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PubMed1992

Hepatic abscesses in immunocompromised patients: ultrasonically guided percutaneous drainage.

Ultrasonically guided percutaneous drainage (US-PD) is considered first-line therapy for hepatic abscesses, but no data are available on its efficacy in severely immunocompromised patients. Therefore, we examined 15 such patients in whom one or more hepatic abscesses of different etiology were treated with US-PD. Eleven patients underwent needle aspiration and four had catheter drainage under US guidance. In 12 cases we achieved complete healing of the abscesses. In one case, clinical improvement was obtained but surgery was required for cure. In another case (fungal abscess in AIDS), we had no improvement and the patient died. No procedural complications were observed. Seven patients died during the follow-up periods of up to 49 months from their underlying disease. We conclude that US-PD must be considered the therapy of choice for hepatic abscess (except the fungal lesions) in severely immunocompromised patients.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Percutaneous drainage of abscesses in patients with Crohn's disease.

The hospital courses of 9 patients with intraabdominal abscesses and Crohn's disease who underwent abscess drainage utilizing percutaneous techniques were reviewed. Percutaneous methods brought about resolution of fever, leukocytosis, and the abscess cavity in 8 patients. In 5 of these, definitive cure was achieved with percutaneous drainage. In 3, single-stage bowel surgery and fistulectomy were performed following resolution of the abscess cavities and improvement of clinical signs and symptoms. All patients had uncomplicated postoperative courses. Percutaneous drainage should be the initial drainage procedure in treating postoperative abscesses, and, when performed preoperatively, can diminish surgical morbidity.

Abdomen↗

PubMed1990

Horseshoe abscess fistula. Seton treatment.

A study was undertaken to analyze seton fistulotomy with counter drainage as a treatment modality for horseshoe abscess fistula. In a previous report of 27 patients with partial or complete horseshoe abscess fistula, 24 patients underwent primary fistulotomy and counter drainage with a recurrence rate of 28.6 percent. Two patients were treated by seton fistulotomy and counter drainage with no recurrence. Therefore, nine additional patients underwent this procedure. Recurrent horseshoe abscess fistula occurred in 2 of 11 patients (18.1 percent). Seton fistulotomy with counter drainage has become the authors' operative procedure of choice for horseshoe abscess fistula. This method may prove more effective if the true primary abscess cavity is identified, the seton is removed appropriately, and postoperative care of the cavity is adequate. Method of management is discussed.

Abscess↗

PubMed1995

Primary suture of anorectal abscess. A randomized study comparing treatment with clindamycin vs. clindamycin and Gentacoll.

UNLABELLED: Gentacoll (Schering-Plough A/S, DK-3520 Farum, Denmark) implant is a biologically absorbable collagen with gentamicin, which enables local use of gentamicin in an abscess cavity. PURPOSE: To increase healing rate in treatment of perianal abscess with primary suture, the effect of intraoperative parenteral clindamycin and Gentacoll was investigated against monotherapy with intraoperative clindamycin in a randomized study. METHODS: One hundred seven patients, 55 in the Gentacoll group and 52 in the control group, were enrolled in the study and followed for three months. RESULTS: Twelve patients (22 percent) in the Gentacoll group developed a new abscess and/or fistula. In the control group nine patients (17 percent) developed a recurrent abscess or a fistula. In both groups 43 patients had an uneventful course. The differences between the two groups were not significant. Of all 107 patients, 19.5 percent had recurrent disease in the follow-up period. Duration of hospitalization and reconvalescence were identical in both groups. One case of superficial thrombophlebitis was seen after clindamycin. No other adverse effects to either Gentacoll or clindamycin were seen. CONCLUSION: The study shows that Gentacoll is a safe preparation but is without value as a supplement to clindamycin in the treatment of acute perianal abscess with primary suture. The study has documented the value of this treatment under cover with a intraoperative dose of clindamycin.

Abscess↗

PubMed2000

Does technique of anastomosis play any role in developing late perianal abscess or fistula?

PURPOSE: This study examines the risk factors for developing perianal abscess or fistula formation after ileal pouch-anal anastomosis procedure for chronic ulcerative colitis or familial adenomatous polyposis. METHODS: A total of 1,457 patients with J-pouch, 1,304 (89.5 percent) with chronic ulcerative colitis and 153 (10.5 percent) with familial adenomatous polyposis who had a two-stage procedure without any evidence of previous perianal disease were included in the study. The effect of pouch-to-anal anastomosis type on perianal abscess or fistula formation was evaluated. RESULTS: A total of 108 patients (7.4 percent) had a perianal abscess or fistula after the ileal pouch-anal anastomosis procedure after at least one year of follow-up. No statistically significant difference was identified in fistula formation regarding the age and gender of the patients (P > 0.05), nor did the risk of fistula formation differ significantly between the patients with handsewn vs. stapled anastomoses (P > 0.05). However, patients with a diagnosis of chronic ulcerative colitis, compared with patients with familial adenomatous polyposis, had a statistically higher risk of developing abscess or fistula (P = 0.012). CONCLUSION: The most important risk factor in developing perianal sepsis in long-term patients with ileal pouch-anal anastomosis is the initial disease type. After excluding patients without Crohn's disease, the risk of developing an abscess or fistula was found to be significantly greater in patients with chronic ulcerative colitis compared with patients with familial adenomatous polyposis, and this risk is independent of anastomotic technique.

Abscess↗

PubMed1985

Abscesses and caseous lymphadenitis in goats in tropical semi-arid north-east Brazil.

This study reports the incidence of abscesses in relation to Corynebacterium pseudotuberculosis infection in goats in north-east Brazil. Among 656 goats examined periodically over almost two years 41.6% were found with superficially palpable abscesses. Most of the infected areas were in the anterior half of the body in front of the pre-scapular region; the inguinal region formed the other prominent area. Among 486 dead or slaughtered goats, 56 (11.5%) revealed abscesses in the internal organs. Lungs and epididymis were affected most, liver, spleen, udder and lateropharyngeal nodes were next in order and kidneys and mediastinal nodes were least affected. Thus the overall incidence of external and internal abscesses was 28.8%; of all the abscesses 27.7% were due to C. pseudotuberculosis and the rest due to infections of Corynebacterium pyogenes and several species of streptococci or staphylococci. The growth of C. pseudotuberculosis-infected and non-infected goats was of the same order and it seems that caseous lymphadenitis is not the cause of much financial loss in north-east Brazil but in view of its high incidence remedial measures should be considered necessary in regions where the goat meat industry is likely to become more intensive and important.

Abscess↗

PubMed1988

Percutaneous drainage for post-traumatic hepatic abscess in children under ultrasound imaging.

Hepatic abscess is rare in children. A patient with a post-traumatic hepatic abscess was successfully treated by ultrasound-guided percutaneous drainage. Although he underwent a drainage operation for the perihepatic abscesses, high fever continued. It was then considered that the traumatic hematoma had been infected and had become an abscess. Sonographically-guided percutaneous aspiration is useful for the definite diagnosis of hepatic abscess. Subsequent percutaneous drainage under ultrasound imaging is a safe and useful therapeutic method even in a poor-risk patient.

Child↗

PubMed1999

The occurrence of an abdominal wall abscess 11 years after appendectomy: report of a case.

Most complications after appendectomy occur within 10 days; however, we report herein the unusual case of a patient in whom a wound abscess was detected more than 10 years after an appendectomy. A 26-year-old woman presented to our hospital with nausea and vomiting, pain, and a mass in the right lower abdominal wall. She had undergone an appendectomy 11 years previously. Physical examination revealed a tender mass, 5 cm in diameter, under the appendectomy scar. An abdominal ultrasonography demonstrated a low-echoic mass lesion measuring 9.0 x 5.0 x 2.0 cm. Incision of the connective tissue revealed about 3 ml of cream-colored and odorless fluid in the abscess cavity. Fistulography revealed an abscess cavity not communicating with the bowel lumen. Floss was discovered in the connective tissue and removed. Debridement of the abscess wall was performed and a piece of the wall was sent for histologic examination. Pathological examination revealed panniculitis of the subcutaneous tissue, and panniculitis with granulation and granuloma of the abscess wall. This case report demonstrates that a preoperative diagnosis should be based not on one finding, but on all findings collected, inclusively.

Abdominal Abscess↗

PubMed1986

Psoas abscess: changing patterns of diagnosis and etiology.

From 1976 to 1984, 43 patients with psoas abscess were seen at the Mayo Clinic. Intestinal disease, including Crohn's disease, diverticulitis, and carcinoma, was the most frequent cause (14 patients). Eleven patients had osteomyelitis, five had postoperative complications, four had a foreign-body reaction, and three had a primary staphylococcal abscess. Two patients each had extension of a primary pancreatic and perinephric abscess. One patient had tuberculosis of the spine, and in the remaining patient, an exact cause was not determined. Definitive treatment of psoas abscess includes adequate debridement, drainage of the abscess cavity, and resection of involved bowel.

Abscess↗

PubMed1986

Management of anorectal horseshoe abscess and fistula.

Over a 10-year period 69 patients were treated consecutively for posterior and anterior horseshoe abscesses and fistulas. Fifty-nine patients had posterior and ten had anterior abscesses or fistulas. There were 52 patients with acute abscess. Treatment consisted of incision and drainage, incision and drainage with primary fistulotomy, incision and drainage with primary fistulotomy and counter-drainage, and incision and drainage with insertion of seton. Seventeen patients with chronic fistulas were treated by primary fistulotomy with curettage, or incision and drainage with insertion of seton. Patients were followed from three months to ten years with a mean follow-up of three years. No incidences of incontinence were reported in this series. The overall rate of recurrence was 18 percent, and included only patients with posterior abscesses and fistulas. Recurrence was related to the failure to maintain prolonged drainage in the midline after primary fistulotomy. The use of seton for delayed fistulotomy appears to promote wound drainage and precludes premature wound closure. More liberal use of the seton in the treatment of horseshoe abscesses and fistulas is advocated.

Abscess↗

PubMed1990

Percutaneous drainage of lung abscess.

Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6-12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess.

Adult↗

PubMed2006

Brain abscess in children.

OBJECTIVES: Brain abscess is a serious life-threatening complication of several diseases. The objective of this study was to look at the clinical profile of patients, predisposing conditions, microbiology and outcome of children suffering from brain abscess. METHODS: Thirty children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was 5.6+/-4.4 years. RESULTS: The duration of illness at the time of admission was 17.6+/-24.6 days. Typically patients presented with fever, vomiting, headache and seizures. The predisposing conditions found were cyanotic congenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%) and no underlying cause was found in 5 (17%) children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcus milleri group (52%). Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6 children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5. CONCLUSION: Brain abscess is a serious infection with poor outcome if diagnosed late. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosis should be low, particularly in children with a predisposing condition like cyanotic congenital heart disease.

Adolescent↗

PubMed1985

A case of pericholecystic abscess diagnosed by ultrasonography.

Pericholecystic abscess is a serious complication of cholecystitis. Though preoperative diagnosis is easy by gray-scale ultrasonography, there has been no case reported in which the communication between pericholecystic abscess and the gallbladder was demonstrated ultrasonically. We experienced a case in which the communication route between a pericholecystic abscess and the gallbladder was successfully demonstrated by a real-time electric linear scanner. Furthermore, the abscess was successfully treated by percutaneous drainage following ultrasonically guided puncture. This success demonstrates that ultrasonography by a real-time scanner can be effective for diagnosis and treatment of acute cholecystitis and pericholecystic abscess.

Abscess↗

PubMed1997

Epidural abscess after combined spinal-epidural block.

PURPOSE: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may constitute an additional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present. CLINICAL FEATURES: The combination of a spinal and a continuous epidural block (CSE) using a needle through needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb. On the fourth postoperative day the patient demonstrated back pain, fever, and exudation of pus from the CSE-puncture site. An epidural abscess was diagnosed by magnetic resonance imaging and subsequently an emergency hemiaminectomy was performed. Physical examination and surgery did not show evidence of bacterial spread into the subarachnoid space. CONCLUSION: Epidural abscess formation after CSE may increase the risk of bacterial spread into the subarachnoid space. In this case spontaneous exudation and surgical drainage of abscess material may have prevented intrathecal infection. Rapid diagnosis and treatment of an epidural abscess appears particularly essential after CSE to prevent neurological sequelae.

Abscess↗

PubMed1996

Percutaneous drainage of subperiosteal abscess: a potential treatment for osteomyelitis.

OBJECTIVE: Intravenous antibiotics and surgical drainage are the accepted methods of treating osteomyelitis complicated by abscess formation. The objective of this study was to determine whether percutaneous drainage of subperiosteal abscess is a potential treatment for osteomyelitis. MATERIALS AND METHODS: Three pediatric patients with subperiosteal abscesses from acute osteomyelitis had percutaneous drainage with sonographic and fluoroscopic guidance using a Seldinger technique and an 8-F catheter. RESULTS: Two patients required no further intervention and had the drainage catheter removed after 72 h. After completing a course of antibiotics they healed completely. One patient, after a week of purulent drainage, required open drainage including a bone debridement of an area of septic necrosis. CONCLUSION: Percutaneous drainage of subperiosteal abscess may be an alternative to surgical drainage when medical therapy alone is inadequate. Development of intraosseous abscess, necrosis or persistent drainage suggests further intervention may be necessary.

Abscess↗

PubMed2000

Spinal epidural abscess: a meta-analysis of 915 patients.

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. The problem with spinal epidural abscesses is not treatment, but early diagnosis - before massive neurological symptoms occur" (Strohecker and Grobovschek 1986).

Epidural Abscess↗

PubMed2004

[Detection and identification of the pathogenic cause of a brain abscess by molecular genetic methods].

Brain abscesses are life-threatening and detection and identification of the causative pathogens are crucial for substantiating the diagnosis and for selecting the optimal antibiotic regimen. In approximately 20% of the patients microbiological cultures of abscess material remain sterile. The polymerase chain reaction (PCR) provides a methodological alternative, but data about the use of broad spectrum PCR assays to detect the causative pathogens in brain abscesses are rare. We report on the case of a 65-years-old patient with a brain abscess caused by Fusobacterium spp., which was only diagnosed by broad spectrum PCR. To our knowledge this is the second report about a brain abscess, where Fusobacterium spp. was identified only by broad spectrum PCR and subsequent DNA sequencing.

Aged↗

PubMed2005

[Injection site abscesses in intravenous drug users. Frequency of associated complications related to localisation].

BACKGROUND: Skin and soft tissue infections are the most frequent cause of hospital admissions among intravenous drug users. Associated complications include septic arthritis, septic thrombosis and embolisation, peripheral ischaemia due to intra-arterial injections, venous and arterial pseudoaneurysms, local destruction of adjacent structures, and necrotising fasciitis. METHODS: We conducted a retrospective review of the associated complications of 85 patients with 130 abscesses treated during 108 hospital stays. RESULTS: The majority of abscesses (55%) were located on the lower extremities, where the complication rate following injections was significantly higher than in other parts of the body (12/71 vs 0/55, P=0.0005). Patients with abscesses on the lower extremities had significantly longer hospital stay than those with abscesses on other localisations (8.5 days vs 4.2 days, P=0.0005) and therefore were more expensive to treat. CONCLUSIONS: Surgeons treating abscesses caused by intravenous drug use must be aware of the higher rate of associated complications after injection in the lower extremities. Prevention in drug addiction programs could reduce complications and costs related to drug use by avoiding injection sites on the lower extremities.

Abscess↗