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PubMed1995

Review of hepatic abscess from Klebsiella pneumoniae. An association with diabetes mellitus and septic endophthalmitis.

I present the only comprehensive review of hepatic abscess from Klebsiella pneumoniae. The world literature contains 46 individually reported cases and 3 large studies of K pneumoniae liver abscess. The source of the abscesses frequently was not found. Diabetes mellitus was a frequent underlying condition and may predispose patients to the development of liver abscess with this organism. The exact mechanism is unclear, and further investigation is necessary. In addition, extrahepatic metastases, such as septic endophthalmitis, often occurred with serious complications, particularly in patients with diabetes. The association between K pneumoniae liver abscess and diabetes is so close that a search for underlying diabetes mellitus is warranted in all patients with K pneumoniae liver abscess. Fortunately, earlier diagnoses and better treatment modalities have improved the outcome for these patients.

Adult↗
PubMed1995

Post-traumatic brain abscess: experience of 36 patients.

Thirty-six patients with post-traumatic brain abscess were managed over 18 years. They constituted 9.3% of all brain abscesses encountered during the same period. The head injury was associated with an external compound fracture in 20, internal compounding in three and was closed in 13 patients. The mean interval between the time of injury to presentation with an abscess was 113 days. This did not differ significantly in patients with closed and compound head injury, and amongst patients who had wound sepsis and with clean wounds after the injury. The occurrence of focal neurological deficit was more frequent in patients with a closed injury (p < 0.05). Twenty patients underwent primary excision of the abscess with recurrence of the abscess in one patient. Of the 14 patients in whom the abscess was initially aspirated, eight patients required a subsequent excision. Excision was required in 18 patients (94.7%) with external compound injury, five (50%) of those with closed injury and in all patients with internally compound injuries. Two patients had 'coned' and died before they could be operated upon. The operative mortality in the absence of signs of herniation preoperatively was 12.5% in patient with compound injury and none among patients with closed head injury.

Brain Abscess↗
PubMed1994

[Analysis of cases with liver abscess following transcatheter arterial chemoembolization (TAE) for malignant hepatic tumors].

A total of 182 TAE procedures were carried out in 98 patients with malignant hepatic tumors during the last five years. Liver abscess following TAE occurred in 3 cases (3.1%) and in 3 procedures (1.7%). All cases were discharged after successful percutaneous transhepatic abscess drainage. One case had hepatocellular carcinoma. Another case had undergone total gastrectomy and esophagojejunostomy with Roux-Y reconstruction for gastric leiomyosarcoma. The other had undergone right hemicolectomy and pancreatoduodenectomy for colon cancers and carcinoma of the ampulla of Vater. Communication between the abscess and the intrahepatic bile duct was recognized in 2 cases. In the abscess culture, E. coli and Citrobacter freundii were detected. These results suggest the major factor leading to abscess formation is biliary infection. Therefore, a previous bilio-enteric anastomosis should be regarded as a risk factor for liver abscess following TAE.

Aged↗
PubMed1994

[Cervical spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA)].

Epidural abscess is an uncommon infectious disease. The cervical spine is the least frequent site of spinal epidural abscess. It has been reported that early diagnosis and surgical treatment prevent neurological deficit, but it is difficult to diagnose this disease clinically. We presented a rare case of cervical epidural abscess caused by MRSA. A 54-year-old man was admitted to our hospital because of acute renal failure and hepatitis. He was treated with hemodialysis via the femoral route. His renal function recovered but high fever continued. MRSA was identified from the AV shunt catheter. He noted pain and dysesthesia on his left shoulder one month after admission. He was transferred to our department with suspect of spinal tumor. Neurological examination demonstrated left hemiparesis with superficial sensory disturbance between C8 and Th2. Cervical CT scan showed osteomyelitis at the left C7 lamina and facet. MR imaging disclosed that an epidural mass at C7 had low signal intensity on T1 weighted and high signal intensity on T2 weighted and ring-like enhancement with gadolinium. He was treated conservatively for a month. Sequential MR imaging showed the mass had homogeneous enhancement at C7 epidural space extending to the left intervertebral foramen. Laboratory examination showed normal. The patient was diagnosed as having cervical epidural abscess. A C6 through Th2 laminectomy and C8 foraminotomy were performed and an encapsulated abscess including yellowish pus was totally removed. The pathological diagnosis was non-specific abscess in the subacute stage. MRSA was identified by the intraoperative pus culture. After the surgery, antibiotics were administered.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1994

[Brain abscess complicating dental caries in children].

Brain abscess following dental or periapical infection is rare in childhood. This report describes brain abscesses found in two children with dental caries. Case 1.--A 12 year-old boy was admitted because he had suffered from acute meningitis for 3 days. Clinical examination showed symptoms of meningitis plus palsy of the right third and fourth cranial nerves and of the left facial nerve, and a defect in the left temporal field. Funduscopic examination showed papilledema; CT scan and MRI showed a ring-shaped lesion in the right occipital area. The patient was given cefotaxime and thiamphenicol. The abscess was drained; bacteriological examination showed Actinomyces viscosus and Peptostreptococcus magnus. The neurological condition and the CT scan lesion improved, but intracranial pressure increased again on the 17th day after the onset, requiring replacement of the antibiotics by rifampicin and ampicillin plus clavulanic acid for 2 months. This brain abscess appeared to be metastatic, derived from the infection of a large dental cyst due to a dental infection that had been treated 6 months earlier. Case 2.--A 8 1/2 year-old girl was admitted because she was suffering from palsy of the left facial nerve and left arm. She had had headaches and fever for a few days. Clinical examination showed the palsies and drowsiness. CT scan showed two brain abscesses. The patient was given ceftriaxone, fosfocin and metronidazole. She had been treated for a gingival abscess 1 month earlier, and had two infected teeth extracted. Improvement of the intracranial pressure was transient and the antibiotics were changed on the 12th day of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

[Pyogenic liver abscess. Study of 20 patients treated with percutaneous drainage].

We conducted a descriptive study of pyogenous hepatic abscesses (PHA) and their treatment with percutaneous drainage and antibiotherapy in the general hospital of Galdácano between 1989 and 1992. We assessed prevalence, clinical characteristics, responses to treatment, evolution and complications. We studied 20 PHAs in adults confirmed through puncture guided with echography and/or computerized tomography. We considered as causal germs those isolated in the abscess and/or hemocultures. All the patients were treated with catheter drainage and antibiotics. After discharge, follow-up and regular TC controls were performed at least for 6 months. The average age of the patients was 56 +/- 3 years and the men/women rate was 2.5:1. The most frequent origin of the infection was cholecystitis/cholangitis in 50% of patients and hydatidic cysts in 20%. Twelve patients had isolated abscess and 8 patients, multiple abscesses. The diagnostic sensitivity was 95% for the echography and 100% for CAT. The most frequent germs were E. Coli, Streptococcus, K. pneumoniae and Salmonella spp. In three cases, it was not possible to bacteriologically identified the germ. After drainage, the abscesses disappeared in 16 patients. The average duration of percutaneous drainage was 10 days. Three patients required surgery after drainage due to complications or incomplete drainage; two other patients required extirpation of hydatidic cysts. The mortality rate was 10%, although it was not related to PHA. We did not observe any differences between isolated or multiple abscesses with regard to prognosis. The drainage guided by echography and/or CT, associated to antibiotic therapy, is a successful technique for the treatment of PHAs in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Laparoscopy-guided drainage of hepatic abscess.

Hepatic abscess is a serious surgical condition with a mortality rate of up to 63% reported if not adequately treated. Laparotomy and computed tomographic (CT) guidance have been used to drain these collections, each with their own problems. Herein we describe a method of draining laparoscopically a hepatic abscess. A 45-year-old Haitian man presented with night sweats and fevers to 103 degrees F; he was diagnosed by CT to have a large (7 cm) abscess in the posterosuperior portion of the right hepatic lobe. The CT-guided drainage yielded only 8 cc fluid. The patient underwent laparoscopy-guided drainage of the abscess with placement of intra-hepatic and perihepatic drains. The patient had dramatic clinical improvement with no morbidity from the procedure. A follow-up CT of the abdomen revealed near-complete disappearance of the abscess cavity within 48 h. A straightforward method of laparoscopic drainage of hepatic abscesses is presented in detail. It provides a simple alternative for drainage with excellent results and minimal morbidity.

Drainage↗
PubMed1993

Liver abscess after percutaneous ethanol injection (PEI) therapy for hepatocellular carcinoma. A case report.

We present a case of liver abscess after percutaneous ethanol injection (PEI) therapy for the treatment of recurrent hepatocellular carcinoma (HCC). The 56-year-old woman had a past history of cholecystoduodenostomy for cogenital dilatation of the bile duct, and pneumobilia was observed in the intrahepatic bile ducts prior to PEI. The abscess was successfully treated by percutaneous abscess drainage and antibiotic therapy. Klebsiella pneumonia, one of the most common causative organisms of biliary tract infection, was isolated from the abscess. Thus, biliary tract infection related to the previous biliary-enteric anastomosis operation may have been one of the causative factors in the liver abscess in this patient. The rare experience reported here suggests that a careful search for coexistent abscess at the time of PEI is important in HCC patients with biliary-enteric anastomosis, especially in those with pneumobilia.

Carcinoma, Hepatocellular↗
PubMed1993

Percutaneous catheter drainage of abdominal abscess after abdominal surgery. Results in 121 cases.

One hundred and twenty-one peritoneal, retroperitoneal and pelvic abscesses were treated percutaneously using CT or US guidance. The lesions developed after abdominal surgery. Sixty-three abscesses (52%) were situated in the peritoneal cavity, 31 (26%) in the retroperitoneal cavity and 27 (22%) in the pelvis. A definitive treatment was obtained in 74% of peritoneal abscesses, 67% of retroperitoneal abscesses and 82% of pelvic abscesses. Failure most commonly occurred with multiloculated lesions or lesions associated with fistulous communication. There was a low rate of complication (1%). percutaneous drainage avoids the risks inherent in surgery and anesthesia, saves considerable time and meets greater patient acceptance. If a total cure is not systematic, a beneficial temporizing effect may however be obtained by percutaneous drainage. This procedure should be indicated for the initial treatment of postsurgical abscesses.

Abdomen↗
PubMed1993

Abdominal pain associated with an umbilical abscess in a llama.

A 3-month-old llama with a presenting complaint of lethargy, anorexia, and a painful, distended abdomen was evaluated. The llama had intermittently strained to defecate during the 3 days prior to admission. Physical examination results, hematologic data and lateral abdominal radiographs were used to diagnose a large umbilical abscess, which was causing a partial obstruction of the gastrointestinal tract. Under general anesthesia, 3 liters of purulent exudate were drained from the abscess. The abscess cavity was then lavaged with saline solution and its capsule was marsupialized to the skin. Cultures of the abscess content yielded Proteus sp, Streptococcus equisimilis, and Clostridium septicum. Two days after surgery, the llama was drinking, eating, and passing feces. The abscess was lavaged daily for a total of 11 days. Six months after surgery, the llama was the same size as other llamas of the same age, and the owners were pleased with the cosmetic appearance of the ventral abdomen. Umbilical abscesses can vary in size and clinical presentation; they should be recognized as a possible cause of abdominal pain with a potential for causing intestinal obstruction in llamas.

Abdominal Pain↗
PubMed1995

[Tubo-ovarian abscess. An analysis of 20 cases].

The authors make a 3-year retrospective analysis of the tubo-ovarian abscess cases admitted to the Gynecology Ward of Dr Alfredo da Costa Maternity Hospital. In the period studied (1991 through 1993) there were 20 such cases. The incidence in nulliparous patients was 25%. A significant percentage (30%) of the patients had recently undergone uterine instrumentation. A prior history of pelvic inflammatory disease was obtained in only 15% of the cases. In the IUD users the incidence of unilateral and bilateral abscesses was identical. Most patients (85%) became apyretic within 48 hours of instituting intravenous antibiotics. In most cases (90%) the patients underwent surgical therapy. The mean time elapsed between instituting antibiotics and the surgical procedure was 3 days. There was one case of intra-abdominal rupture of the abscess. Intraoperatively, an appendiceal abscess was found in 3 (15%) patients. In 30% of the cases a total hysterectomy with unilateral or bilateral adnexectomy was performed. One of the 2 (10%) patients treated solely with medical therapy presented abscess recurrence one month after hospital discharge. Although the management of tubo-ovarian abscesses has become more conservative it still includes, in most cases, surgical drainage or extirpation after appropriate antibiotic therapy.

Abscess↗
PubMed1996

Hepatic abscesses in dogs: 14 cases (1982-1994).

OBJECTIVES: To determine typical clinical signs and clinicopathologic findings in dogs with hepatic abscesses, to assess outcome of treatment, and to evaluate the role that abdominal ultrasonography has in the diagnosis of hepatic abscesses in dogs and in monitoring response to treatment. DESIGN: Retrospective case series. ANIMALS: 14 dogs with hepatic abscesses. RESULTS: Anorexia and lethargy were the most common historical complaints, followed by vomiting and diarrhea. Physical abnormalities included fever, dehydration, signs of abdominal pain, hepatomegaly, and mucosal bleeding. Hematologic abnormalities included leukocytosis with neutrophilia, mild to moderate thrombocytopenia, and mild anemia. Serum biochemical abnormalities included high alkaline phosphatase and alanine aminotransferase activities and high bilirubin concentration; hypoalbuminemia and prolonged coagulation values were also reported. Abdominal radiography revealed hepatomegaly, poor abdominal detail, a hepatic mass, or splenomegaly in 9 dogs. Thoracic radiography revealed alveolar consolidation or mixed bronchial/interstitial pulmonary patterns in 6 dogs. Hypoechoic, heteroechoic, or hyperechoic masses were identified in all dogs in which ultrasonography was performed. Escherichia coli, Clostridium sp, Klebsiella pneumoniae, Enterococcus sp, Staphylococcus epidermidis, and S intermedius were the most common bacteria isolated from hepatic abscesses. Concurrent infections were identified in the biliary tract, spleen, blood, endocardium, lung, prostate gland, peritoneum, lymph nodes, salivary gland, or brain of several dogs. Seven dogs died or were euthanatized before definitive treatment could be initiated. One dog was successfully treated with antibiotics and was alive 12 months after medical treatment. Six dogs were treated surgically (ie, full or partial liver lobectomy, drainage, abdominal lavage) and medically (ie, antibiotic administration). Five of these dogs survived and were alive 12 months after surgery. Ultrasonography was used to monitor response to treatment in several dogs. CLINICAL IMPLICATIONS: Hepatic abscesses are rare in dogs, but the clinical signs and clinicopathologic findings are similar to other inflammatory hepatic disease. Ultrasonography revealed abnormalities in all animals in which imaging studies were performed, and was successfully used to monitor response to treatment in several dogs. Medical and surgical treatments were used successfully to treat hepatic abscesses in dogs.

Animals↗
PubMed1996

Colonic carcinoma presenting as an appendiceal abscess in a young woman.

A 38-year-old woman with stage T4N0M0 adenocarcinoma of the cecum presented with what seemed to be an appendiceal abscess. She had a 10-month history of intermittent abdominal pain in the right lower quadrant. Initial laparotomy revealed an abscess in that quadrant. The abscess was drained. A mass in the cecum, associated with dense fibrous tissue and abscess formation, was found on subsequent surgical exploration. Pathological examination revealed a well-differentiated mucinous adenocarcinoma of the cecum with transmural invasion. The lesion had replaced most of the vermiform appendix and was associated with a periappendiceal abscess. Colonic carcinoma masquerading as acute appendicitis or an appendiceal abscess is a well-recognized entity in the elderly but may be overlooked in younger patients because malignant disease is not suspected.

Abscess↗
PubMed1996

[Brain abscess. A difficult diagnosis?].

It is vital to diagnose brain abscess early, but this can be intricate. Four cases of brain abscess are described, illustrating the diagnostic difficulties. One of the patients had multiple brain abscesses. Important aspects of brain abscess are discussed. Brain abscess should be suspected in cases of increasing intracranial pressure combined with focal neurological signs or epileptic seizures, even with no apparent signs of infection. The characteristic contrast-enhancing ring lesion and surrounding oedema may be sufficient for diagnosis, but biopsy and bacteriological culture are often necessary. Epileptic seizures and various neurological sequelae are common, even if the abscess is treated immediately. Delay in diagnosis may lead to fatal outcome.

Adult↗
PubMed1996

[Putaminal abscess occurring at the site of hemorrhage: a case report].

Brain abscesses following stroke have been reported only rarely. We presented a case of putaminal abscess following putaminal hemorrhage. The patient was admitted to our hospital because of acute onset of left hemiplegia. The size of the hematoma was medium and the patient was conservatively treated. In about two months after the ictus, he became intermittently febrile and laboratory examinations suggested the presence of general infections including meningitis. Meanwhile, CT and MRI revealed clearly abscess formation at the site of the hematoma with remarkable brain edema. Cerebrospinal fluid analysis showed the findings of meningitis. On diagnosis of brain abscess, stereotactic exploration was performed and pus mixed with old blood was aspirated. Bacteriological study of the specimen demonstrated Morganella morganii. Postoperative course was uneventful and the abscess cavity gradually subsided following drainage and irrigation of the abscess cavity.

Brain Abscess↗
PubMed1996

[Outcome of cardiac valve ring abscesses after medical treatment: attempt to identify criteria of favorable prognosis].

OBJECTIVES: Identify factors predicting favorable outcome after medical management of valve ring abscesses in order to propose a surveillance schedule for conservative treatment. METHODS: A multicentric study conducted from July 1989 to February 1996 included 28 patients (mean age 64 +/- 16 years, range 26-83) hospitalized for active endocarditis and valve ring abscesses diagnosed at transthoracic or transesophageal echography. Conservative medical therapy was given because of a decision of the medico-surgical team (n = 9), high surgical risk (n = 12), or patient refusal of surgery (n = 7). Outcome was favourable in 18 patients (Group I) and unfavorable in 10 (Group II) due to death (n = 9) or subsequent surgery (n = 1). Univariate and multivariate analysis were used to determine differences between the groups in terms of clinical and laboratory data. RESULTS: Mean follow-up in Group I was 33 +/- 18 months and 15 +/- 10 months in Group II. Univariate analysis showed significant differences between Group I and II respectively for age (59 +/- 18 yr vs 72 +/- 10, p = 0.04), delay to apyrexia after antibiotics (4.3 +/- 2.8 vs 8.3 +/- 2.4 days, p < 0.0008), heart failure (5% vs 70%, p = 0.003), grade III or IV valvular regurgitation (5% vs 60%, p < 0.04), and mean surface area of the abscess (1.5 +/- 1.2 vs 5.4 +/- 6.4 cm2, p < 0.03). Independent factors at multivariate analysis were by decreasing order: lack of heart failure at admission, delay to apyrexia, abscess surface area, and age. Outcome was favorable (mean follow-up 33 +/- 10 months) in all patients with an abscess surface area < 1.5 cm2, no signs of heart failure, no grade III or IV valvular regurgitation, apyrexia after less than 8 days on antibiotics and no staphylococcus positive blood culture. CONCLUSION: Medical management of valve ring abscesses may be indicated in selected patients in care units with rigorous surveillance facilities. Further studies are needed to precisely identify surveillance and treatment criteria.

Abscess↗
PubMed1997

Iatrogenic spinal epidural abscesses: early diagnosis essential for good outcome.

Spinal epidural abscess usually arises by hematogenous, lymphatic or venous spread. The frequent use of invasive procedures at the spinal cord such as epidural injections to produce analgesia has led to an increased incidence of iatrogenic abscesses. We describe 8 patients who developed iatrogenic spinal epidural abscesses after paravertebral or intragluteal punctures respectively intravenous catheters to produce analgesia. Deep paravertebral or intragluteal injections were the cause of abscess formation in five, a contaminated intravenous line in two and a peridural catheter in one case. Pain of the affected vertebral column and malaise were the leading symptoms and Staphylococcus aureus was isolated in all cases. Diagnosis was made by means of magnetic resonance (n = 7) or Computed tomography (n = 1). Outcome was excellent with early therapy consisting of laminectomy and/or antibiotic treatment in the six patients treated within two days of appearance of symptoms. Invasive procedures at the spinal cord can lead to iatrogenic spinal epidural abscesses. Physicians dealing with deep punctures and catheter procedures should be aware of early symptoms and signs of an epidural abscess, since early diagnosis and specific therapy are the most important factors for a good outcome.

Abscess↗
PubMed1997

[Anorectal abscess and fistula].

Anal glands which lie in the intersphincteric space at the dentate line play an important role in the development of abscesses and fistulas. Secondary causes are inflammatory colorectal diseases and skin infections. For the classification of anorectal abscesses and fistulas a simple and practible nomenclature is proposed. Clinical presentation and diagnostic are described with regard to new means of diagnostic. The opening of the abscess without a fistulotomy appears to be the treatment of choice in patients with a perianal abscess whereas patients with an intersphincteric abscess are treated by fistulotomy. Perianal fistulas can be detected in 50% of the cases after drainage of a perianal abscess. The therapy of the perianal fistula below the dentate line consists in the fistulotomy. In contrast intersphincteric fistulas and fistulas above the dentate line are more often treated with a mucosa flap where by the sphincteric musculature is spared.

Abscess↗