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PubMed2006

Percutaneous drainage of postoperative abdominal abscess with limited accessibility: preexisting surgical drains as alternative access route.

PURPOSE: To retrospectively assess the effectiveness and safety of postoperative percutaneous drainage of abdominal abscesses with limited accessibility by using a preexisting surgical drain as an access route. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was not required. The authors reviewed the medical records of 92 patients (62 male, 30 female; median age, 59 years; age range, 3-79 years) with postoperative abdominal abscesses in whom percutaneous drainage was performed by using surgical drains as an access. Factors evaluated included the location and size of the lesion; time between surgery and the drainage procedure; distance between the lesion and surgical drain; presence of fistula; duration of drainage; type of surgical drain; size, type, and length of drainage catheter; and complications. Technical success was defined as adequate placement of a new drainage catheter into the target abscess. Midterm success was defined as avoidance of surgery or additional percutaneous drainage during the 6 months of follow-up. Univariate analysis and multiple logistic regression analysis were performed to determine factors that affected the technical or midterm success of the procedure. RESULTS: Of 92 postoperative abscesses for which the technique was attempted, 56 (61%) had a subphrenic location and 36 (39%) had a peripancreatic location. Technical success was achieved in 87 of the 92 patients (95%). Technical success was not significantly associated with any of the factors tested. Midterm success was achieved in 75 of the 87 patients (86%) in whom technical success was achieved. Midterm failure showed a statistically significant relationship with the presence of fistula (P = .04). No procedure-related complications were identified. CONCLUSION: Percutaneous drainage by using the surgical drain as an access route is an effective and safe alternative for draining postoperative abdominal abscesses that are less accessible with direct puncture..

Abdominal Abscess↗
PubMed1985

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Abscess↗
PubMed1987

Pancreatic abscess: predictive value of early abdominal CT.

The value of a recently reported grading system of early abdominal computed tomography (CT) for predicting development of pancreatic abscess in patients with acute pancreatitis was reassessed. When the previously described CT grading system was used in another patient population, it did not demonstrate the same degree of prognostic value of baseline CT. In this series pancreatic abscess occurred in only eight of 29 patients (28%) with grade E CT scans (with grade E representing the most severe involvement), compared with 60% in the previous series. Of 44 patients with either grade D or E baseline CT scans, abscesses developed in only 30%, with a minimum clinical follow-up of 3 months. A second grading system, which used a semiquantitative analysis of the degree of peripancreatic inflammation (a "CT severity score"), also did not strongly correlate with the future risk of abscess, The authors conclude that early abdominal CT should be performed selectively in patients with acute pancreatitis and reserved for patients who are either diagnostic dilemmas or who fail to respond to supportive treatment and have clinically suspected surgical complications such as pancreatic abscess.

Abscess↗
PubMed1987

Amebic liver abscess: diagnosis and treatment evaluation with MR imaging.

Magnetic resonance images were obtained before and after treatment in 17 patients with 29 amebic liver abscesses. Pretreatment T1-weighted images showed a sharply circumscribed, heterogeneous, low-signal-intensity mass, devoid of normal hepatic tissue and corresponding to the abscess cavity as measured sonographically. T2-weighted images showed the abscess cavity as a hyperintense region and also showed a larger region of hyperintensity extending from the cavity margins to the liver surface, corresponding to edematous but morphologically normal liver tissue. After treatment, the abscess cavity became homogeneously hypointense on T1-weighted images, corresponding to liquefaction of the abscess center. With successful treatment, concentric rings corresponding to (a) an inner margin of inflamed granulation tissue, (b) bands of type I collagen, and (c) the outer margin of atrophic and/or mildly inflamed liver tissue became prominent on T1- and T2-weighted images. T2-weighted images showed rapid resolution of the perifocal hepatic edema.

Adolescent↗
PubMed1989

Perforated amebic liver abscesses: successful percutaneous treatment.

Perforation of hepatic amebic abscess is associated with high morbidity and may result in death. Traditional treatment has been emergency surgery. The authors report successful percutaneous drainage of perforated hepatic amebic abscesses in five severely ill patients. These perforations resulted in abscesses in the subhepatic space, pelvis, chest, right and left paracolic gutters, lesser sac, retroperitoneum, and flank. A total of ten intrahepatic abscesses also were drained in these patients. Catheter drainage lasted from 7 to 34 days and was combined with metronidazole therapy; the latter had been used for 1 week in two patients and in one patient for 2 days without success before drainage. Associated fistulas were demonstrated to the bile ducts, duodenum, and colon; all healed spontaneously. This experience suggests an expanded use of catheter drainage for perforation, a serious complication of amebic abscess.

Adult↗
PubMed1989

Postoperative abscesses with enteric communication: percutaneous treatment.

Patients with abscesses that have enteric communication in the absence of underlying inflammatory bowel disease require modification of the usual percutaneous treatment techniques. An ongoing source of output (gastrointestinal secretions) is a complicating factor in treatment. The results of percutaneous treatment of 17 abscesses with enteric communication in 16 patients without a history of inflammatory bowel disease were reviewed. The long-term cure rate was 71%. Pancreatic involvement in abscess-bowel communication diminished the cure rate to 50% (two of four) and lengthened the duration of drainage required. The results suggest that percutaneous treatment of abscesses with enteric communication is a viable alternative to surgical intervention. Minimal morbidity and no mortality were directly attributable to percutaneous therapy in this series. When the pancreas is involved in the establishment or persistence of the abscess-bowel communication, or when the underlying bowel is diseased, the rate of success decreases.

Abscess↗
PubMed1991

Pelvic abscesses: CT-guided transrectal drainage.

Percutaneous drainage of pelvic abscesses has been performed by using a number of approaches, including transabdominal, transgluteal, and transrectal. The authors present a technique for the drainage of pelvic abscesses by a transrectal route with use of computed tomographic (CT) guidance. Equipment for the technique included a plastic introducer tube, standard needle, angiographic guide wire, and pigtail catheters. The pelvic abscesses of 10 patients (six after appendectomy, three after colon resection, one secondary to diverticulitis) were successfully drained by using the new technique. No complications or recurrences were experienced. After initial catheter placement, patients were treated with use of gravity drainage and appropriate antibiotics. Success of drainage was determined with sequential CT scans. Compared with the transgluteal approach, the transrectal approach offered increased patient comfort and minimal risk of potential complications such as injury to the sciatic nerve or tracking of the abscess. Use of the plastic introducer tube promoted operator safety by protecting the guiding finger. On the basis of this initial series, CT-guided transrectal drainage appears to be an effective and well-tolerated method for the drainage of pelvic abscesses.

Abscess↗
PubMed1998

Spondylodiskitic abscesses: CT-guided percutaneous catheter drainage.

PURPOSE: To determine whether computed tomographically (CT) guided percutaneous catheter drainage of spondylodiskitic abscesses is an appropriate and effective alternative to surgery. MATERIALS AND METHODS: CT-guided percutaneous catheter drainage was performed in 21 patients (16 men, five women; age range, 24-81 years) with 33 spondylodiskitic abscesses. Nine intradiskal, 12 paravertebral, and 12 psoas abscesses were drained with 5.6-14.0-F catheters. In 29 cases, the catheter was inserted by using the Seldinger technique in four cases, a trocar technique was used. All patients underwent follow-up CT or magnetic resonance imaging examinations for 6 months. RESULTS: Successful placement of the drainage catheter was achieved in each patient without procedural complications. The duration of drainage was 4-56 days (average duration, 26.8 days). Three of 33 catheters were changed because of insufficient drainage; one of the 33 catheters had to be reinserted because of dislocation. Two patients underwent surgery for stabilization of the spine with the drainage catheter in place. In 16 of the 21 patients, specific organisms were isolated; thus, definitive medical therapy was possible. Complete evacuation of all abscesses was achieved initially, with no evidence of recurrence during the follow-up. CONCLUSION: CT-guided percutaneous catheter drainage is an efficient and safe procedure in the management of spondylodiskitic abscesses.

Abscess↗
PubMed2003

Abscess in adenomyosis mimicking a malignancy in a 54-year-old woman.

BACKGROUND: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. CASE: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. CONCLUSION: The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.

Abscess↗
PubMed2005

[Brain abscess in children].

INTRODUCTION: Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003. METHODS: We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome. RESULTS: Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae. CONCLUSIONS: Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed.

Adolescent↗
PubMed2000

Splenic abscess. An old disease with new interest.

BACKGROUND/AIMS: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. METHOD: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. RESULTS: The mean age of patients was 43 years (range 7-79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. CONCLUSION: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.

Abdominal Abscess↗
PubMedDate not supplied

Effect of ravuconazole, a new triazole antifungal, in a rat intraabdominal abscess model.

BACKGROUND: Ravuconazole (BMS-207147) is a long-lasting triazole antifungal agent active against a broad spectrum of fungal pathogens including non-albicans Candida, Aspergillus, Cryptococcus and key dermatophytic fungi. METHODS: The efficacy of ravuconazole was evaluated using an experimental intraabdominal abscess model in rats caused by Candida albicans (E81022). Two hundred milligrams of cyclophosphamide per kilogram was injected intraperitoneally into 40 rats. Four days (96 h) after the injection of cyclophosphamide, a mixture of C. albicans and autoclaved rat cecal contents [C. albicans 1.7 x 10(8) colony-forming units/rat] was inoculated into the peritoneal cavity. The rats were divided into four groups: ravuconazole treated, fluconazole treated, itraconazole treated and untreated. Each antifungal was given orally at a dose of 10 mg/kg twice a day for 5 days. On the day after the last administration, the rats were dissected and the viable fungi in the abscesses were determined. The number of C. albicans in each abscess was determined by a quantitative culture technique. RESULTS: Ravuconazole inhibited abscess formation and significantly decreased the viable cell counts in abscesses in comparison with the untreated group. It's efficacy was at least equivalent to fluconazole and itraconazole against this pathogen. The rank order of potency (inhibition) was ravuconazole > itraconazole > fluconazole. CONCLUSION: Taking into consideration the antifungal spectrum of ravuconazole, which includes non-albicans Candida as well as C. albicans and Aspergillus, it is suggested that ravuconazole would be a good agent for the treatment of fungal peritonitis.

Abdominal Abscess↗
PubMed2001

Pyogenic liver abscess: an audit of 10 years' experience and analysis of risk factors.

BACKGROUND/AIMS: Despite continuous improvement in image modalities, availability of potent antibiotics and advancement in the knowledge and treatment of pyogenic liver abscess, mortality remains high. The high mortality rate has underlined the important role of prognostic factors and prompts a number of studies to identify the risk factors. The present study aims to audit our experience in managing patients with pyogenic hepatic abscess during the period of 1989-1999, and to document changes in etiology, bacteriology and outcome, and to identify any risk factor associated with mortality. METHODS: One hundred and thirty-three patients with pyogenic hepatic abscess were studied to determine the demographic characteristics, clinical features, laboratory, bacteriological findings, methods of treatment, final outcome and risk factor analysis. All patients were treated with parenteral antibiotics. One hundred and twelve patients were subjected to ultrasound-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in all patients. Laparotomy was done in 21 patients. RESULTS: The overall hospital mortality rate was 6% (8/133). Biliary tract disease was the most frequently identified cause. Leukocytosis, hypoalbuminemia and hyperbilirubinemia were common laboratory findings. The most common microorganism cultured was Klebsiella pneumoniae. The most common concomitant disease was diabetes mellitus. On univariate analysis, large abscess, diabetes mellitus and sepsis were significantly associated with hospital mortality. On multivariate logistic regression analysis, the presence of sepsis (p = 0.0031) was found to be an independent risk factor. CONCLUSIONS: In addition to early diagnosis and prompt treatment, making every effort to treat patients with adverse prognostic factors and systemic complications, the hospital mortality rate will be decreased significantly.

Adult↗
PubMed2001

Brucellar spinal epidural abscess of cervical location: report of four cases.

Spinal epidural abscesses account for 1 or 2 of every 10,000 hospital admissions, Staphylococcus aureus being the bacterium most frequently involved. Brucellosis is a disorder of worldwide distribution, relatively frequent in South America and in Mediterranean countries in Europe and Africa. Whilst in the USA only 200 cases are reported every year, in Spain it is the most frequent zoonosis. This systemic disease seldom produces spondylodiscitis which in a minority of cases may be complicated by spinal epidural abscesses, in general of lumbar location. The purpose of this article is to analyse 4 cases of brucellar spinal epidural abscess of cervical location and diagnosed in the Province of Teruel, Spain, an endemic area for the disease, through 10 consecutive years (1990-1999). We consider noteworthy the following facts: the first case was a technical employee who acquired the infection in our laboratory of microbiology, the second presented with an extensive purulent collection invading prevertebral and retropharyngeal regions, the third case was cured only with antibiotics without residual deficits. In the fourth case we were not able to demonstrate spondylodiscitis accompanying the epidural abscess at the C2-C6 levels. We discuss especially the epidemiological aspects of brucellosis, the existence of epidural abscess without spondylodiscitis, the clinical manifestations, the diagnosis by means of magnetic resonance imaging, specific serological tests for Brucella, antibiotic treatment and the prognosis of our cases.

Adult↗
PubMed2003

Primary excision of pediatric posterior fossa abscesses--towards zero mortality? A series of nine cases and review.

Nine children with infratentorial brain abscesses were treated at our institution over a 3-year period. Seven of them were boys and two were girls. In five cases, the abscesses were otogenic, and in two cases, the cause was tubercular (including one case of tubercular otitis). There were three cases of abscess formation in dermoids. All cases were managed with primary excision of the abscess. The average hospital stay was 12 days, and there was no mortality. The most common complication was hydrocephalus, noticed in three patients, of whom one eventually required shunt placement. Our policy of primary excision of these abscesses has yielded gratifying results. This approach also resulted in minimal morbidity and a substantially shortened hospital stay. Moreover, primary excision yields definitive histopathology of the lesion, especially in cases of tubercular and dermoid etiologies.

Adolescent↗
PubMed1982

Spinal epidural abscesses. Surgical and parasurgical management.

42 cases of spinal epidural abscesses were operated on in the years 1957-1980, among approximately 8,000 spinal operations. Staphylococcus aureus was the microorganism most commonly isolated from infected material and the primary source of infection was in most cases cutaneous and/or subcutaneous lesions. Typical clinical history included back pain and fever, with progressive nerve root and spinal cord involvement. The cases were divided into three groups according to the operative findings: (a) acute abscesses; (b) chronic abscesses, and (c) mixed or subacute abscesses. These three groups differed as to duration of illness, incidence of meningeal signs, white blood cell concentration and lumbar puncture results. Plain X-rays were positive in 20% of cases. Myelography, whose indications were maximally restricted, gave in some instances inaccurate results. Treatment consisted of extensive laminectomy of all the affected spinal segments, and drainage of infected material. Local and systemic appropriate antibiotic therapy was also given. An average of 16 daily sessions of barotherapy, consisting of 1.7-2.0 atm given in 40-60 min, were administered in the last 9 cases. When compared with the patients to which barotherapy was not given, these cases showed a lower rate of permanent disability (11 vs. 21%), even if they were managed under less favorable clinical and neurological conditions. These results seem to support a favorable role of hyperbaric treatment in the management of spinal epidural abscesses. Early diagnosis and appropriate management remain essential in order to have satisfactory treatment results.

Abscess↗
PubMed1995

Inhibition of macrophage procoagulant activity with lipids reduces intra-abdominal abscess formation in mice.

Macrophage procoagulant activity (PCA) has been proposed as a critical element in the formation of intra-abdominal abscesses. We tested the ability of local and systemic lipids (a known PCA inhibitor in vitro) to alter both peritoneal macrophage PCA and mixed Escherichia coli/Bacteroides fragilis intra-abdominal abscess formation in vivo. Lipids given intraperitoneally inhibited measured inducible peritoneal macrophage PCA for 8 h, and, in other animals, significantly decreased the number of abscesses formed and prevented abscesses in 29% of animals. Parallel experiments using subcutaneous intralipids did not show these effects. These results support the hypothesis that macrophage PCA produced locally is critical for intraperitoneal abscess formation.

Abdomen↗
PubMed1997

Empyema thoracis and lung abscess caused by viridans streptococci.

We retrospectively studied the bacteriology and clinical features of empyema thoracis and lung abscess caused by viridans streptococci in 72 patients seen from January 1984 to September 1996. A total of 76 strains of viridans streptococci were isolated, of which the most common isolates were Streptococcus constellatus (21 strains), S. intermedius (17), and S. sanguis (10). Species belonging to the S. milleri group accounted for the majority (68%) of isolates. In 38 (53%) patients these organisms were recognized as the sole pathogens. Of the 72 patients, 53 had empyema, 14 had lung abscesses, and five had both empyema and lung abscess. Forty-six (64%) patients had underlying diseases. Of these, malignancies were the most common (17 patients), followed by diabetes mellitus (12 patients) and central nervous system diseases (10 patients). Of the 48 patients who underwent chest-tube drainage, 27 (56%) received further treatments, including intrapleural streptokinase (18 cases), surgery (9), and both intrapleural streptokinase and surgery (3). Two (14%) of the patients with lung abscess alone underwent surgical treatment. Although all viridans streptococcal isolates were susceptible to penicillin, the patients in the study had a high mortality (21%). Univariate and multivariate analysis of data for patients with empyema alone (n = 53) showed a significantly increased risk of death in those with underlying malignancy (OR = 16.0, p = 0.023) and those with non-S. milleri-group isolates (OR = 3.72, p = 0.030). These data imply a strong clinical significance of viridans streptococci in the pathogenesis of empyema and lung abscess, as well as the need for species identification of viridans streptococci in patients with pleuropulmonary diseases.

Adult↗