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PubMed2006

[Perianal abscess and anal fistula in infancy and childhood. A congenital etiology?].

BACKGROUND: Perianal abscess and anal fistula in childhood are commonly treated in the same way as abscess and fistula in adults. We questioned whether they represent a cryptoglandular infection, as in adults, or two different diseases with the same symptoms. MATERIALS AND METHODS: We retrospectively analyzed all medical records of 80 children (seven male, 73 female) who underwent surgical treatment for primary perianal abscess or primary anal fistula during a 10-year period. The records were analyzed concerning age at appearance of lesion, sex, diagnosis (fistula and/or abscess), and anatomic localization of the lesion. RESULTS: Of all the children, 67.5% were treated during their 1st year of life and another 10% during their 2nd year (group 1: 77.5%, n=62). Only 22.5% were 3 or older (group 2, n=18). Group 1 contained significantly more male infants (m:f 30:1). However, much more balanced sex distribution was detected in group 2 (m:f 2.6:1), similarly to adults. Analyzing anatomic localization, a second important difference could be found: in contrast to group 2, almost two thirds of all anal fistulas/abscesses in group 1 were localized horizontally between 3:00 and 9:00 o'clock in crown-rump position. CONCLUSIONS: Divergences in preference of age, sex, and localization suggest a congenital etiology for anal fistulas and perianal abscesses in children.

Abscess↗
PubMed2006

Prepubic and thigh abscess after successive placement of two suburethral slings.

We present a case of prepubic and thigh abscess after the placement of two types of suburethral slings in a 65-year-old woman suffering from stress urinary incontinence (SUI). The first surgical procedure (prepubic tension-free vaginal tape) was unsuccessful. Thus, 2 months later, we placed an ObTape sling by transobturator approach. This second procedure was successful. Seven months later, the patient presented with vaginal erosion of the sling with no inflammatory signs. The suburethral portion of the sling was immediately removed and the vagina was sutured. Nine months later, a prepubic abscess occurred and required removal of the prepubic sling, drain placement, and antibiotic therapy. Unfortunately, 9 months later, a thigh abscess occurred. Magnetic resonance imaging (MRI) allowed precise diagnosis and anatomic localization of the thigh abscess. Surgery consisted of opening and draining the abscess and removing the transobturator sling. At 6 months follow-up, no persistent inflammatory sign was observed on MRI, and SUI did not recur.

Abscess↗
PubMed2006

CT features of tuberculous intracranial abscesses in children.

BACKGROUND: Intracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy. OBJECTIVE: To report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses. MATERIALS AND METHODS: We undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses. RESULTS: Eight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n = 5), ring enhancement (n = 8), cerebral hemisphere location (n = 7), mass effect (n = 6), surrounding oedema (n = 5) and absence of a soft-tissue-density mass (n = 8). CONCLUSION: In endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy.

Brain Abscess↗
PubMed2004

MRI demonstration of cervical spondylodiscitis and distal full-length bilateral paraspinal cold abscesses successfully treated by drug regimen only.

OBJECTIVE: Cold abscesses, although common in spinal tuberculosis, are usually localized to the level of infection, follow tissue planes, and may extend into the spinal canal at any level. They may cause symptoms resulting from neurovascular compression, hemorrhage, and direct mass effect. DESIGN AND PATIENTS: We present an unusual case of cervical tuberculous spondylodiscitis in a 25-year old man with a cold abscesses involving the retropharyngeal, mediastinal, and retroperitoneal areas bilaterally. The abscess tracked from the neck to the psoas muscles bilaterally. Following the diagnosis the patient received 9 months of antituberculous therapy. RESULTS: MRI showed resolution on medical treatment alone. CONCLUSIONS: Even in the presence of massive paravertebral cold abscesses medical treatment alone may well suffice for this common worldwide disorder. MRI is ideal for monitoring regression of massive abscesses in deep anatomical locations.

Abscess↗
PubMedDate not supplied

Prostatic abscess in young males: a rare complication of Crohn's disease.

We report a rare case of prostatic abscess with Crohn's disease in a 21-year-old male. Computed tomography showed a typical prostatic abscess. Moreover, filling of the abscess cavities with contrast medium was demonstrated after micturition, which represented the rupturing of the abscess into the urethra. Crohn's disease should be included in the differential diagnosis of prostatic abscesses even in young males.

Abdominal Abscess↗
PubMed1998

Primary pyogenic abscess of the psoas muscle.

During a six-year period, eleven persons with primary pyogenic abscess of the psoas muscle were treated at the Mackay Memorial Hospital. Five were males and six were females and their average age was 47.2 years (range 6-83 years). The abscess was identified by CT in 7 patients, MRI in 2 and ultrasonography in 1. One abscess was found during laparotomy. Treatment included extraperitoneal drainage of the abscess in 7 patients and CT guided aspiration in 3. One patient improved after antibiotic therapy and they all recovered after treatment. The diagnosis of primary pyogenic abscess requires a high index of suspicion and the best treatment is early operative drainage and administration of systemic antibiotics.

Adolescent↗
PubMed2002

Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children).

BACKGROUND: Tubercular brain abscess (TBA) is a rare manifestation of CNS tuberculosis. It is characterised by an encapsulated collection of pus, containing viable tubercular bacilli without evidence of tubercular granuloma. PRESENTATION AND HISTORY: Patients may present with features of raised intracranial pressure and focal neurological deficit commensurate with the site of the abscess. A history of pulmonary tuberculosis may be present, as documented in one of our six cases; three of our six children developed TBA despite 3-weeks to 12-month courses of antitubercular chemotherapy prescribed for post-TBM hydrocephalus. DIAGNOSIS: Contrast CT head, MRI, MR spectroscopy is helpful in making the diagnosis and planning the treatment. TBA may be unilocular or multilocular on contrast CT scan. A relatively long clinical history and an enhancing capsule with thick wall are suggestive of TBA. Pyogenic abscess, however, has a thin rim on contrast CT. The capsule of TBA is formed of vascular granulation tissue containing acute and chronic inflammatory cells, particularly polymorphs. Proof of tubercular origin must be demonstrated either by presence of acid fast bacilli in culture or staining of pus or wall. TREATMENT: Treatment options include simple puncture, continuous drainage, fractional drainage, repeated aspiration through a burr hole, stereotactic aspiration and total excision of the abscess. Total excision usually becomes necessary in multilocular noncommunicating and thick-walled abscesses. Antitubercular therapy is the mainstay of management. The development of fulminant tubercular meningitis is sometimes problematic following surgical excision of TBA, as seen in one of our four operated cases. Mortality is reported to be high despite progress in treatment, while five of the six children treated by us responded well to the treatment.

Brain Abscess↗
PubMed2004

Tuberculous osteomyelitis of the lumbosacral region: a spinal epidural abscess with presacral extension.

INTRODUCTION: Tuberculous osteomyelitis in the lumbosacral region is an uncommon occurrence, and its treatment is not well-defined in the literature, particularly when it is associated with abscess formation. We present the outcome of a patient who had an epidural abscess with presacral extension. MATERIALS AND METHODS: A 30-year-old man had microbiologically confirmed tuberculous infection of the lumbosacral vertebrae complicated by extensive abscess formation. After a trial of chemotherapy, the infection proved refractory, and the treatment proceeded with abscess drainage through the anterior route. RESULTS: Approximately 1 year after surgery, the patient was symptom-free and did not show any significant radiologic changes. CONCLUSION: Antituberculous chemotherapy combined with anterior surgery seems to be beneficial in the setting of lumbosacral osteomyelitis complicated by epidural abscess formation with presacral extension.

Adult↗
PubMed2004

Evolution of acute focal bacterial nephritis into a renal abscess.

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation, which may represent a relatively early stage of renal abscess. The pathogenesis of AFBN is thought to be hematogenous infection or ascending infection from the lower urinary tract. For the majority of children, the pathogenesis may be related to ascending infection, because pre-existing malformative uropathy, especially vesicoureteral reflux (VUR), is common in pediatric patients. Few clinical reports have demonstrated the evolution of this condition into renal abscess in children. We report a girl with AFBN associated with VUR that evolved into a renal abscess despite appropriate intravenous antibiotic therapy. We undertook serial radiological observation of its evolution. It is important to differentiate AFBN from renal abscess because the management of the two entities may be different, and follow-up studies are indispensable to determine appropriate therapy.

Abscess↗
PubMed2006

Amebic liver abscess rupturing into the lesser omentum space.

A case of an amebic abscess localized in the lesser omentum is reported. There was no sign of a liver abscess in the imaging examination or the operative findings. However, it is likely that the amebic infection occurred after a liver abscess ruptured into the abdominal cavity. Early diagnosis and therapy are required when an abscess of unknown origin borders the liver, given the possibility of amebic abscess.

Animals↗
PubMed2006

Easy drainage of presacral abscess.

Presacral region is one of the difficult regions for drainage of abscess as the approaches described for this carry a lot of morbidities. Transpedicular approach is described for the drainage of presacral abscess. Further, tuberculous abscess as a cause of cauda equina syndrome is reported. Patient had complete neurological recovery within weeks of drainage of abscess. Transpedicular drainage of presacral abscess is a safer option for recently developed neurological deficit. Late presentation may need anterior approach, which is associated with increased morbidity.

Abscess↗
PubMed2004

Primary abscess of the omentum: report of a case.

We report a case of a primary abscess of the omentum without any obvious etiology. A 62-year-old man was referred to our clinic with lower abdominal pain, and computed tomography showed an intra-abdominal abscess in the left pelvic area. Laparotomy revealed that the abscess adhered to the urinary bladder and abdominal wall, but no perforation of the alimentary tract was identified and there was no foreign body in the abscess cavity. A culture of the abscess fluid grew Clostridium perfringens. The patient was discharged on the 16th hospital day after an uneventful postoperative course without any complications.

Abdominal Abscess↗
PubMed2001

Pneumoperitoneum following the spontaneous rupture of a gas-containing pyogenic liver abscess: report of a case.

We report herein the case of a ruptured liver abscess that resulted in pneumoperitoneum. A patient with diabetes mellitus presented with symptoms of acute abdomen. The plain abdominal radiograph and computed tomography findings revealed abdominal free air and a gas-containing liver abscess, whereby a diagnosis of a ruptured liver abscess was made. An emergency operation was performed, and the abscess was drained followed by peritoneal lavage and the administration of appropriate antibiotics. To the best of our knowledge, very few cases of spontaneous pneumoperitoneum occurring secondary to the rupture of a gas-containing liver abscess have been encountered in Japan.

Anti-Bacterial Agents↗
PubMed2002

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case.

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications.

Adult↗
PubMed2004

Aspergillus pituitary abscess.

BACKGROUND: Pituitary abscess is rare and most of the cases are of bacterial origin. True fungal pituitary abscess is extremely rare only five cases have been reported. In this report, we present a case of aspergillus pituitary abscess. Mortality rate in intracranial aspergillosis is close to 100% especially in immunsuppressed patients when undiagnosed and untreated. In focal CNS aspergillosis total cure can be achieved in approximately 30% of the cases by surgical drainage and intensive antifungal therapy. Although this is the first reported case with magnetic resonance imaging examination the definitive diagnosis was established only by histopathological examination. CLINICAL PRESENTATION: A 42 year-old man was referred to our hospital with the diagnosis of sellar suprasellar mass accompanied by frontal headache and decreased visual acuity. His medical history was insignificant. Physical examination was normal and the patient was afebrile. The neurological examination revealed bilateral papilledema and bitemporal hemianopsia but no stiff neck and motor or sensory deficit. In the light of MRI examination, the preoperative diagnosis was pituitary abscess secondary to paranasal sinus infection or hemorrhagic pituitary adenoma. INTERVENTION: The patient was successfully treated by transsphenoidal surgery. Histopathological examination of sphenoid sinus mucosa revealed normal mucosal appearance with inflammation and histopathological examination of the intrasellar mass resulted in the diagnosis of aspergillosis. All cultures obtained from sphenoid sinus were reported as having no growth. However in the second week after the operation fungal culture of the intrasellar mass grew aspergillus. After 8 weeks of amphothericine-B treatment, the patient was discharged. At the last follow up examination two years after the operation, the patient was symptom free with normal pituitary function. CONCLUSION: Aspergillus pituitary abscess should be considered in the differential diagnosis of a pituitary mass. The correct diagnosis of pituitary aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific and culture results are obtained later. Immediately after the diagnosis, intensive antifungal therapy should be started for a successful treatment.

Abscess↗
PubMed2003

Lumbar epidural abscess causing septic shock: case report.

This case report describes a lumbar epidural abscess that caused septic shock. A 48-year-old woman who developed a high temperature was diagnosed as having a respiratory tract infection. She became unconscious the next day and was transferred to the intensive care unit for monitoring and treatment. She complained of increasing lower back pain as consciousness improved. Magnetic resonance images of the lumbar spine showed an abscess shadow between the vertebral body and dura mater at the level of L3-S1. Surgical drainage of the epidural abscess was performed as an emergency procedure, and the patient recovered immediately. The primary source of the epidural abscess was probably the respiratory tract infection, which spread to the epidural space through hematogenous dissemination. The initial treatment of the epidural abscess was rest and antibiotics, but surgical treatment was needed to save the patient because of septic shock.

Bronchitis↗
PubMed2003

Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases.

Sixty-six consecutive patients with brain abscesses referred to a department of neurosurgery during a 10-year period and treated with cefotaxime were studied retrospectively by means of a prospectively designed protocol whose main areas of emphasis were duration of antibiotic treatment, sterilization rate, clinical outcome in relation to prognostic factors, and side effects. Sixty-two of these patients were treated additionally with metronidazole, and surgery was performed in 53 patients. Mental status was altered in 33 patients, 11 of whom were comatose. Rupture of the abscess into the ventricles occurred in eight patients. Death was attributable to brain abscess formation in three patients (4.5%). Forty-six percent of the surviving patients recovered without any neurological deficits. Reversible adverse reactions, which occurred in 38 patients, were the most common reason for withdrawal of cefotaxime. In 76% of these cases, there was a significant improvement before the onset of the adverse reaction. The median duration of parenteral antibiotic treatment was 36, 41, 22, and 46 days in patients treated with excision, aspiration, evacuation of subdural empyema, and antibiotics alone, respectively. Taking prognostic factors into consideration, mortality attributable to brain abscess was lower than previously reported. This finding, along with the abscess sterilization results, indicates that cefotaxime in combination with metronidazole is a highly effective treatment but is associated with a high frequency of reversible side effects. The results indicate that a shorter duration of treatment should be investigated.

Adolescent↗
PubMed2005

Experience with aspiration in cases of amebic liver abscess in an endemic area.

The study presented here was performed to evaluate the need for aspiration in patients with amebic liver abscess (ALA). Patients older than 12 years with a diagnosis of ALA based on clinical features, ultrasound results, and positive amebic serology were included in the study (n=144). Serological testing was performed to detect the presence of immunoglobin G antibody against Entamoeba histolytica, and a value of more than 0.4 optical density units was considered positive. All patients were given intravenous metronidazole (500 mg every 8 h) and their clinical progress and need for abscess aspiration was documented. Fever, pain in the upper abdomen, and tender hepatomegaly was seen in 133 (92.3%), 128 (88.8%), and 144 (100%) patients, respectively. Multiple abscesses were seen in 40 (27.7%) patients. Six (4.1%) patients died. Seventy-one (49.3%) patients responded to metronidazole alone. A total of 73 (50.69%) patients required aspiration of the abscess. This study shows that almost 50% of the patients with amebic liver abscess failed to respond to metronidazole and required aspiration.

Adolescent↗