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PubMed1997

Spinal epidural abscess--a case report.

Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis is elusive. The incidence of spinal epidural abscess is approximately one to two cases per 10,000 among all patients admitted to hospitals. The symptoms of spinal epidural abscess are varied but include lower back pain, fever, local tenderness and neurological deficit especially in such high risk groups as patients with diabetes, intravenous drug abuse, chronic renal failure, alcoholism, liver disease and immunocompromization. Accumulation of data is difficult in that many physicians will never see a case during their careers. Herein, we present a case with lower back pain associated with both lower legs weakness. His abdomenon CT revealed retroperitonium and right perirenal abscess. External drainage as well as antibiotic treatment was done immediately. However, the lower legs weakness became severe and a lumbar spine MRI revealed T11-L4 epidural abscesses and L2-3 intervertebral space pus formation. Then, the patient was transfered to our Neurosurgical Ward for further treatment. His postoperative condition improved in both lower legs. This case report is to enhance the recognition and treatment of spinal epidural abscess, a rare affliction.

Abscess↗
PubMed1997

[Retropharyngeal abscess in cattle. A case report].

This case report describes history, clinical, laboratory, radiographic, and endoscopic findings, therapy, and outcome of a 5-year-old cow, suffering from retropharyngeal abscessation. Clinical findings at admission included elevated body temperature, head and neck held in extended position, excessive salivation, swelling of the retropharyngeal area, and slight inspiratory noise. Radiographic and endoscopic examination confirmed the tentative diagnosis of retropharyngeal abscessation. Treatment consisted of parenteral application of procaine-penicillin for 10 days and local application of linseed rubefacients for 2 weeks. At that time, abscessation had developed. The abscess was subsequently surgically, approached by a modified Whitehouse approach. During this procedure, the abscess drained into the oropharynx, allowing interruption of surgery. Five months later, clinical, radiographic, and endoscopic follow-up examination revealed complete healing of the retropharyngeal abscess.

Animals↗
PubMed1997

[Debatable questions of surgical tactics in appendiceal infiltrates and periappendiceal abscess].

The disease course in 68 patients with appendicular infiltrate (AI) and periappendicular abscess (PAA) is analysed. There were 42 men and 26 women at the age of 15-76 years. AI was detected in 12 patients, PAA-in 56 patients. In 39 patients diagnosis was made on the basis of clinical examination, laboratory tests and X-ray examination. Ultrasound examination was used in 19 cases. Conservative treatment appeared to be effective in 7 patients. The abscess developed in 4 patients. In 5 patients the diagnosis of AI was confirmed at the surgery. Opening and draining of the abscess was performed in 35 patients. The transabdominal opening of the abscess in combination with appendectomy was used in 19 patients. The median laparotomy, appendectomy and abdominal drainage were conducted in 2 patients with the break of the abscess into the abdominal cavity that led to the development of disseminated purulent peritonitis. The long-term results after the resolution of the infiltrate and opening of the abscess were analysed in 38 patients. The postoperative complications have developed in 29 patients, reoperation was performed in 7 of them. 2 of the 68 patients died after surgery. The total mortality rate was 2.9%, postoperative mortality-3.4%. Acute liver insufficiency (1) and intoxication (1) were the causes of death.

Abscess↗
PubMed1997

Paraintestinal mesenteric abscess and chronic peritonitis in a bull.

A 2-year-old bull was examined because of intermittent anorexia, signs of mild colic, and weight loss of 3 weeks' duration. A tympanitic resonance (ping) could be heard during simultaneous auscultation and percussion of the right paralumbar fossa, and a mass could be felt in the right dorsal quadrant of the abdominal cavity during palpation per rectum. Right flank laparotomy was performed, and intraoperative ultrasonography and ultrasound-guided fine-needle aspiration were used to determine that the mass was an abscess. However, the abscess could not be removed or drained into the colon because of extensive adhesions to other organs. Because the owner refused to pursue continued medical treatment, the bull was euthanatized. At necropsy, the abscess was found to be connected to a caudal mesenteric lymph node through a fistula. Histologic evaluation of the lymph node revealed hyperplastic lymphadenitis, and an alpha-hemolytic streptococcus was recovered from the abscess fluid. The most likely possibility for the findings in this bull were that the lymphadenitis was of hematogenous origin and that the abscess developed as a direct extension of the infectious process, similar to development of mesenteric abscesses in horses with chronic streptococcal infection (i.e., strangles).

Abdominal Abscess↗
PubMed1997

[Interventional therapy of intra-abdominal abscess: outcome and limits].

The postoperative course following digestive surgical procedures was prospectively analysed in 2985 patients between 6/92 and 12/96. A CT-guided percutaneous drainage of intraabdominal abscesses was performed in 144 patients (4.8%). In 123 patients (85.4%) percutaneous abscess drainage (PAD) was successful, additional surgery was not required. Twenty-one patients (14.6%) underwent additional surgery. Reasons for drainage failure were abscesses caused by internal fistulas (8 patients), pancreas involvement of the abscesses (5 patients), infected clots impossible to drain (3 patients), multiple abscesses (3 patients) and persistent abscess formation despite drainage (2 patients). Puncture-related complications were seen in 8 patients (5.5%). Puncture-related mortality was 0.7%.

Abdominal Abscess↗
PubMedDate not supplied

Multiple large pyogenic liver abscesses of the tropics: a new entity.

BACKGROUND: Pyogenic liver abscesses most commonly occur in males in -he sixth decade, are usually associated with biliary tract disease, malignancy and immunosuppression and the mortality rate is high. We describe another form of pyogenic abscess occurring in females which, if treated aggressively, carries a much better prognosis. METHODS: Between 1986 and 1993 we treated 8 patients with multiple pyogenic liver abscesses. Diagnosis was established by ultrasound and CT scan followed by needle aspiration to confirm pus. Amoebic aetiology was excluded by a serology, poor response to metronidazole and biopsy of the abscess wall. RESULTS: The mean age of our patients was 30 +/- 7 years and there were 2 males and 6 females. They presented with fever and abdominal pain for more than 2 months, tender hepatomegaly, a raised ESR and alkaline phosphatase. US and CT scans showed multiple large abscesses in the right lobe. Histology suggested chronic inflammation and with no definite organism isolated except for visceral larva migrans in one case. All patients underwent surgery--deroofing with drainage was done in four, segmental hepatic resection in three and right hepatectomy in one. One patient had a recurrence and underwent repeated resection. Only one patient died and 7 did well with no recurrence at a mean followup of 24 +/- 27 months. CONCLUSIONS: Large multiple cryptogenic pyogenic abscesses of the liver occurring mostly in young females, which respond well to aggressive excisional surgery may constitute a distinct clinical entity.

Adult↗
PubMed1998

Spinal epidural abscess.

AIMS: To review the clinical presentation and outcome of patients with spinal epidural abscess. METHODS: Following an index case, additional cases were identified during 1991-6. RESULTS: There were a total of seven patients with spinal epidural abscess and an average age of 52 years (range 24-75 years). The abscess locations were cervical (3), thoracic (3) or thoracolumbar (1), and extended on average 4.3 vertebral bodies (range 2-9). Staphylococcus aureus was the aetiologic agent in all of the six microbiologically confirmed cases. Three abscesses arose from adjacent vertebral osteomyelitis, one followed epidural anaesthesia and two arose by haematogenous spread. New spinal or radicular pain were the most frequent early symptoms, later, nerve root weakness or a sensory level. An ESR > 30 mm/hour was consistently present but fever and leukocytosis were absent in some patients. MRI (five cases) and myelography (one case) were diagnostic. Five patients underwent laminectomy and abscess drainage; in three, limb weakness improved markedly post operatively. Three of the four patients with paralysis died, two despite laminectomy. CONCLUSIONS: New spinal pain, radicular symptoms or signs, and a raised ESR were the most consistent early abnormalities in patients with a spinal epidural abscess. Diagnosis at an early clinical stage was associated with a better outcome.

Abscess↗
PubMedDate not supplied

[Pyogenic hepatic abscesses: 16 years experience in its diagnosis and treatment].

BACKGROUND: The aim of the present was to know the epidemiologic characteristics and clinico-biological variables presented by pyogenic hepatic abscesses and to evaluate the different therapeutic alternatives with special emphasis on percutaneous drainage. METHODS: A historical retrospective review of the hepatic abscesses diagnosed and treated in the authors' hospital over a 16.5 year period was carried out. RESULTS: A total of 44 cases of pyogenic hepatic abscesses were collected representing a rate of 0.088% of the hospital admissions. The mean age of the patients was 61.8 years. Thirty-four percent were cryptogenetic, being followed in frequency by those of biliary, post abdominal surgery and venoportal origin. Fever and right hypochondrial pain were the most frequent clinical manifestations, accompanied by an elevation in VSG and leucocytosis being the most common analytical alterations. Ultrasonography and CAT were found to be valuable in the diagnosis and treatment. The microorganism responsible was identified in 48% of the cases, with enterobacteria being the greatest number isolated. Fifty-two percent of the abscesses were treated with percutaneous drainage (73% if only patients post 1984 are considered), with minimum complications and a reduction in the number of days of hospitalization in comparison with surgical treatment. CONCLUSIONS: The presentation of a pyogenic hepatic abscess may be unspecific. Imaging techniques (echography and CAT) provide the main support in both the diagnosis and treatment. Percutaneous drainage plus early empiric antibiotherapy are the treatment of choice in pyogenic hepatic abscesses.

Adolescent↗
PubMed1998

[MRI aspects of spinal cord abscesses. Report of 5 cases and review of the literature].

The spinal canal is an uncommon site for abscess formation resulting from bloodstream disseminated infection. Prognosis is often unfavorable. Rapid treatment is essential for satisfactory neurological recovery. Abscesses within the spinal canal are thus diagnostic and therapeutic emergencies. The neuro-infectious and inflammatory manifestations and laboratory findings vary considerably and are insufficient for diagnosis. MRI plays a decisive role. The most commonly reported signs are the presence of an intramedullary collection giving a low-intensity signal on T1-weighted images and a high-intensity signal on T2-weighted images with peripheral contrast uptake and generally extended adjacent medullary edema. We report here five cases of spinal canal abscesses diagnoses with MRI at different stages of development (pre-suppurative myelitis in two cases, constituted abscess in three cases). For each case we reviewed the clinical course and describe the details of the imaging findings. In our series, the collected abscesses presented as round lesions within the canal with contrast uptake. It is noteworthy that the periependymal gray matter adjacent to the lesion also took up the contrast agent in all patients with a collected abscess. This sign has not been described previously and appears to be a going argument orienting the diagnosis towards an infectious rather than tumoral formation.

Abscess↗
PubMedDate not supplied

[Clinical picture of single and multiple rhinogenic brain abscesses].

The authors examined 11 patients with rhinogenous abscesses of the brain aged from 2 to 45, 5 of them with multiple abscesses. According to their data the infection penetrated into the cranial cavity by two principal ways, namely, contactual (in 2 patients) and hematogenous via venous passages (in 4 patients). Contactual cerebral abscesses of rhinogenous genesis more frequently appear during frontitis, have a lingering chronic course and localize at the pole of the frontal lobe. Clinically they manifest themselves by focal and total cerebral symptoms including craniographic changes of hypertensive character. In patients with rhinogenous abscesses of phlebitic genesis a subacute course of the disease was noted. In addition to focal and total cerebral symptoms of general intoxication charater the authors noted in such cases symptoms of depression of the superior truncal structures of the brain. Cerebral abcesses of contactual and phlebitic genesis have mostly a benign course after surgical treatment (out of 6 patients there was only 1 lethal case). Hematogenous spreading of the infection along the arteries is often noted to cause multiple cerebral abscesses (in one or in both lobes) and is frequently accompanied by suppurative meningitis, periventriculitis. All cases of mutiple rhinogenous abscesses had a lethal end.

Adolescent↗
PubMedDate not supplied

Internal carotid artery narrowing in children with retropharyngeal lymphadenitis and abscess.

BACKGROUND AND PURPOSE: Our purpose was to describe the association between narrowing of the internal carotid artery (ICA) and retropharyngeal abscess in children. METHODS: Neck CT scans from 13 consecutive children with suppurative retropharyngeal lymphadenitis and abscess were evaluated retrospectively for asymmetric ICA diameters at the level of the abscess. Clinical status at the time of illness was established via a chart review. Twenty control CT scans obtained from pediatric patients with normal imaging findings were evaluated prospectively to determine symmetry and size of the ICA. RESULTS: Mean diameter of the normal ICA, contralateral to the retropharyngeal abscess, was 5 mm (range, 3-8 mm), while mean diameter ipsilateral to the abscess was 3 mm (range, 1-5 mm). The diameters of the normal and abnormal ICAs were statistically significantly different. All children were neurologically normal. The right and left ICAs in children with normal CT findings in the neck were symmetrical in diameter. CONCLUSION: Despite dramatic narrowing of the ICA ipsilateral to retropharyngeal lymphadenitis and abscess, no children in this series had neurologic deficits, suggesting that such narrowing is a common, benign, and, most likely, incidental imaging finding.

Adolescent↗
PubMedDate not supplied

Abscess formation following spilled gallstones during laparoscopic cholecystectomy.

OBJECTIVE: Our purpose was to report the occurrence of abscess following spilled gallstones during laparoscopic cholecystectomy as experienced at Good Samaritan Hospital, and to compare it to the experience of other institutions in order to identify the incidence, characteristics and possible risk factors for the development of this complication. METHODS: Four case reports of abscess following spilled gallstones during laparoscopic cholecystectomy are presented. The English literature was reviewed, and characteristics of the case reports found in the literature were compared. RESULTS: In four years at this institution, four reports of abscess formation following laparoscopic cholecystectomy have been identified. Two occurred in elderly females and were located in the right flank in both. Two were in middle-aged men, both diabetic. One abscess was in the right flank and one in the right pleural space. Twenty-three cases were found in the literature. The average age was 65 years; there were 12 men and 11 women. The locations of abscess formation were trocar sites (most common), right subphrenic space, right flank or retroperitoneum, and pelvis. The average time to presentation was 4-5 months (range 4 days-12 months). CONCLUSIONS: Abscess formation following spilled gallstones during laparoscopic cholecystectomy occurs infrequently, but can be debilitating and require more than one procedure. The older population appears to be at greater risk. Future prospective studies of patients who undergo laparoscopic cholecystectomy are needed to more accurately determine the incidence of this complication and to identify the population at risk.

Abdominal Abscess↗
PubMed1981

Non-surgical drainage of intra-abdominal and mediastinal abscesses: a report of twelve cases.

Twelve patients with intra-abdominal or mediastinal abscesses were treated by percutaneous drainage. Three abscesses were subphrenic, three were adjacent to enteric leaks, two were intrahepatic, two were pancreatic pseudocysts, one was a pancreatic abscess extending to the lesser sac, and one was an infected adrenal hematoma. All 12 lesions were entered percutaneously using fluoroscopic guidance without traumatizing the adjacent normal tissue. Localization was frequently aided by computed tomography. Various catheters were positioned using basic angiographic techniques. Following drainage all patients had a favorable clinical response. Seven of the 12 patients required no surgical management. Careful radiologic follow-up and frequent changing of catheters was necessary in six of the patients. Two patients benefited from the addition of auxiliary drains. Five of the 12 patients were electively operated upon because of incomplete drainage of the abscess cavity. Causes of failure were: persistent anastomotic leak (two patients), sequestered, loculated extension of abscess cavity (two patients), or necrotic, viscous hepatic tissue requiring removal at laparotomy (one patient).

Abscess↗
PubMed1986

Percutaneous aspiration and catheter drainage of abscesses.

Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.

Abdomen↗
PubMed1986

[Ultrasound-guided fine-needle puncture in the diagnosis and therapy of liver and spleen abscesses].

A total of 41 diagnostic and therapeutic fine-needle aspiration punctures were performed under ultrasound control in 28 patients with solitary or multiple abscesses of liver (26) or spleen (2). Nonoperative measures (drainage-fine needle puncture, local and systemic antibiotics) cured 19 patients; in nine, primary surgical abscess drainage was performed. One operated patient with multiple liver abscesses died of generalized sepsis (mortality rate 3.6%). All 14 hepatic or splenic abscesses in which percutaneous fine-needle drainage was performed, including local and systemic antibiotic administration, were treated successfully. In two of 41 fine-needle aspiration punctures bleeding complications were recorded but did not require any treatment. The method was reliable and effective in the definitive diagnosis and treatment of hepatic and splenic abscesses, with a lower complication and mortality rate than surgical drainage.

Abscess↗
PubMed1992

Tuberculous abscesses in patients with AIDS.

Five cases of large tuberculous abscesses in patients with AIDS were observed over a 2-year period at the New York Veterans Affairs Medical Center. These cases represent 11.6% of the 43 cases of tuberculosis diagnosed in patients with AIDS during that period. The abscesses were located in the liver, abdominal wall, psoas muscle, mediastinum, and peripancreatic area. All patients presented with localized pain or swelling, and four of five patients had fever. The diagnosis was made on the basis of detection of abscesses on computed tomography (CT) and the results of culture of abscess material obtained by CT-guided aspiration. CT-guided therapeutic drainage was performed in two cases. Despite administration of therapy, two of five patients died of tuberculous infection. Formation of tuberculous abscesses appears to be a common complication of tuberculosis in patients with AIDS. This diagnosis should be considered for patients with AIDS who have fever and localized pain or swelling.

Abdominal Muscles↗
PubMed1986

CT features of intraabdominal abscesses: prediction of successful percutaneous drainage.

Fifty-three patients with 71 intraabdominal abscesses identified on computed tomography (CT) and treated with percutaneous abscess drainage were evaluated for the possible predictive value of any particular CT feature in relation to the outcome of percutaneous drainage. Features analyzed included the presence of a "rind," sharp exterior margin, air-fluid level, scattered internal gas bubbles, and internal septations, as well as size, site, and the presence or absence of fistulas as determined by sinography. Statistical analysis revealed that only site has predictive value; liver and subphrenic abscesses were more likely to have a successful outcome than abscesses in other locations (84% vs 47% complete cure). The presence of a long air-fluid level denoted communication with the gastrointestinal tract, which led to significantly longer drainage times and larger drainage volumes. Since there are no CT features that can strongly predict a poor outcome, all intraabdominal abscesses should be considered candidates for percutaneous drainage.

Abdomen↗
PubMed1990

[Percutaneous drainage of abdominal abscesses].

Percutaneous drainage has been widely accepted as the preferred treatment for abdominal abscess. Indications have been clarified recently and the absence of a secure route is the only absolute contraindication. We performed this procedure in 65 patients with abdominal abscess at different locations: liver 27, subphrenic 33, lesser cavity 3 and perirenal 3. Overall success rate was 85%, with 89% for liver and 88% for the subphrenic location. Six patients died of multisystemic failure even though the abscess was properly drained. Four patients were operated on for persistent abscess. A pancreatic fistula was shown in 1 and a peritoneal hydatid cyst was the original lesion in the other. Pneumothorax occurred in 5 patients requiring drainage in 2. Two other patients developed hydro-pneumothorax and empyema, that was drained. The overall complication rate was 14%. Thus, percutaneous drainage is a simple and highly successful treatment for abdominal abscess. Results are influenced by the accuracy of diagnosis and a proper selection of patients.

Abdomen↗