about 35 intraabdominal abscesses, which were sonographically diagnosed in 32 patients. 22 times the diagnosis could be proven with percutaneous fine-needle-aspiration guided by ultrasound, five of them had a sonographically guided percutaneous abscess drainage, while 7 only could be diagnosed by operation. The sonomorphologic criteria of intraabdominal abscesses are polymorphous. Therefore we could subdivide the abscesses into five types according to their different echogeneity. Probes of pus, won by percutaneous five-needle-aspiration, were examined under experimental conditions in a waterbath. The sonomorphologic appearance is comparable to the in-situ-situation. Our experiments showed, that the echogeneity of intraabdominal abscesses is based on echogenic microbubbles besides echoforming detritus and protein-bodies. The polymorphous sonographic appearance of intraabdominal abscess formation and the well known problems of differential diagnosis gives percutaneous, sonographically guided fine-needle-aspiration an important position.

Abdomen↗
PubMed1991

[Percutaneous sonographically guided fine-needle puncture and drainage of pyogenic abscesses].

Between January 1988 and April 1991, a total of 79 ultrasound-directed percutaneous punctures and (or) drainage of abscesses were performed on 31 patients (15 men, 16 women; mean age 63 [31-85] years). There were 14 hepatic, 4 splenic, 4 abdominal wall and 3 pancreatic abscesses, and one each subphrenic, presacral, retrocaecal, ischiorectal, pulmonary and in the psoas. After ultrasound localization of the abscess a fine-needle puncture was performed, after which the abscess cavity was emptied as much as possible or, in abscesses larger than 5 cm in diameter, drained through a pig-tail catheter (6-8, 4 F). Several punctures were needed in 16 patients, while in 15 a percutaneous drainage over 2-8 days was necessary. Treatment was successful after 4-17 days in 25 patients. One patient died in septic shock. Operative intervention after diagnostic puncture was undertaken in 5 patients. There were no complications related to the method. In 11 patients the further course was determined by an underlying malignant disease. No recurrence has been noted (4-36 months after treatment) in 14 patients with a benign underlying disease. Percutaneous puncture and drainage of pyogenic abscesses is a technically simple method which achieves good results.

Abscess↗
PubMed1995

Medical treatment of postappendectomy intraperitoneal abscesses in children.

Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) of our experience in providing exclusively medical treatment for 11 such isolated abscesses in children. The abscess was detected 7 times within the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouch. In 4 cases it was larger than 5 cm in diameter. Parenteral antibiotic therapy associated ticarcillin and clavulanic acid 6 times and piperacillin, tobramycin and metronidazole 5 times. Drug efficacy was evaluated by clinical signs (fever, pain, ileus) and ultrasonography. In one case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first week of treatment. At day 7, parenteral was replaced by oral antibiotic therapy (metronidazole 7 times, amoxicillin-clavulanic acid 3 times) continued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolated postappendectomy abscesses in children would thus appear to be a logical choice in the absence of an associated ileus.

Abdominal Abscess↗
PubMed2002

Definitive treatment of pancreatic abscess by endoscopic transmural drainage.

BACKGROUND: Experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of pancreatic abscess. The aim of this study was to assess the feasibility, safety, and effectiveness of endoscopic transmural drainage for the treatment of pancreatic abscesses compressing the gut lumen. METHODS: In 9 patients, a total of 11 pancreatic abscesses compressing the stomach, duodenum, or both organs were drained endoscopically by means of endoscopic fistulization followed by saline solution irrigation and subsequent stent(s) placement. Complete resolution of the pancreatic abscess was defined as the absence of symptoms and no residual collection on follow-up CT. OBSERVATIONS: Endoscopic transmural drainage was technically successful in all cases. Ten abscess cavities (91%) resolved completely after stent placement for a mean duration of 32 days. In 2 patients, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. Bleeding occurred in 1 case (11%) but there was no mortality. The relapse rate was 13% over a mean follow-up of 18 months. CONCLUSION: Endoscopic transmural drainage is an effective therapy with minimal morbidity for pancreatic abscess compressing the gut lumen and is a valuable alternative to surgical drainage.

Abdominal Abscess↗
PubMed1982

Lung abscess: back for an encore?

The rise in incidence of lung abscess due to opportunistic organisms has reemphasized the need for early recognition and treatment. Opportunistic organisms can cause lung abscess in immunocompromised hosts. Most lung abscesses are primary, occurring as a result of aspiration of oral contents into the dependent portions of the lung in persons with dysphagia or decreased consciousness. Symptoms of lung abscess include productive cough, fever, leukocytosis, weight loss, and putrid sputum. Among the complications are progression to a chronic stage, empyema, massive hemoptysis, metastatic brain abscess, and bronchopleural fistula. Treatment of lung abscess is primarily medical, consisting of an appropriate antibiotic regimen and chest physical therapy. Surgery is reserved for unresponsive patients or those with complications.

Anti-Bacterial Agents↗
PubMed2002

Abscess-like formation concomitant with pituitary adenoma in Cushing's disease: case report and pathological considerations.

Pituitary abscess is a rare condition and a histological misnomer since cultures of abscess material are often negative or non-pathogenic. We report the first case of pituitary abscess-like formation concomitant with pituitary adenoma and discuss the physiopathological mechanism. A 37-year-old woman presented classic symptoms of Cushing's disease. Endocrine studies indicated the presence of adenocorticotropin (ACTH)-producing pituitary adenoma. Preoperative magnetic resonance imaging revealed two separate tumours of the pituitary. During transsphenoidal surgery, a 14-mm adenoma was removed from the right side of the gland and a pus-filled cystic tumour was opened and drained on the left. Histological diagnosis was ACTH-producing pituitary adenoma and cyst material compatible with pituitary abscess. Association of separate adenoma and abscess of the pituitary gland has not been reported previously. We speculate that spontaneous adenoma infarction may provide a more comprehensible pathophysiological explanation than abscess formation.

Abscess↗
PubMed2002

Reliability of endosonography in evaluation of anal fistulae and abscesses.

OBJECTIVE: To assess the reliability of anal endosonography (AES) in the diagnosis of anal fistulae and abscesses. MATERIAL AND METHODS: 86 patients with different types of anal fistulae and abscesses were prospectively examined with a 7.0 MHz transducer. Type of anal fistulae, differentiation between simple and complex tracts, and location of their internal openings were defined. In 66 cases with permeable external opening, hydrogen peroxide solution was introduced into the fistula tract. Reliability of AES was defined after surgical treatment of all cases. RESULTS: 74 anal fistulae, including 43 transsphincteric, 11 intersphincteric, 6 suprasphincteric, 3 superficial, and 11 ano-vaginal were found on AES. 27 fistulae were complex, and 47 simple fistulae. In 10 patients a coexisting abscess was found; the remaining 12 abscesses were without any fistula. Surgery confirmed the type of anal fistula in 64 patients (86.5%), and location of internal openings in 60 cases (81.1%). All abscesses were confirmed. CONCLUSION: AES showed high accuracy in diagnosing anal fistulae and abscesses.

Abscess↗
PubMed2003

Successful treatment of renal abscess with percutaneous needle aspiration in a diabetic patient with end stage renal disease undergoing hemodialysis.

Renal abscesses in patients with end stage renal disease are quite rare, and misdiagnosis or delaying in diagnosis is frequent. This report examines a case of renal abscess in a patient with end stage renal disease on maintenance hemodialysis and diabetes mellitus, which presented with a prolonged fever. An infected diabetic foot was impressed initially. Purulent urine, pyuria, bacteriuria, and bacteremia were noted after admission. Renal abscess was diagnosed by percutaneous needle aspiration under computerized tomography guidance. The patient was treated with parenteral antibiotics and percutaneous aspiration of the abscess. Follow-up ultrasonography showed renal abscess resolution. This case demonstrated that nephrectomy was not required in selected uremic patients with renal abscess.

Abscess↗
PubMed2000

High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco.

The prevalence of and risk factors for abscesses and cellulitis were investigated among a community sample of injection drug users (IDUs). Participants were interviewed, and those with symptoms were examined. Of 169 IDUs, 54 (32%) had abscesses (n=35), cellulitis (n=5), or both (n=14); 27% had lanced their own abscesses; and 16% had self-treated with antibiotics they purchased on the street. IDUs who skin-popped (injected subcutaneously or intramuscularly) were more likely to have an abscess or cellulitis than those who had injected only intravenously (odds ratio, 4.9; 95% confidence interval, 2.2-11). The likelihood of abscesses and cellulitis increased with frequency of skin-popping and decreased with increasing duration of injection drug use. Abscesses are extremely prevalent among IDUs in San Francisco. Skin-popping is a major risk factor, and self-treatment is common.

Abscess↗
PubMed2000

Spinal epidural abscesses in children: a 15-year experience and review of the literature.

We reviewed medical records and laboratory and diagnostic evaluations for 8 pediatric patients with spinal epidural abscesses who were treated during the last 15 years at our institution. Staphylococcus aureus was isolated from 5 of 8 epidural abscesses, including 2 abscesses with methicillin-resistant S. aureus. Unusual isolates were group B Streptococcus in a patient with chronic vesicouretral reflux associated with the posterior urethral valves and Aspergillus flavus in a patient with acute myelogenous leukemia. An analysis incorporating our results and a review of the English-language literature about abscesses in children and adults revealed differences related to age. Abscesses in children were more posterior in epidural location, had greater spinal column extension, and were associated with more favorable clinical outcomes than were abscesses in adults. Magnetic resonance imaging is the diagnostic procedure of choice; however, radionuclide bone scans should be considered for associated distant osteomyelitis in children. Prompt diagnosis and combined medical and surgical treatment remain the cornerstones for the prevention of adverse outcomes.

Adolescent↗
PubMed2001

Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study.

Skin and soft-tissue abscesses, a common problem among injection drug users (IDUs), result in serious morbidity for the patient and costly hospitalizations for incision and drainage; however, there has been little etiologic or preventive epidemiologic research on this problem. We performed a case-control study that enrolled 151 IDUs who had been given a new diagnosis of abscess requiring incision and drainage (cases) and 267 IDUs who did not have abscess or other bacterial infection during the previous year and who were stratum-matched to cases according to age, sex, and race (controls). Subcutaneous or intramuscular, instead of intravenous, injection is a major risk factor for abscess among IDUs. The injection of a cocaine and heroin mixture, or "speedball," may predispose patients to develop abscess by inducing soft-tissue ischemia. Cleaning the skin with alcohol before injection was found to have a protective effect. Neither human immunodeficiency virus nor human T-lymphotropic virus type II seropositivity was significantly associated with abscess.

Abscess↗
PubMed1999

Obturator internus muscle abscess in children: report of seven cases and review.

Obturator internus muscle (OIM) abscess is an uncommon entity often mistaken for septic arthritis of the hip. We describe seven children with OIM abscess and review seven previously reported cases. The most common presenting symptoms were hip or thigh pain (14 patients), fever (13), and limp (13). The hip was flexed, abducted, and externally rotated in 11 patients. Magnetic resonance imaging and computed tomography (CT) were diagnostic for OIM abscess in the 14 patients. Associated abscesses were located in the obturator externus muscle (5 patients), psoas muscle (2), and iliac muscle (1). The etiologic agents were Staphylococcus aureus (8 patients), Streptococcus pyogenes (2), Neisseria gonorrhoeae (2), and Enterococcus faecalis (1). Three patients underwent CT-guided percutaneous drainage, and three had surgical drainage. Three patients had ischial osteomyelitis in addition to OIM abscess. The 11 children with uncomplicated OIM abscess were treated for a median of 28 days. All patients had an uneventful recovery.

Abscess↗
PubMed1998

Primary liver abscess due to Klebsiella pneumoniae in Taiwan.

Pyogenic liver abscess is an uncommon complication of intra-abdominal or biliary tract infection and is usually a polymicrobial infection associated with high mortality and high rates of relapse. However, over the past 15 years, we have observed a new clinical syndrome in Taiwan: liver abscesses caused by a single microorganism, Klebsiella pneumoniae. We reviewed 182 cases of pyogenic liver abscess during the period September 1990 to June 1996; 160 of these cases were caused by K. pneumoniae alone, and 22 were polymicrobial. When patients with K. pneumoniae liver abscess were compared with those who had polymicrobial liver abscess, we found higher incidences of diabetes or glucose intolerance (75% vs. 4.5%) and metastatic infections (11.9% vs. 0) and lower rates of intra-abdominal abnormalities (0.6% vs. 95.5%), mortality (11.3% vs. 41%), and relapse (4.4% vs. 41%) in the former group. Liver abscess caused by K. pneumoniae is a new clinical syndrome that has emerged as an important infectious complication in diabetic patients in Taiwan.

Female↗
PubMed2006

Case report: tubercular cold abscess of seminal vesicle: minimally invasive endoscopic management.

BACKGROUND: Tubercular cold abscess of the seminal vesicle is very rare, and only a few cases are reported in literature. Preoperative diagnosis is difficult and to the best of our knowledge has not been reported. CASE REPORT: A 35-year-old man presented with a 7-year history of blood in the semen and a reddish brownish discharge per urethra while defecating. On rectal examination, a soft fluctuant mass was felt above the prostate. Abdominal ultrasonography showed cystic swelling of the right seminal vesicle bulging into the posterior bladder wall. Semen examination showed abundant pus cells and 90% immotile sperm with normal morphology. Acid-fast bacilli were not seen, but acid-fast bacilli were found in a 24-hour urine specimen. Cystoscopy showed tubercles in the urethra and brownish discharge from the orifice of the right ejaculatory duct on per-rectal compression of the mass. The abscess cavity was incised with a Collings' knife. Brownish material was evacuated, and the abscess cavity was seen. An 18F Foley catheter was placed for 3 days. Antitubercular therapy was instituted. Ultrasonography repeated after 3, 25, 45, and 75 days showed gradual regression of the abscess cavity. Semen examination after 75 days was normal, with 75% motility, and cystoscopy 45 days postoperatively showed complete healing of the wound. CONCLUSION: The incision connecting the bladder with the abscess cavity facilitated evacuation of pus and complete resolution of the abscess.

Abscess↗
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↗
PubMed1993

Liver abscess due to Listeria monocytogenes: case report and review.

Involvement of the liver in cases of Listeria monocytogenes infection is uncommon but has been manifested as solitary liver abscess, multiple liver abscesses, and hepatitis. We describe a 73-year-old diabetic woman who presented with a solitary liver abscess and prolonged fever, and we review the world literature on hepatic manifestations of L. monocytogenes infection. Patients presenting with solitary liver abscesses uniformly recovered with antimicrobial therapy and abscess drainage, whereas almost all patients presenting with multiple liver abscesses died.

Adult↗
PubMed1994

Brain abscess following marrow transplantation: experience at the Fred Hutchinson Cancer Research Center, 1984-1992.

The etiology of brain abscess in patients undergoing marrow transplantation at the Fred Hutchinson Cancer Research Center in Seattle was assessed in a retrospective review. Fifty-eight patients with histology- or culture-proven brain abscess diagnosed between January 1984 and March 1992 were identified. A fungus was isolated in 92% of cases. Aspergillus species were the most prevalent fungi (58% of cases), and Candida species were second in frequency (33%); sporadic cases were caused by Rhizopus, Absidia, Scopulariopsis, and Pseudallescheria species. Bacteria were involved in fewer than 10% of cases. There was no appreciable variation from year to year in the incidence of brain abscess over this period. Aspergillus brain abscess was associated with concomitant pulmonary disease (87% of cases), whereas candida brain abscess often occurred in association with fungemia (63% of cases) or neutropenia (63%). Mortality was high (97%); the risk of death was unrelated to etiology or therapeutic regimen. Since the etiology of brain abscess in patients undergoing marrow transplantation is primarily fungal, the development of better antifungal therapeutic and/or prophylactic modalities is warranted.

Adolescent↗
PubMed1995

Gonococcal abscess of the obturator internal muscle: use of new diagnostic tools may eliminate the need for surgical intervention.

Obturator internal muscle (OIM) abscess or pyomyositis, a poorly recognized intrapelvic infection, is characterized by limping, pain in the hip with limited movement, and the sciatic type of radiating leg pain. With the use of advanced diagnostic tools such as computed tomography (CT), magnetic resonance imaging, and radionuclide scans, several cases of OIM abscess have been diagnosed; these cases have recently been reported in the English-language literature. Staphylococcus aureus is the predominant organism isolated from OIM abscesses. Gonococcal abscess involving the OIM has not been reported. We describe a case of gonococcal OIM abscess in an adolescent female whose condition was successfully diagnosed and managed with the use of CT-guided needle aspiration and antibiotic therapy. We review the English-language literature regarding the use of newly developed tools in the diagnosis of OIM abscess.

Abscess↗