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Three cases of abdominal abscesses involving gauze were studied by B-mode ultrasound. Thick irregular boundary echoes and irregular internal echoes of high amplitude were most characteristic. The ultrasound tomograms are presented, and their characteristics are discussed.
OBJECTIVE: To find out whether small-bore catheters (7 F) are as effective as the 14F sump drains generally used for drainage of abdominal abscesses. DESIGN: Retrospective review. SETTING: University hospital, Switzerland. SUBJECTS: 64 patients with intra-abdominal abscesses. INTERVENTIONS: 40 were drained with 7F pigtail catheters and 24 by 14F sump drains. RESULTS: Drainage was successful in 34/40 (85%) and 20/24 (83%), respectively. There were 3 recurrences in the small-bore and 1 in the large-bore group (p=0.4). Mean drainage time was 8 (SD 5) days and 11 (SD 11) days, respectively (p=0.29). One patient (3%) developed a complication in the small-bore group and 2 (8%) in the large-bore group. 4/6 failures in the small-bore group and 1/4 failures in the large-bore group were pancreatic abscesses. CONCLUSIONS: We conclude that percutaneous drainage with small-bore catheters is as effective as drainage with bigger tubes.
The usefulness of computed tomography (CT) in diagnosing abdominal abscesses was evaluated prospectively in 69 septic patients who had suffered massive trauma. For the 82 abdominal CT scans obtained, the accuracy rate was 84%, the sensitivity was 92%, and the specificity was 79%. With the use of abdominal CT, 32 patients were spared a "blind" laparotomy in the search for the focus of infection. It is concluded that CT is of significant value in the diagnosis of abdominal abscess in the septic trauma patient.
We have studied the penetration of aztreonam into pus with a low mortality intra-abdominal abscess model in the Wistar rat. The mean peak serum concentration (standard error) of aztreonam was 74.6 +/- 9.88 mg/l at 30 min falling to 2.31 +/- 1.28 mg/l at 8 h. The mean concentration in pus was 17.04 +/- 2.01 mg/l at 2 h and was 14.47 +/- 2.23 mg/l at 8 h. These concentrations are in excess of the MICs of most Gram-negative aerobic bacilli commonly isolated from intra-abdominal abscesses.
In this study of the aerobic and anaerobic microbiology of 23 intra-abdominal abscesses, aerobic bacteria alone were present in one specimen, anaerobic bacteria only in four, and mixed aerobic and anaerobic flora in 18. Ninety bacterial isolates (3.9 isolates per specimen), 63 anaerobic (2.7 per specimen), and 27 aerobic and facultative (1.2 per specimen) isolates were recovered. The predominant organisms were Bacteroides fragilis group (23 isolates), Peptostreptococcus sp (20 isolates), and Escherichia coli (15 isolates). This study demonstrates the polymicrobial aerobic-anaerobic etiology of intra-abdominal abscesses in children.
Gas within the hepatic venous system on abdominal roentgenogram prompted exploratory laparotomy in a patient with repeated rigors and high fever following total hip replacement. Although the patient had no localizing abdominal symptoms or signs, an intra-abdominal abscess was found and cured by surgical drainage and antibiotics. Occult, life-threatening, but treatable abdominal disease may be detected by the unusual roentgenographic finding of portal venous gas.
Sixty-eight indium-111-labeled leukocyte imaging studies were performed in 53 patients with suspected abdominal abscesses. Twenty-nine studies gave abnoramal results. Nine wound infections were demonstrated, and 14 abscesses were correctly identified. Four studied demonstrated colonic accumulation, one of which remains unexplained, and two accessory spleens were identified. Indium-111 leukocyte imaging is a sensitive and specific study in evaluating patients with suspected abdominal abscess. Differentiation of abscess from other causes of inflammation has not been a problem. The exact role of leukocyte imaging compared with gallium-67 citrate imaging, ultrasound and computerized tomography remains to be determined.
PURPOSE: A case report of patient with an intra-abdominal abscess 8 weeks after radical cystectomy and construction of an ileal neobladder is presented. METHODS/RESULTS: The patient was admitted with nausea, vomiting and singultus. A perforation of the neobladder due to overdistension was assumed to be the underlying cause of the intra-abdominal abscess formation as the patient admitted infrequent voiding during the day and no emptying of the neobladder at night. The patient underwent explorative laparotomy and 4200 mL of pus was removed from the abdominal cavity. The patient made an uneventful recovery and was discharged from hospital after 5 weeks. Neobladder function remained stable and the patient was leading a normal life at 24 months follow-up. CONCLUSIONS: The present case demonstrates the need for careful patient selection prior to radical cystectomy with continent urinary diversion. Reduced compliance and mental disabilities of a patient can increase the complication rate.
An immunologically compromised patient was found to have a postoperative intra-abdominal abscess from which Staphylococcus epidermidis was the sole isolate. Studies of the isolate in a rabbit and in mice showed no evidence for unusual virulence of the organism. The S epidermidis probably was introduced into the peritoneal cavity during surgery and, because of the patient's neutropenia, produced a serious infection within a few weeks. To our knowledge, this is the first case of a intra-abdominal abscess associated with S epidermidis to be described in the literature.
During a ten year period, 69 patients underwent 100 operations for more than 147 intra-abdominal abscesses. The over-all mortality was 24.6 per cent and the redrainage rate, 30.4 per cent. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored two or more different organisms. Mortalities were low in patients less than 20 years of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients more than 40 years of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures, and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intra-abdominal abscess are confirmed.
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A retrospective analysis of the results of 67Ga citrate radionuclide imaging and computed tomography (CT) in 45 patients with suspected abdominal abscess was conducted to determine the mertis of each method. Both techniques were highly sensitive in detecting abdominal abscesses, and often provided complementary and supplementary diagnostic information; their combined use many times offset the limitations of each method used alone. Guidelines are suggested that permit rapid evaluation, while limiting diagnostic errors, when using 67Ga citrate radionuclide imaging and CT in the presence or absence of localizing symptoms and signs.
A pathophysiological study of intra-abdominal abscess and their systemic effects were reported. Different methods of diagnosis were examined together with their respective value. Possible operative procedures were presented and analyzed. A certain number of practical points designed to avoid postoperative intraabdominal abscess and to reduce their gravity and systemic effects were developed from a series of 530 observations.
BACKGROUND/AIMS: Ultrasound has been suggested to be a first-line test for the detection of intra-abdominal abscess (IAA). However, according to our experience, ultrasound seemed not so effective when applied to the patients after colorectal surgery. Computed tomography (CT) and gallium scan have also been suggested as very useful for the detection of IAA. The purpose of this study was to evaluate the efficacy of sonography and gallium scan in diagnosing intra-abdominal abscess after colorectal surgery and to compare these results with CT. METHODOLOGY: Twenty-three patients with suspected IAA after colorectal surgery at our institution were eligible for the study. A positive IAA was verifed only if pus was drained or on postmortem examination. Negative reports of abscesses were verified by adequate outpatient review following hospital discharge that indicated the clinical absence of an abscess. Within 4 days of the clinical suspicion of abscess, all patients were evaluated by three techniques: sonography, CT and gallium scan. We compared the sensitivity, specificity and accuracy of these modalities. RESULTS: Fourteen of the 23 patients (60.9%) were verified as IAA. We found the sensitivity, specificity, and accuracy of CT scan for the detection of LAA in the patients with colorectal surgery to be 92.9%, 100%, and 95.7%, respectively. The sensitivity, specificity and accuracy of gallium scan were 100%, 77.8% and 91.3%, respectively. Ultrasound had a 42.9% sensitivity, 100% specificity, and 65.2% overall accuracy for diagnosing IAA. CONCLUSIONS: Sonography plays a small role in the detection of IAA in the patients after colorectal surgery. CT and gallium scan are more helpful than sonography for the detection of IAA.
The combination of clavulanic acid (CA) with penicillin or ticarcillin was evaluated in a rat intra-abdominal abscess model. Gelatin capsules filled with a mixture of Bacteroides fragilis and Escherichia coli were implanted intraperitoneally in male Wistar rats. Four different groups of animals with appropriate controls were treated with penicillin or ticarcillin alone or in combination with CA. The treatment was started either immediately or delayed for 48 h after peritoneal inoculation. The therapeutic regimen was given for ten days at 8-hourly intervals. The mortality rate decreased to almost one-half when antibiotic therapy was started within 6 h. Seventy-nine to 89% of animals were cured when treated with ticarcillin in combination with CA showing that ticarcillin + CA was the most effective regimen of those tested in the treatment of experimental intra-abdominal abscess of rats caused by Bact. fragilis and E. coli.
BACKGROUND: Multi-drug-resistant bacteria are rarely isolated from patients with acute appendicitis. METHODS: Case report and literature review. RESULTS: We report an unusual case of post-appendectomy intra-abdominal abscess with intra- operative cultures that grew multi-drug-resistant Acinetobacter baumannii. An 11-year-old boy underwent open appendectomy for perforated appendicitis. He developed a superficial surgical site infection at the Penrose drain site on the seventh postoperative day; cultures grew multi-drug-resistant Acinetobacter baumannii. A computed tomography scan revealed an intra- abdominal abscess. Open drainage was performed, and intra-operative cultures grew the same multi-drug-resistant A. baumannii along with Escherichia coli. CONCLUSIONS: Post-operative therapy with ceftriaxone may have predisposed the patient to nosocomial infection caused by multi-drug-resistant A. baumannii.
Postoperative intra-abdominal abscess (IAA) is a dreaded surgical complication. Percutaneous drainage (PD) has been offered as an alternative to surgical drainage for IAA because of the perceived lower morbidity and mortality rates. Seventeen consecutive unselected instances of IAA were reviewed to determine the value of the routine use of PD. Two patients with obvious anastomotic dehiscence and one with a retroperitoneal abscess were believed to be inappropriate for PD. Patients who could be managed by PD (group 1, n = 6) were similar to patients undergoing PD plus surgical drainage (group 2, n = 8) with respect to age, initial procedure, interval from operation to diagnosis of IAA and extent of organ failure. However, in group 2, more abscesses were greater than 5 centimeters (16.7 versus 62.5 percent), associated with polymicrobial growth (0.0 versus 50.0 percent), associated with enteric organisms (16.7 versus 100 percent; p < 0.05), accompanied by anastomotic dehiscence (16.7 versus 62.50 percent) and followed by a greater degree of mortality (16.7 versus 50 percent). Overall, only 33 percent of IAA were successful managed with PD alone. We conclude from these data that PD is of value only in selected instances of IAA. If an anastomotic dehiscence is a possibility, the patient should be managed operatively.
Two patients had convincing mass lesions demonstrated with gray-scale echography and strongly supporting clinical evidence for intra-abdominal abscesses. Neither patient had a lesion at the time of surgery. Although modern echography is an accurate diagnostic method for intra-abdominal abscess, false-positive results can occur.