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PubMed2006

A peritonitis model with low mortality and persisting intra-abdominal abscesses.

Intra-abdominal abscesses are a potential source of recurrent or residual infection after surgical intervention for secondary peritonitis. The development of therapies requires a model which combines low mortality with the formation of persisting abscesses and which is also suitable to study the local inflammatory response. Male Wistar rats were injected intraperitoneally with a mixture of sterile rat faeces, increasing doses of E. coli (10(4)-10(8) cfu/ml) and a fixed dose of B. Fragilis (10(4) cfu/ml). After one h a laparotomy was performed and the peritoneal cavity was debrided. Blood samples were taken under anaesthesia after 6 and 24 h. Abdominal fluid samples were collected (by laparotomy) after 24 and 72 h. The rats were killed after 5 days and the abdomen was inspected for abscesses. Mortality was 90% in the two groups with the highest doses of E. coli and 30% in those with the two lowest doses. In the latter groups all surviving rats but one showed intraabdominal abscesses and bacteremia was encountered frequently, especially after 24 h in the 10(5) cfu E. coli group. The groups receiving 10(4)-10(6) cfu E. coli showed similar plasma IL-6 concentrations after 6 h which were lowered significantly after 24 h. No circulating TNF-alpha was found. Considerable concentrations of TNF-alpha, IL-6, IL-1beta, and IL-10, were found in the peritoneal fluid after 24 h but no differences were observed between the contro groups and those receiving 10(4)-10(6) cfu E. coli. At 72 h cytokine levels were reduced significantly and remained the highest in the animals dosed with 10(6) cfu E. coli. The present model is suitable to study the mechanisms involved in, and prevention of, intra-abdominal abscess formation after surgical treatment of generalized peritonitis.

Abdominal Abscess↗
PubMed2005

The clinical significance of gas-containing liver abscesses converting from total gas content to gas and fluid content: a case report.

The first case of gas-containing liver abscesses converting from total gas content to gas and fluid content is reported, and the clinical significance of such a conversion is emphasised. A 58-year-old diabetic woman suffered from fever and chill due to totally gas-containing liver abscesses shown by computerised tomography (CT). The patient did not recover despite ultrasound-guided aspiration of the abscess. CT carried out 2 weeks later revealed that the initial totally gas-containing liver abscesses converted to ones with gas and fluid content. The patient recovered after CT-guided drainage of the abscesses.

Drainage↗
PubMed1998

Nocardia choroidal abscess in a patient with systemic lupus erythematosus.

PURPOSE: Nocardia asteroides, a respiratory saprophyte in humans, may cause localized infection of the lungs in debilitated or immunosuppressed individuals. Haematogenous spread to the eye via the choroidal circulation may result in choroidal abscess formation. METHOD: We report the development of a choroidal abscess in the left eye of a woman treated with steroids and cyclophosphamide for systemic lupus erythematosus. Haematogenous spread of N. asteroides from a localized infection of the lung (empyema) is thought to have been the cause of the choroidal abscess. RESULTS: Surgical drainage of the empyema combined with intravenously administered antibiotics resulted in resolution of the choroidal abscess and improvement of vision. CONCLUSIONS: A choroidal abscess, caused by haematogenous spread of N. asteroides, may respond to appropriate systemic antibiotic treatment alone and not require ocular treatment.

Abscess↗
PubMed1987

A simple method for the management of anorectal abscess.

All patients referred to the University Department of Surgery in Wellington with anorectal abscess were managed by simple de Pezzer drainage. The catheter used was between 3-5 mm in diameter and was inserted when possible under local anaesthetic. Ninety-seven patients have presented with anorectal abscess. After exclusion of those patients with intersphincteric abscess, 91 have been managed in this way with a male : female ratio of 2.8 : 1. a perianal abscess was present in 76 patients. General anaesthesia was necessary in 18 patients and 16 of these patients were admitted to hospital. Twelve patients were admitted for underlying medical problems. One patient had Crohn's disease. Over half of the patients had symptoms which had lasted for 4 days or less and 22 patients had antibiotics prescribed by their local practitioners. There was no past history of anorectal sepsis in 75 patients. Sixty-two of the catheters were removed in less than 15 days. Of the patients who were drained under local anaesthetic only eight said that the pain was so intolerable that they would opt for a general anaesthetic in the future. Thirty-five patients returned to their normal activities or work within 5 days and 68 were back at work 14 days after drainage. One abscess was inadequately drained. Twenty-two patients developed fistulae within the follow-up period. It is suggested that this simple technique is safe and reliable, is well tolerated by patients, results in minimal hospitalization and an early return to work.

Abscess↗
PubMed1996

Spinal epidural abscess: a report of nine cases and the use of intra-operative ultrasonography.

BACKGROUND: Spinal epidural abscess is an uncommon and dangerous lesion. Once neurological complications occur the damage is often irreversible. METHODS: The clinical presentation, operative findings, management and follow up of nine cases of spinal epidural abscess were reported. Four patients were diabetic and four others were intravenous drug addicts. The last patient had a history of a protracted stay in an intensive care unit complicated by pneumonia and pleural effusion. Ultrasonography was used intraoperatively to guide and to assess the adequacy of drainage and decompression of the epidural abscess. RESULTS: Multiple level laminectomy was necessary and Staphylococcus aureus was the most common organism cultured. None of the five patients presenting with acute complete paralysis regained neurological function. Two of the four patients with incomplete paralysis were able to walk with an aid. CONCLUSIONS: Spinal epidural abscess usually presents late and the prognosis is generally poor. Ultrasound may be useful in determining the extent of the abscess during operation to drain the collection.

Abscess↗
PubMedDate not supplied

Fourth branchial sinus causing recurrent cervical abscess.

BACKGROUND: Three patients who presented with recurrent cervical abscesses were found to have a branchial sinus arising in the piriform fossa. Each patient had previously had cervical abscess drainage procedures. METHODS: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out. RESULTS: In each case, imaging and endoscopy identified a sinus tract from the left piriform fossa. Neck exploration with hemithyroidectomy and excision of the sinus tract was performed without further recurrence of abscess. CONCLUSIONS: We believe these cases to represent a fourth branchial sinus. The relevant embryology and anatomy of the branchial apparatus is discussed and the pathways for the sinus and fistulous tracts of branchial sinus origin are reviewed. Branchial sinuses are uncommon, but should be considered as the underlying aetiology in patients who present with recurrent cervical abscesses.

Abscess↗
PubMed1997

A study of tubo-ovarian and ovarian abscesses, with a focus on cases with endometrioma.

OBJECTIVE: To determine the incidence and causes of endometrioma-associated tubo-ovarian abscesses (TOAs) and ovarian abscesses. METHODS: The medical records of 6,557 gynecologic inpatients were reviewed, and the data were analyzed using the median test and chi 2 test. RESULTS: The incidence of TOAs was 2.3% (5/218) in patients with endometrioma, and 0.2% (11/6,339) in patients without endometrioma (p = 0.0001). Among the TOA cases (n = 16), no significant differences in age, parity, history of pelvic surgery, or isolated organisms were observed between the subgroups with (n = 5) and without endometrioma (n = 11). There were only 2 cases of ovarian abscess, and both were associated with endometrioma. The causes of the abscesses in the 7 cases with endometrioma were contamination during surgery (1 case), contamination during a transvaginal endometrioma aspiration (1 case), and ascending infection (1 case), and unknown in 4 cases. CONCLUSIONS: The presence of endometrioma is a risk factor for the development of a TOA or an ovarian abscess.

Abdominal Abscess↗
PubMed1999

Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report.

A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.

Abscess↗
PubMed2005

Factors related to breast abscess after delivery: a population-based study.

OBJECTIVE: To investigate whether there are underlying factors, other than breastfeeding behaviours, which may contribute to the development of breast abscess during the year following delivery. DESIGN: A population-based study. SETTING: In Sweden. POPULATION: The 1,454,068 singleton deliveries during 1987-2000. Methods Data retrieval from two national patient registers: the Medical Birth Registry and the National Discharge Register. Stratified Mantel-Haenszel analysis. MAIN OUTCOME MEASURES: Odds ratios with 95% confidence intervals for possible risk factors for breast abscess in the year following delivery. RESULTS: During the year following delivery 1401 women had surgery because of a breast abscess. This gives a rate of 0.1%. Sixty-five percent of cases occurred between three and eight weeks postpartum. An annual increase in the odds ratio (OR) was found between 1993 and 1999. Lowest risk was found among mothers who were < or =24 years and a significantly increased risk among mothers > or =30 years. There was a 3.6-fold increased risk for breast abscess associated with primiparity and OR for post-maturity (>41 weeks) was 5. CONCLUSION: Primiparous women appear to be at a greater risk for the development of breast abscess during lactation than multiparous women. Mothers over the age of 30 years and those who give birth post-maturely are also at a significantly increased risk. Primiparous women and women over 30 years could be targeted for extra information in preparation for parenthood classes about how to avoid over distension of the breasts during breastfeeding. Further research is needed to understand the role of post-maturity and to investigate why some women recover spontaneously from inflammatory processes of the breast.

Abscess↗
PubMed2001

Amoebic liver abscess in pregnancy.

We describe the case of an amoebic liver abscess (ALA) presenting in the third trimester of pregnancy which raised both diagnostic and treatment dilemmas as well as being associated with preterm labour. Amoebic liver abscess is caused by the protozoan organism Entamoeba histolytica which is endemic in many parts of the developing world. Invasion of the colonic mucosa results in the clinical syndrome of amoebic dysentery and in some cases dissemination to the liver or other organs occurs resulting in abscess formation. Amoebic liver abscess is a rare complication of pregnancy and there are few reports in the world literature, these being mostly from endemic areas. We present here the case of a caucasian female who presented with an amoebic liver abscess in the third trimester of pregnancy, thirteen months after returning to Australia from a short holiday in Bali.

Adult↗
PubMedDate not supplied

Intracapsular prostatic omentalization: a new technique for management of prostatic abscesses in dogs.

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependent Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.

Abscess↗
PubMed1998

Cholangiocarcinoma presenting as pyogenic liver abscess: is its outcome influenced by concomitant hepatolithiasis?

OBJECTIVE: The etiology of pyogenic liver abscess is changing. Malignant biliary obstruction has emerged as one of the most important causes. We explored the clinical course of pyogenic liver abscess caused by cholangiocarcinoma. METHODS: The medical records of 19 patients with cholangiocarcinoma presenting as pyogenic liver abscess were reviewed. Of them, 57.8% (11 of 19) had concomitant hepatolithiasis. Escherichia coli and Klebsiella pneumoniae were the most common pathogens isolated from aspirates of the abscesses. Eight patients received percutaneous drainage, whereas 11 patients initially underwent surgical drainage because of the presence of ascites or coagulopathy or lack of awareness of the underlying cholangiocarcinoma. RESULTS: Overall, the hospital mortality rate was 36.8% (seven of 19). Patients with hepatolithiasis had a hospital mortality rate of 54.5% (six of 11), compared with 12.5% (one of eight) in those without (p < 0.01). Notably, 84.2% (16 of 19) of the patients died within 6 months after the diagnosis was made. CONCLUSIONS: Cholangiocarcinoma presenting as liver abscess has a dismal prognosis. Concomitant hepatolithiasis worsened the infectious process and adversely affected the survival.

Adult↗
PubMed1990

Multiple periodontal abscesses after systemic antibiotic therapy.

Multiple periodontal abscesses were reported in medically compromised patients. We examined patients with a non-contributory medical history referred for the treatment of numerous periodontal abscesses. All patients had taken oral broad spectrum antibiotics 1 to 3 weeks prior to the outburst of the abscesses (8 patients: penicillin, 2 patients: tetracycline). The patients suffered from advanced periodontal disease, 82% of the examined sites showed probing depths greater than 3 mm, 56% attachment loss greater than 3 mm. Subgingival plaque samples were analysed from 2 different abscess sites. Bacteroides gingivalis (19/20), Fusobacterium nucleatum (13/20) and Streptococcus intermedius (13/20) were the most prevalent anaerobic microbiota. Strains resistant to the prescribed antibiotic were found in 55% (11/20) of the subgingival plaque samples. It was concluded that in patients with advanced periodontal disease, systemic antibiotic therapy without subgingival debridement may change the composition of the subgingival microbiota, thus favouring the outburst of multiple periodontal abscesses.

Adult↗
PubMed2003

Splenic abscess caused by group A beta-haemolytic streptococcus.

UNLABELLED: A case of a pyoderma complicated with splenic abscess and bacteraemia caused by group A streptococcus was treated successfully with antibiotics alone for 4 weeks. To our knowledge, this is the first reported case of splenic abscess associated with group A streptococcal bacteraemia. Advances in antibiotic therapy and imaging techniques have improved the management and outcomes of splenic abscesses. Clinicians should be aware of the possibility of splenic abscess after a pyoderma or a sepsis-like episode. CONCLUSION: Splenic abscesses can be diagnosed by serial ultrasound or CT scan examinations and should be treated with antibiotics for 4-6 weeks.

Abscess↗
PubMedDate not supplied

Hepatic abscesses in 13 dogs: a review of the ultrasonographic findings, clinical data and therapeutic options.

Historical, physical examination, clinicopathologic, radiographic and ultrasonographic findings of 13 dogs with hepatic abscesses were reviewed. Liver abscessation was characterized by number, size, shape, echogenicity and location. Solitary lesions greater than 3 cm were more common than multiple ones. The abscesses were mainly poorly echogenic lesions, often with central cavitation. The shape of the lesion ranged from round to oval or irregular. Enhancement artifact, abdominal effusion, regional lymphadenopathy and hyperechoic perihepatic fat, were identified in several dogs. Ultrasound-guided aspiration was performed in 10 of 13 dogs, and confirmed abscessation with cytologic and microbiologic evaluation. Ultrasound-guided percutaneous drainage of abscesses was performed as an adjunct to medical management in four dogs.

Adipose Tissue↗
PubMedDate not supplied

Magnetic resonance imaging features of brain stem abscessation in two cats.

Premortem magnetic resonance imaging (MRI) was performed in two cats with brain stem abscessation confirmed post mortem by histology and recovery of multiple bacterial species. The MRI features of the abscesses were distinctive and included a thick and marked enhancement of the abscess capsule and extension of the lesion from a tympanic bulla in one cat. A focal area of increased signal intensity was present on T2-weighted images. A circumscribed area of decreased signal intensity was surrounded by a ring of increased signal intensity on precontrast T1-weighted images. A center of decreased signal intensity with a thick, markedly enhanced abscess capsule was observed on post contrast T1-weighted images. These findings are compared to the current experimental and clinical literature of brain abscess. The underlying pathogenesis of MRI features is reviewed.

Animals↗
PubMed1998

Surgical management of an abdominal abscess in a Malayan tapir.

A captive Malayan tapir was observed to have inappetence, weight loss, signs of depression, mild dehydration and diarrhoea. Haematological and serum biochemical tests showed anaemia, hypoproteinaemia, hyperfibrinogenaemia and neutrophilia with a left shift. Ultrasonic examination of the abdomen under anaesthesia revealed a well-encapsulated abscess. The abscess was marsupialised to the ventral body wall. Culture of the pus produced a mixed bacterial growth. Antimicrobial therapy was based on bacterial sensitivity results. Follow-up ultrasonic examinations showed resolution of the abscess. Ninety-one days after surgery the tapir began regurgitating food and water. An abscess originating from the stomach and occluding the lumen of the duodenum was identified at surgery. The abscess ruptured during surgical manipulations and the tapir was euthanased.

Abdominal Abscess↗
PubMed2003

Diagnosis and management of unusual dental abscesses in children.

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.

Abscess↗