1
|
Schlottmann J, Miller S, Scheurig-Münkler C, Merkl C, Weber T, Eser S, Fuchs A, Messmann H, Probst A. [Acute abdomen-Rare cause in an 80-year-old female patient under immunosuppressive treatment]. Inn Med (Heidelb) 2024; 65:503-507. [PMID: 37831085 PMCID: PMC11058932 DOI: 10.1007/s00108-023-01593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/14/2023]
Abstract
An 80-year-old woman presented to the emergency department due to abdominal pain. She had a history of opportunistic pneumonia under the effects of immunosuppression after the diagnosis of autoimmune hepatitis. The imaging showed an omental cake formation and the suspicion of peritoneal carcinomatosis. The patient developed an acute abdomen during the hospital stay, followed by exploratory laparotomy. In the presence of extensive intra-abdominal abscess formation both surgically acquired material and blood culture revealed disseminated nocardiosis. The course was fatal due to fulminant septic shock.
Collapse
Affiliation(s)
- J Schlottmann
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - S Miller
- Institut für Pathologie und molekulare Diagnostik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - C Scheurig-Münkler
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - C Merkl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T Weber
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - S Eser
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Fuchs
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - H Messmann
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Probst
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| |
Collapse
|
2
|
Ksontini FL, Zaimi Y, Nefzi I, Khrouf S, Ayari M, Sghaier S, Zidi A, Magherbi H, Ayadi M. Gastrosplenic fistula due to splenic lymphoma: two case reports and review of the literature. J Med Case Rep 2024; 18:136. [PMID: 38449048 PMCID: PMC10918876 DOI: 10.1186/s13256-024-04441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Gastrosplenic fistula is a rare and potentially fatal complication of various conditions. Lymphoma is the most common cause. It can occur spontaneously or after chemotherapy. Gastrosplenic fistula diagnosis can be confused with a splenic abscess because of the presence of air into the mass. The computed tomography identification of the fistulous tract is the key to a right diagnosis. Treatment modalities include surgical resection, chemotherapy, or a combination of both. CASE PRESENTATION Here we report two patients with gastrosplenic fistula due to diffuse large B cell lymphoma. The first patient was a 54-year-old Caucasian woman with an enormous primary splenic diffuse large B cell lymphoma leading to the development of a spontaneous fistula in the stomach. The second patient was a 48-year-old Caucasian male patient with an enormous splenic diffuse large B cell lymphoma complicated by fistula after chemotherapy. Both patients died of septic shock several days after surgery. CONCLUSION Gastrosplenic fistula is a rare complication with a poor-prognosis, for which surgery is currently the preferred treatment.
Collapse
Affiliation(s)
- Feryel Letaief Ksontini
- Department of Medical Oncology, Salah Azaiez Institute, Tunis El Manar University, Tunis, Tunisia
| | - Yosra Zaimi
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Isaad Nefzi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis El Manar University, Tunis, Tunisia
| | - Salim Khrouf
- Department of Medical Oncology, Salah Azaiez Institute, Tunis El Manar University, Tunis, Tunisia
| | - Myriam Ayari
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia.
| | - Sonia Sghaier
- Department of Surgery A, La Rabta Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Asma Zidi
- Department of Surgery A, La Rabta Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Houcine Magherbi
- Department of Radiology, Salah Azaiez Institute, Tunis El Manar University, Tunis, Tunisia
| | - Mouna Ayadi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis El Manar University, Tunis, Tunisia
| |
Collapse
|
3
|
Selvam S, Singh H, Seth S, Suri V, Bhalla A, Sachdeva MUS. Case Report: A Case of Complicated Typhoid Fever with Rhabdomyolysis and Hemophagocytic Lymphohistiocytosis. Am J Trop Med Hyg 2024; 110:501-503. [PMID: 38295416 PMCID: PMC10919176 DOI: 10.4269/ajtmh.23-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024] Open
Abstract
Typhoid fever can have diverse extra-intestinal complications including encephalitis, Guillain-Barré syndrome, endocarditis, myocarditis, osteomyelitis, renal abscess, and splenic abscesses. Secondary hemophagocytic lymphohistiocytosis with rhabdomyolysis is a rare complication of typhoid fever. Here, we present the case of an adolescent with typhoid fever complicated by rhabdomyolysis and hemophagocytic lymphohistiocytosis.
Collapse
Affiliation(s)
- Suresh Selvam
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonal Seth
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
4
|
Wang YX, Wu JQ, Li N. A case report on the use of 18F-FDG-PET/CT in the diagnosis of splenic abscess. Asian J Surg 2024; 47:1316-1317. [PMID: 38036344 DOI: 10.1016/j.asjsur.2023.11.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Ying-Xin Wang
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Jia-Qian Wu
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China
| | - Ning Li
- Department of Intensive Care Unit, Affiliated Hospital of Hebei University, Baoding, 071000, China.
| |
Collapse
|
5
|
Serrano Concha K, Morales Mayorga H, Acosta Farina D, Mendoza Saldarreaga L, Pólit Guerrero V, Oliveros Rivero J, Acosta Bowen D. Negative pressure device used in pediatric patients with Hostile abdomen. Case series. Cir Pediatr 2024; 37:37-41. [PMID: 38180101 DOI: 10.54847/cp.2024.01.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Hostile abdomen is a surgical condition characterized by loss of space between organs and structures in the abdomen. Negative pressure therapy use has been widely described in adults; the case is not the same for pediatric patients. The goal of this study is to present short-term results of negative pressure therapy use in pediatric patients with hostile abdomen due to different etiologies. MATERIAL AND METHODS Pediatric hostile abdomen patients (< 18 years) who were treated Negative pressure therapy using ABTHERA were identified and retrospectively reviewed. RESULTS 7 patients were included in this study. Median age was 16 (range: 9-17 yo). 5 (71.4%) were male and 2 (28.6%) females. 3 (43%) had significant past medical/surgical history (Systemic Lupus Erythematosus, complicated appendectomy and ventriculoperitoneal-shunt). The device was set at a continuous pressure ranging from -50 to -125 mmHg. Pre and post-surgical findings were reported using Bjork's classification. Devices were replaced every 4-7 days (median 5 days). Total amount of replacements was 1-4 (median 3). 5 (71.4%) patients required invasive mechanical ventilation during use of Negative pressure therapy based on clinical status. 4 (57%) patients received enteral nutrition. 1 (14%) patient required re-intervention posterior to definitive closure due to retroperitoneal abscess development. Outcome, evaluated by (oral tolerance, bowel movement and absence of pain), was favorable in all patients. CONCLUSION Negative pressure therapy devices generate favorable results in hostile abdomen in pediatric population but further information is needed to assess pressure settings and device replacement frequency.
Collapse
Affiliation(s)
- K Serrano Concha
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador)
| | - H Morales Mayorga
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador)
| | - D Acosta Farina
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador). Universidad Católica Santiago de Guayaquil (Ecuador)
| | - L Mendoza Saldarreaga
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador)
| | - V Pólit Guerrero
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador). Universidad Católica Santiago de Guayaquil (Ecuador)
| | - J Oliveros Rivero
- Department of Pediatric Surgery. Hospital de Niños Dr. Roberto Gilbert Elizalde. Guayaquil (Ecuador)
| | | |
Collapse
|
6
|
Ye L, Yang Q, Xue Y, Jia R, Yang L, Zhong L, Zou L, Xie Y. Impact of robotic and open surgery on patient wound complications in gastric cancer surgery: A meta-analysis. Int Wound J 2023; 20:4262-4271. [PMID: 37496310 PMCID: PMC10681412 DOI: 10.1111/iwj.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
This meta-analysis is intended to evaluate the effect of both robotic and open-cut operations on postoperative complications of stomach carcinoma. From the earliest date until June 2023, a full and systemic search has been carried out on four main databases with keywords extracted from 'Robot', 'Gastr' and 'Opene'. The ROBINS-I instrument has been applied to evaluate the risk of bias in nonrandomized controlled trials. In these 11 trials, a total of 16 095 patients had received surgical treatment for stomach cancer and all 11 trials were nonrandomized, controlled trials. Abdominal abscesses were reported in 5 trials, wound infections in 8 trials, haemorrhage in 7 trials, wound dehiscence in 2 trials and total postoperative complications in 4 trials. Meta-analyses revealed no statistically significantly different rates of postoperative abdominal abscesses among patients who had received robotic operations than in those who had received open surgical procedures (OR, 0.91; 95% CI, 0.25, 3.36; p = 0.89). The incidence of bleeding after surgery was not significantly different from that in both groups (OR, 1.37; 95% CI, 0.69, 2.75; p = 0.37). Similarly, there was no significant difference between the two groups (OR, 0.78; 95% CI, 0.52, 1.18; p = 0.24). No significant difference was found between the two groups (OR, 1. 28; 95% CI, 0.75, 2.21; p = 0.36). No significant difference was found between the two groups of patients who had received the robotic operation and those who had received the surgery after the operation (OR, 1.14; 95% CI, 0.78, 1.66; p = 0.49). Generally speaking, this meta-analysis suggests that the use of robotics does not result in a reduction in certain postsurgical complications, including wound infections and abdominal abscesses. Thus, the use of a microinvasive robot for stomach carcinoma operation might not be better than that performed on the surgical site after the operation. This is a valuable guide for the surgeon to select the operative method.
Collapse
Affiliation(s)
- Lu Ye
- Department of Medical Oncology of Cancer Center, West China HospitalSichuan UniversityChengduChina
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Qian Yang
- Clinical Medical CollegeChengdu Medical CollegeChengduChina
| | - Yuyu Xue
- School of Preclinical MedicineChengdu UniversityChengduChina
| | - Rong Jia
- Clinical Medical CollegeChengdu Medical CollegeChengduChina
| | - Li Yang
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Lili Zhong
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Liqun Zou
- Department of Medical Oncology of Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Yao Xie
- Department of Obstetrics and Gynaecology, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Chinese Academy of Sciences Sichuan Translational Medicine Research HospitalChengduChina
| |
Collapse
|
7
|
Michelson KA, Bachur RG, Rangel SJ, Monuteaux MC, Mahajan P, Finkelstein JA. Emergency Department Volume and Delayed Diagnosis of Pediatric Appendicitis: A Retrospective Cohort Study. Ann Surg 2023; 278:833-838. [PMID: 37389457 PMCID: PMC10756921 DOI: 10.1097/sla.0000000000005972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To determine the association of emergency department (ED) volume of children and delayed diagnosis of appendicitis. BACKGROUND Delayed diagnosis of appendicitis is common in children. The association between ED volume and delayed diagnosis is uncertain, but diagnosis-specific experience might improve diagnostic timeliness. METHODS Using Healthcare Cost and Utilization Project 8-state data from 2014 to 2019, we studied all children with appendicitis <18 years old in all EDs. The main outcome was probable delayed diagnosis: >75% likelihood that a delay occurred based on a previously validated measure. Hierarchical models tested associations between ED volumes and delay, adjusting for age, sex, and chronic conditions. We compared complication rates by delayed diagnosis occurrence. RESULTS Among 93,136 children with appendicitis, 3,293 (3.5%) had delayed diagnosis. Each 2-fold increase in ED volume was associated with a 6.9% (95% CI: 2.2, 11.3) decreased odds of delayed diagnosis. Each 2-fold increase in appendicitis volume was associated with a 24.1% (95% CI: 21.0, 27.0) decreased odds of delay. Those with delayed diagnosis were more likely to receive intensive care [odds ratio (OR): 1.81, 95% CI: 1.48, 2.21], have perforated appendicitis (OR: 2.81, 95% CI: 2.62, 3.02), undergo abdominal abscess drainage (OR: 2.49, 95% CI: 2.16, 2.88), have multiple abdominal surgeries (OR: 2.56, 95% CI: 2.13, 3.07), or develop sepsis (OR: 2.02, 95% CI: 1.61, 2.54). CONCLUSIONS Higher ED volumes were associated with a lower risk of delayed diagnosis of pediatric appendicitis. Delay was associated with complications.
Collapse
Affiliation(s)
| | - Richard G Bachur
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | | | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jonathan A Finkelstein
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| |
Collapse
|
8
|
Wu JM, Lin YJ, Wu CH, Kuo TC, Tien YW. ASO Visual Abstract: Novel Non-Duct-to-Mucosa Pancreaticojejunostomy Reconstruction After Pancreaticoduodenectomy-Focus on the Occurrence of Post-Pancreatectomy Hemorrhage and Intra- Abdominal Abscess. Ann Surg Oncol 2023; 30:8646. [PMID: 37743457 DOI: 10.1245/s10434-023-13282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin- Chu county 300, Taipei, Taiwan, ROC
| | - Young-Jen Lin
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
| | - Chien-Hui Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.
| |
Collapse
|
9
|
Osaki M, Takahashi Y, Tokuyama S, Kawai K, Matsui Y, Toshiyama R, Yamamoto M, Sakai K, Takeno A, Gotoh K, Miyazaki M, Takami K, Hirao M, Kato T. [A Case of Radical Resection after Neoadjuvant Chemotherapy for Rectal Cancer with Pelvic Abscess]. Gan To Kagaku Ryoho 2023; 50:1615-1617. [PMID: 38303359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 66-year-old man with a history of frequent diarrhea was diagnosed with rectal cancer with obstruction and a pelvic abscess. Following a transverse colostomy, he was referred to our hospital. The initial diagnosis was rectal cancer(cT4a N1bM0, cStage Ⅲb)and a pelvic abscess due to tumor perforation. To address this condition, we performed neoadjuvant chemotherapy using a combination of 5-fluorouracil, Leucovorin, oxaliplatin, and irinotecan(FOLFOXIRI). Following 6 courses of FOLFOXIRI, the abscess disappeared and no signs of tumor progression and distant metastases were detected. Subsequently, we performed radical resection with D3LD2 lymph node dissection, leading to a pathological diagnosis of ypT3N1aM0, ypStage Ⅲb. The patient then underwent adjuvant chemotherapy with capecitabine and oxaliplatin(CAPOX). No recurrence was observed after 9 months of follow-up.
Collapse
Affiliation(s)
- Mao Osaki
- Dept. of Surgery, National Hospital Organization Osaka National Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tambawala ZY, Saquib S, Shinko IA, Nagshabandi Z. Massive serous cyst adenoma with ovarian abscess causing fatal septicaemia. BMJ Case Rep 2023; 16:e255467. [PMID: 37989331 PMCID: PMC10660798 DOI: 10.1136/bcr-2023-255467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Isolated unilateral ovarian tumour without obvious concomitant tubal pathology is unlikely to cause intrabdominal abscess or septicaemia. Benign serous cystadenoma is a fairly common ovarian tumour but rarely causes fatality. We present a patient in mid-30s with massive ovarian serous cystadenoma presenting with abscess and septicaemia, leading to mortality. To our knowledge, no previous serous cystadenoma causing abscess formation has been reported before.
Collapse
Affiliation(s)
- Zenab Yusuf Tambawala
- Department of Obstetrics and Gynecology, Dubai Hospital, Dubai, UAE
- Department of Obstetrics and Gynecology, Dubai Health, Dubai, UAE
| | - Shabnam Saquib
- Department of Obstetrics and Gynecology, Dubai Hospital, Dubai, UAE
- Department of Obstetrics and Gynecology, Dubai Health, Dubai, UAE
| | - Ikram Abdelaziz Shinko
- Department of Obstetrics and Gynecology, Dubai Hospital, Dubai, UAE
- Department of Obstetrics and Gynecology, Dubai Health, Dubai, UAE
| | | |
Collapse
|
11
|
Quintero-Riaza VM, Chancí-Drago R, Guzmán-Arango N, Posada-Moreno P, López-Sandoval T, Ramírez-Sánchez IC, Vanegas-Munera JM. Aerobic Intraoperative Abdominal Cavity Culture Modifies Antibiotic Therapy and Reduces the Risk of Surgical Site Infection in Complicated Appendicitis with Peritonitis. J Gastrointest Surg 2023; 27:2563-2566. [PMID: 37340103 PMCID: PMC10661740 DOI: 10.1007/s11605-023-05736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Affiliation(s)
| | - Romario Chancí-Drago
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Pablo Posada-Moreno
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | | |
Collapse
|
12
|
Deville PE, Marr AB, Cone JT, Hoefer LE, Mitchao DP, Inaba K, Kostka R, Mooney JL, McNickle AG, Smith AA. Multicenter Study of Perioperative Hepatic Angioembolization as an Adjunct for Management of Major Operative Hepatic Trauma. J Am Coll Surg 2023; 237:697-703. [PMID: 37366536 DOI: 10.1097/xcs.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND The management of major liver trauma continues to evolve in trauma centers across the US with increasing use of minimally invasive techniques. Data on the outcomes of these procedures remain minimal. The objective of this study was to evaluate patient complications after perioperative hepatic angioembolization as an adjunct to management of major operative liver trauma. STUDY DESIGN A retrospective multi-institutional study was performed at 13 level 1 and level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into 2 groups: angioembolization (AE) and no angioembolization (NO AE). Univariate and multivariate analyses were performed. RESULTS A total of 442 patients were included with AE performed in 20.4% (n = 90 of 442) of patients. The AE group was associated with higher rates of biloma formation (p = 0.0007), intra-abdominal abscess (p = 0.04), pneumonia (p = 0.006), deep vein thrombosis (p = 0.0004), acute renal failure (p = 0.004), and acute respiratory distress syndrome (p = 0.0003), and it had longer ICU and hospital length of stay (p < 0.0001). On multivariate analysis, the AE had a significantly higher amount intra-abdominal abscess formation (odds ratio 1.9, 95% CI 1.01 to 3.6, p = 0.05). CONCLUSIONS This is one of the first multicenter studies comparing AE in specifically operative high-grade liver injuries and found that patients with liver injury that undergo AE in addition to surgery have higher rates of both intra- and extra-abdominal complications. This provides important information that can guide clinical management.
Collapse
Affiliation(s)
- Paige E Deville
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
| | - Alan B Marr
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
| | - Jennifer T Cone
- University of Chicago School of Medicine, Chicago IL (Cone, Hoefer)
| | - Lea E Hoefer
- University of Chicago School of Medicine, Chicago IL (Cone, Hoefer)
| | - Delbrynth P Mitchao
- University of Southern California to LA General Medical Center, Keck School of Medicine of USC, Los Angeles, CA (Mitchao, Inaba)
| | - Kenji Inaba
- University of Southern California to LA General Medical Center, Keck School of Medicine of USC, Los Angeles, CA (Mitchao, Inaba)
| | - Ryan Kostka
- Baylor Scott and White Health, Dallas, TX (Koska, Mooney)
| | | | - Allison G McNickle
- University of Nevada, Las Vegas School of Medicine, Las Vegas, NV (McNickle)
| | - Alison A Smith
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
| |
Collapse
|
13
|
Türen Demir E, Energin H, Kilic F. Image-guided drainage management of tubo-ovarian abscess and the role of C-reactive protein measurements in monitoring treatment response: a single-center experience. Arch Gynecol Obstet 2023; 308:1321-1326. [PMID: 37389642 DOI: 10.1007/s00404-023-07117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We aimed to compare the results of image-guided drainage in addition to antibiotic therapy (antibiotherapy) with antibiotherapy alone in the treatment of tubo-ovarian abscesses (TOAs) and evaluate C-reactive protein (CRP) levels in predicting the success of antibiotherapy. METHODS This was a retrospective study of 194 patients hospitalized with TOA. Patients were divided into the following two groups: those who underwent image-guided drainage in addition to parenteral antibiotherapy and those who did not undergo image-guided drainage and received antibiotherapy alone. CRP levels on the day of admission (day 0), day 4 of hospitalization (day 4), and day of discharge (last day) were recorded. The percentage of decrease in CRP levels during day 4 and the last day compared with that on day 0 was calculated. RESULTS A total of 106 patients (54.6%) underwent image-guided drainage with antibiotherapy, whereas 88 patients (45.4%) did not undergo drainage and received antibiotherapy alone. At admission, the mean CRP level was 203.4 (± 96.7) mg/L and was similar in both groups. The mean decrease in the CRP level on day 4 compared with that on day 0 was 48.5% and was statistically higher in the group that underwent image-guided drainage. Antibiotherapy failed in 18 patients, and a statistically significant difference was observed between treatment failure and the rate of decrease in the CRP level on day 4 compared with that on day 0. According to the receiver operating characteristic (ROC) analysis, if the CRP level measured on day 4 decreased by < 37.1% compared with that on day 0, the probability of treatment failure would increase (area under the curve = 0.755; 95% confidence interval, 0.668-0.841; sensitivity, 73.6%; specificity, 60%). CONCLUSIONS Image-guided drainage combined with antibiotherapy in the treatment of TOA has high success rates, lower recurrence rates, and lower surgical requirement, and the mean decrease in the CRP level on day 4 can be monitored at treatment follow-up. In patients receiving antibiotherapy alone, if the CRP level on day 4 decreases by < 37.1%, the treatment protocol should be changed.
Collapse
Affiliation(s)
- Emine Türen Demir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye.
| | - Hasan Energin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye
| | - Fatma Kilic
- Department of Obstetrics and Gynecology, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye
| |
Collapse
|
14
|
Zhang M, Zhang Z. Progressive retroperitoneal abscess by colonic retroperitoneal perforation. Asian J Surg 2023; 46:3789-3790. [PMID: 37012160 DOI: 10.1016/j.asjsur.2023.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Menglai Zhang
- Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
| | - Zhenbin Zhang
- Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, China.
| |
Collapse
|
15
|
Eakes AM, Burkbauer L, Purcell LN, Akinkuotu AC, McLean SE, Charles AG, Phillips MR. Difference in Postoperative Outcomes and Perioperative Resource Utilization Between General Surgeons and Pediatric Surgeons: A Systematic Review. Am Surg 2023; 89:3739-3744. [PMID: 37150834 DOI: 10.1177/00031348231173943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Background: Both general surgeons (GS) and pediatric surgeons (PS) perform a high volume of appendectomies in pediatric patients, but there is a paucity of data on these outcomes based on surgeon training. We performed a systematic review and meta-analysis to compare postoperative outcomes and perioperative resource utilization for pediatric appendectomies.Methods: We searched PubMed to identify articles examining the association between surgeon specialization and outcomes for pediatric patients undergoing appendectomies. Study selection, data extraction, risk of bias assessment, and quality assessment were performed by one reviewer, with another reviewer to resolve discrepancies.Results: We identified 4799 articles, with 98.4% (4724/2799) concordance after initial review. Following resolution of discrepancies, 16 studies met inclusion criteria. Of the studies that reported each outcome, GS and PS demonstrated similar rates of readmission within 30 days (pooled RR 1.61 95% CI 0.66, 2.55) wound infections (pooled RR 1.07, 95% CI .55, 1.60), use of laparoscopic surgery (pooled RR 1.87, 95% CI .21, 3.53), postoperative complications (pooled RR 1.40, 95% CI .83, 1.97), use of preoperative imaging (pooled RR .98,95% CI .90, 1.05), and intra-abdominal abscesses (pooled RR .80, 95% CI .03, 1.58). Patients treated by GS did have a significantly higher risk of negative appendectomies (pooled RR 1.47, 95% CI 1.10, 1.84) when compared to PS.Discussion: This is the first meta-analysis to compare outcomes for pediatric appendectomies performed by GS compared to PS. Patient outcomes and resource utilization were similar among PS and GS, except for negative appendectomies were significantly more likely with GS.
Collapse
Affiliation(s)
- Ali M Eakes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Burkbauer
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura N Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adesola C Akinkuotu
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean E McLean
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony G Charles
- Department of Surgery, Division of General and Acute Care Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Phillips
- Department of Surgery, Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
16
|
Concha-Mora LA, Tamez-Rivera O, Robles-Lomelin I, Carreño-Salcedo SA. Brucellosis With Pericardial Effusion and Splenic Abscess: An Unusual Presentation. Pediatr Infect Dis J 2023; 42:e357-e358. [PMID: 37579063 DOI: 10.1097/inf.0000000000003962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Lindsay Ariadna Concha-Mora
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Morones Prieto, Monterrey Nuevo León, México
| | | | | | | |
Collapse
|
17
|
Han JH, Cha RR, Kwak JY, Jeon H, Lee SS, Jung JJ, Cho JK, Kim HJ. Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body. Medicina (Kaunas) 2023; 59:1504. [PMID: 37763623 PMCID: PMC10533137 DOI: 10.3390/medicina59091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.
Collapse
Affiliation(s)
- Ji-Hee Han
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ra-Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ji-Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Hankyu Jeon
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Sang-Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Jin Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| |
Collapse
|
18
|
Abstract
Background Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses. Aim To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center. Methods From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed. Results A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months. Conclusion EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.
Collapse
Affiliation(s)
- H Peeters
- Department of Gastroenterology, University Hospitals Leuven, Belgium
| | - M Simoens
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
| | - J Lenz
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
| |
Collapse
|
19
|
Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:182. [PMID: 37389666 DOI: 10.1007/s00384-023-04478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CA125 is a widely used serum marker for epithelial ovarian cancer which levels may also rise in benign conditions involving peritoneal irritation. We aimed to determine if serum CA125 levels can predict disease severity in patients presenting with acute diverticulitis. METHODS We conducted a single-center prospective observational study, analyzing CA125 serum levels in patients who presented to the emergency department with computerized tomography-proven acute left-sided colonic diverticulitis. Univariate, multivariate, and receiver operating characteristic (ROC) analyses were used to correlate CA125 serum levels at time of initial presentation with the primary outcome (complicated diverticulitis) and secondary clinical outcomes (need for urgent intervention, length of hospital stay (LOS) and readmission rates). RESULTS One hundred and fifty-one patients were enrolled between January 2018 and July 2020 (66.9% females, median age 61 years). Twenty-five patients (16.5%) presented with complicated diverticulitis. CA125 levels were significantly higher among patients with complicated (median: 16 (7-159) u/ml) vs. uncomplicated (8 (3-39) u/ml) diverticulitis (p < 0.001) and also correlated with the Hinchey severity class (p < 0.001). Higher CA125 levels upon admission were associated with a longer LOS and a greater chance to undergo invasive procedure during the hospitalization. In patients with a measurable intra-abdominal abscess (n = 24), CA125 levels were correlated with the size of the abscess (Spearman's r = 0.46, p = 0.02). On ROC analysis to predict complicated diverticulitis, the area under the curve (AUC) for CA125 (AUC = 0.82) was bigger than for the leukocyte count (AUC = 0.53), body temperature (AUC = 0.59), and neutrophil-lymphocyte ratio (AUC = 0.70) - all p values < 0.05. On multivariate analysis of factors available at presentation, CA125 was found to be the only independent predictor of complicated diverticulitis (OR 1.12 (95% CI 1.06-1.19), p < 0.001). CONCLUSIONS The results from this feasibility study suggest that CA125 may accurately discriminate between simple and complicated diverticulitis, meriting further prospective investigation.
Collapse
Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| |
Collapse
|
20
|
Ding JG, Zhang G, Wang Y. Successful eradication of renal allograft abscess by CT-guided percutaneous pigtail drainage: A case report. Medicine (Baltimore) 2023; 102:e33551. [PMID: 37058038 PMCID: PMC10101242 DOI: 10.1097/md.0000000000033551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
RATIONALE Renal allograft abscess is an infrequent complication in kidney transplant recipients. The mainstay of treatment is adequate drainage and optimal antibiotic administration. PATIENT CONCERNS A 25-year-old female who presented with dysuria, frequency, chills, fever, and allograft pain was initially diagnosed with a urinary tract infection complicated by septic shock 15 months after kidney transplantation. Ultrasound depicted a hypoechoic mass and contrast-enhanced computed tomography (CT) revealed a lesion with no enhancement in the renal allograft. CT-guided percutaneous pigtail drainage placement was implemented. DIAGNOSES Blood-stained pus was aspirated from the lesion in the renal allograft. The aspirate culture revealed Escherichia coli and Proteus mirabilis with an antibiogram consistent to urine culture. The diagnosis of renal allograft abscess originated from urinary tract infection was confirmed. INTERVENTIONS The patient underwent CT-guided percutaneous pigtail drainage and conducted culture of the aspirate. OUTCOMES The patient's symptoms immediately abated after drainage and renal allograft function recovered normally. Ultrasound and CT showed total regression of the renal allograft abscess at the 1-month outpatient follow-up. LESSONS Heightened alertness should be attached to that severe urinary tract infections presenting with sepsis shock and antibiotic treatment non responders are likely to progress to renal allograft abscess in kidney transplant recipients. CT-guided percutaneous pigtail drainage was a safe and effective minimally invasive treatment.
Collapse
Affiliation(s)
- Jing Gang Ding
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
| | - Ge Zhang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
| | - YuHui Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hang Zhou, Zhe Jiang, China
| |
Collapse
|
21
|
Ramos D, Linhares M, Pereira M, Caldeira A, Banhudo A. Endoscopic ultrasound-guided drainage of a pelvic abscess - An alternative use of lumen-apposing metallic stents. Rev Esp Enferm Dig 2023; 115:151. [PMID: 36043539 DOI: 10.17235/reed.2022.8919/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of lumen-apposing metal stent is well defined for endoscopic ultrasound-guided drainage of pancreatic collections (e.g. WON). However, it is not yet a well-established approach in the management of postsurgical collections. We present an alternative application of LAMS for EUS drainage of pelvic abscess, showing that it is a safe and minimally invasive technique, with excellent clinical results. This technique should be considered as a drainage alternative in these scenarios due to its lower morbidity and mortality, opening a new era in the approach to these lesions.
Collapse
Affiliation(s)
- Diana Ramos
- Gastrenterology, Hospital de Castelo Branco, Portugal
| | | | | | | | | |
Collapse
|
22
|
Abstract
PURPOSE Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes). METHODS Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included. RESULTS This meta-analysis included 16 studies whose differences were related to the need of reoperation (p < 0.01) and the duration of surgery (p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min). CONCLUSIONS The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.
Collapse
Affiliation(s)
- Ana Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables & Biomimetics; Headquarters of the European Institute of Excellence on Tissue Engineering & Regenerative Medicine, University of Minho, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
| | - Susana Faria
- Centre of Mathematics (CMAT), Department of Mathematics, University of Minho, Guimarães, 4800-058, Portugal
| | - Nuno Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Albino Martins
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables & Biomimetics; Headquarters of the European Institute of Excellence on Tissue Engineering & Regenerative Medicine, University of Minho, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
| | - Pedro Leão
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| |
Collapse
|
23
|
Mozgova Y, Mishyna M, Syplyviy V, Ievtushenko O, Ievtushenko D, Marchenko I, Mishyn Y. MICROBIOLOGICAL ANALYSIS OF ABDOMINAL CAVITY EXUDATE, BLOOD AND AFFECTED TISSUES SAMPLES FROM PATIENTS WITH INTRA- ABDOMINAL ABSCESSES IN COMPLICATED INFECTION OF ABDOMINAL CAVITY. Wiad Lek 2023; 76:1717-1724. [PMID: 37740961 DOI: 10.36740/wlek202308102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim: To conduct an analysis of the results of a microbiological examination of biological samples taken from patients with intra-abdominal abscesses. PATIENTS AND METHODS Materials and methods: Material for microbiological examination was collected from 60 patients during surgery and transported to laboratory at the same day. Isolation and identification of microbial pure cultures were performed by standard microbiological methods. Statistical analysis was performed using Statistica software. RESULTS Results: Analyzing the microbiological research results indicated importance of the sample collecting time (first or repeated surgery). In pa¬tient's blood taken during first surgery it was found a statistically significant predominance of no growth of microflora. In abdominal cav¬ity exudates anaerobic cultures increased statistically significantly in repeated surgery. It was noted that in samples taken during first sur¬gery mixed pathogens were represented mainly by facultative anaerobic cocci, then in repeated surgery anaerobic microorganisms were predominant. Examination of liver abscess content found that monoculture was isolated in 85.7 %. Blood and affected tissue samples in such patients were sterile. Investigation of samples from patients with multiple abdominal cavity abscesses revealed anaerobic microorganisms in 16.7 %. Blood samples of that patients in 40 % were sterile. CONCLUSION Conclusions: An analysis showed that in appendicular abscesses content gram-negatives were predominant. Gram-positive bacteria dominated in paravesical abscesses with 65 % isolates from gallbladder and 66.7 % from the affected tissue samples. In liver abscesses gram-positive cocci were isolated in 57.1 %. In multiple abdominal abscesses due to bowel perforation rod-shaped microflora was predominant (76 %) and represented by either obligate aerobes or obligate and facultative anaerobes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yuriy Mishyn
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| |
Collapse
|
24
|
Taira T, Broussard N, Bugg C. Pelvic inflammatory disease: diagnosis and treatment in the emergency department. Emerg Med Pract 2022; 24:1-24. [PMID: 36378827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
Pelvic inflammatory disease is associated with complications that include infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when properly diagnosed, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and\ evolving resistance patterns among pelvic inflammatory disease pathogens, are reviewed.
Collapse
Affiliation(s)
- Taku Taira
- Associate Professor of Clinical EmergencyMedicine, LAC+USC Department of Emergency Medicine, Keck School of Medicine, Los Angeles, CA
| | - Nolan Broussard
- Resident Physician, Emergency Medicine, University of Chicago, Chicago, IL
| | - Charles Bugg
- Emergency Physician, Department of Medicine, Huntington Hospital, Pasadena, CA
| |
Collapse
|
25
|
Mazzarella G, Picardi B, Rossi S, Del Monte SR, Muttillo EM, Rullo E, Gomes V, Muttillo IA. Solid-pseudopapillary tumor of the pancreas. An extrapancreatic loco-regional site and a review of the literature. Ann Ital Chir 2022; 11:S2239253X22037343. [PMID: 36412249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPT) of the pancreas are rare, low malignancy and predominantly affect young women, but it may be locally aggressive. Pancreatic resection is the main treatment for SPTs. However, low malignancy SPT may give insidious extrapancreatic invasions. CASE REPORT A 20-year-old woman was admitted with non-specific abdominal pain and diarrhea. A 9-cm SPT of the pancreas was discovered with extra-pancreatic invasion of the left adrenal gland and the spleen, in close contact with the body-tail of the pancreas, proximal portion of the jejunum, splenic flexure of the colon and the gastric fundus, with no signs of infiltration. For the young patient, a pancreas-preserving tumor excision was performed, with en-bloc resection of the spleen and adrenal gland, lymphadenectomy of the splenic vessels (13 lymph-nodes) and pre-pancreatic lymph node dissection, with no need for distal pancreatectomy. The duration of the surgery was 145 min, with no transfusion. The woman's postoperative course was complicated by a splenic lodge abscess treated via CT-guided percutaneous drainage, and a left pleural effusion treated medically, with a hospital stay of 16 days. Histology confirmed the diagnosis of a 9- cm low-grade SPT of the pancreas. In a close follow-up, the patient was asymptomatic 21 months later, with no tumor recurrence and good health. CONCLUSIONS Low-grade SPT of the pancreas with extra-pancreatic invasion of loco-regional organs can be treated by a pancreas-preserving approach to avoid a pancreatectomy. Moreover, still few cases of extra-pancreatic SPT are reported in the literature and there is an urgent need for more relevant evidence. KEY WORDS Extrapancreatic, Frantz's tumor, Pancreas preserving, Pancreas, Pancreatic neoplasm, Solid pseudopapillary tumor, Solid pancreatic tumor.
Collapse
|
26
|
Liu W, Zhang Z, Li D. Primary ovarian abscess in virginal young woman with huge endometriosis cyst: A case report. Medicine (Baltimore) 2022; 101:e29463. [PMID: 35623079 PMCID: PMC9276374 DOI: 10.1097/md.0000000000029463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/26/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Primary ovarian abscess which develops as an isolated lesion without simultaneous tubal infection is a rare entity. Ovarian abscess (OA) is a serious complication of pelvic inflammatory disease (PID) rarely seen in virginal girls. Early diagnosis and treatment are essential to prevent further sequela including infertility, ectopic pregnancy, and chronic pelvic pain. PATIENT CONCERNS A 19-year-old virginal girl who presented with abdominal pain and pelvic mass with no risk factors. DIAGNOSES Laparoscopic surgery was performed to confirm a primary ovarian abscess in the adolescent virginal female with a huge endometriosis cyst. INTERVENTION Ovarian abscess with extensive intestinal adhesions was determined during the laparoscopic operation. Abscess drainage and postoperative antibiotic therapy cured the patient. OUTCOME After the surgery, the CRP level on the day of discharge was 3.18 mg/d. The histological findings revealed a cystic tissue sample with the fibrous wall infiltrated by neutrophilic granulocytes, and ectopic endometrium, suggesting abscess formation in the ovary and endometriosis cyst. LESSONS Although primary ovarian abscess in an adolescent virginal female is rare, given the severity of outcomes following ovarian abscess, this pathology should be considered in the differential diagnosis of virginal adolescents with fever and abdominal pain.
Collapse
|
27
|
Negm S, Mohamed H, Shafiq A, AbdelKader T, Ismail A, Yassin M, Mousa B, Abozaid M, Orban YA, Al Alawi M, Farag A. Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial. World J Emerg Surg 2022; 17:24. [PMID: 35610657 PMCID: PMC9131571 DOI: 10.1186/s13017-022-00429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/12/2022] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage. METHODS This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management. RESULTS One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively). CONCLUSION Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.
Collapse
Affiliation(s)
- Said Negm
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hatem Mohamed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shafiq
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Adel Ismail
- Ismailia Teaching Oncology Hospital, Ismailia, Egypt
| | | | - Bassam Mousa
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | - Ahmed Farag
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
28
|
Banza MI, Kapessa ND, Shutsha NT, Omole PW, N’dwala YTB, Kasanga TK, Nafatalewa DK, Katambwa PM. Abcès mésentérique du au Chryseobacterium meningosepticum révélant la maladie de Castleman à localisation mésentérique chez un jeune adulte immunocompétent. Pan Afr Med J 2022; 41:99. [PMID: 35465379 PMCID: PMC8994466 DOI: 10.11604/pamj.2022.41.99.19121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/16/2020] [Indexed: 11/21/2022] Open
Abstract
Un abcès mésentérique causé par le Chryseobacterium meningosepticum est une entité clinique extrêmement rare, le plus souvent retrouvé sur un terrain d´immunodéficience et la maladie de Castleman peut être révélée par un abcès mésentérique. Nous présentons le cas d´un patient de 23 ans admis pour péritonite aiguë généralisée évoluant depuis 2 semaines. L´échographie abdominale montrait une masse hypoéchogène dans les anses grêles sans donner des plus amples détails. A la laparotomie, du pus avait été retrouvé dans la grande cavité et un abcès mésentérique présent dans le mésentère jéjunal à 35 cm de l´angle de Treitz sans aucune ouverture de l´anse en regard mais également une adénopathie mésentérique en regard de l´abcès. La pyoculture a isolé le Chryseobacterium meningosepticum et l´adénopathie mésentérique enlevée a montré à l´analyse histologique des anomalies structurales évoquant le type vascularisation hyalinisée de la maladie de Castleman. Le traitement a consisté en une incision et drainage de l´abcès avec résection de la coque et un nettoyage de la cavité abdominale au sérum physiologique. La Ciprofloxacine était le seul antibiotique sensible au Chryseobacterium meningosepticum. Les suites post-opératoires étaient simples avec sortie du patient au 10e jour post-opératoire. Un suivi clinique et paraclinique du patient pendant 12 mois n´a objectivé aucune autre adénopathie ni aucune récidive. Le but de cette publication est de présenter un cas extrêmement rare associant un abcès mésentérique à Chryseobacterium meningosepticum et une maladie de Castleman unicentrique à localisation mésentérique chez un immunocompétent ainsi que les modalités de cette prise en charge.
Collapse
Affiliation(s)
- Manix Ilunga Banza
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
- Corresponding author: Manix Ilunga Banza, Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo.
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Néron Tapenge Shutsha
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Pius Wonga Omole
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Yannick Tietie Ben N’dwala
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Trésor Kibangula Kasanga
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Dimitri Kanyanda Nafatalewa
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| | - Prince Muteba Katambwa
- Département de Chirurgie des Cliniques universitaires de Lubumbashi, Université de Lubumbashi, Haut Katanga, Lubumbashi République Démocratique du Congo
| |
Collapse
|
29
|
Simsek A. Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis. Wounds 2021; 33:226-230. [PMID: 34734841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. OBJECTIVE This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. MATERIALS AND METHODS The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. RESULTS All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. CONCLUSIONS Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.
Collapse
Affiliation(s)
- Arife Simsek
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
| |
Collapse
|
30
|
Mahata R, Chakraborty M, Chakraborty PP, Maiti A. Splenic abscess by Cutibacterium propionicum in poorly controlled type 2 diabetes. BMJ Case Rep 2021; 14:e241106. [PMID: 33795281 PMCID: PMC8023628 DOI: 10.1136/bcr-2020-241106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rahin Mahata
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Mandira Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | | | - Animesh Maiti
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| |
Collapse
|
31
|
Dotlacil V, Frybova B, Polívka N, Kardos D, Vajda P, Toczewski K, Pechanová R, Babala J, Rygl M, Patkowski D. Current management of pediatric appendicitis: A Central European survey. ADV CLIN EXP MED 2020; 29:745-750. [PMID: 32603558 DOI: 10.17219/acem/122176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Appendicitis is one of the most common diagnoses in pediatric populations. Although new recommendations for the treatment of pediatric appendicitis were published, management varies among different institutions. OBJECTIVES To determine current practices in 4 (n = 4) representative pediatric surgical departments in Central Europe. MATERIAL AND METHODS One department from each of the 4 countries was surveyed using an online questionnaire. Questions focused on preoperative, operative and postoperative practices in 2018, particularly those related to antibiotic (ATB) therapy and laparoscopy. RESULTS A total of 519 appendectomies were performed, among which 413 (79.6%) were laparoscopic appendectomies (LAs), with a conversion rate of 5.1%. Appendectomy, as an elective procedure, was performed in 43 (8.3%) patients. One-quarter (129 patients) had complex appendicitis and 72.3% of these were operated laparoscopically. In 3 departments, ATB prophylaxis was administered, based on the decisions of the operating surgeon. One department used standard ATB prophylaxis (metronidazole). Whenever phlegmonous appendicitis was detected, ATB were administered therapeutically in 2 departments. Two other departments administered ATB based on surgeon decision. The choice of ATB was not standardized. If complex appendicitis was detected, all sites administered ATB therapeutically. The type of ATB treatment was standardized in complex cases in 2 departments. Thirty-four complications (6.6%) at surgical sites were recorded - 4.1% (16/390) after uncomplicated and 14% (18/129) after complex appendicitis. Thirty-two occurred after acute surgeries and 26 of these followed laparoscopic procedures. Postoperatively, intra-abdominal abscesses occurred in 3.5% of laparoscopic and in 2.9% of open appendectomy (OA) cases. CONCLUSIONS This questionnaire study showed that treatment outcomes for appendicitis in children in Central Europe are comparable with data reported in the literature. Laparoscopic appendectomy is the predominant surgical method, but there is a little consensus for ATB treatment in the management of appendicitis at our 4 pediatric surgical departments.
Collapse
Affiliation(s)
- Vojtech Dotlacil
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Frybova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Natalie Polívka
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Daniel Kardos
- Department of Pediatrics, Surgical Division, University of Pecs, Hungary
| | - Peter Vajda
- Department of Pediatrics, Surgical Division, University of Pecs, Hungary
| | - Krystian Toczewski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
| | - Rebeka Pechanová
- Department of Pediatric Surgery, Comenius University in Bratislava, National Institute of Children's Diseases, Slovakia
| | - Jozef Babala
- Department of Pediatric Surgery, Comenius University in Bratislava, National Institute of Children's Diseases, Slovakia
| | - Michal Rygl
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
| |
Collapse
|
32
|
Daňa P, Adamová Z, Slováček R. Abdominal abscess associated with salmonellosis case report. Rozhl Chir 2020; 99:232-235. [PMID: 32545975 DOI: 10.33699/pis.2020.99.5.232-235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Although gastroenteritis is considered to be a non-surgical disease, rare complications necessitating surgical intervention may occur. CASE REPORT We present a patient who underwent acute small bowel resection due to an abdominal abscess, which developed in association with Salmonella enteritis.
Collapse
|
33
|
Boyko VV, Riga AS. Type 2 diabetes mellitus - IL-8 and IL-10 profile in patients with intraabdominal postoperative abscesses. Wiad Lek 2020; 73:220-223. [PMID: 32248148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: To assess of pro-inflammatory IL-8 and anti-inflammatory IL-10 serum concentration in patients with T2DM with intraabdominal postoperative abscesses in perioperative period. PATIENTS AND METHODS Materials and methods: The 48 participants, aged 40 - 75 years, among them 24 males and 24 females. All patients were divided into groups: group 1 - 12 patients with T2DM and intra-abdominal postoperative abscesses, group 2 - 12 patients without T2DM but with intra-abdominal postoperative abscesses and 24 healthy individuals. The level of IL-8and IL-10 serum was determined on the day before surgery, on the 2-3rd and 5-7th day after surgery in patients with type 2 diabetes and intra-abdominal postoperative abscesses. RESULTS Results and conclusions: The trajectories of the level of interleukins in patients with type 2 Diabetes mellitus were different from the trajectories of their level in patients without diabetes, which indicates a special immune response to nosocomial infection and surgical trauma. The mechanism of changes in serum levels of IL-8 and IL-10 in patients with type 2 Diabetes mellitus and postoperative intra-abdominal abscesses should be further studied in future studies on the specific causative agent of nosocomial infection and the cytokine response to it.
Collapse
Affiliation(s)
| | - Artem S Riga
- Kharkiv National Medical University, Kharkiv, Ukraine
| |
Collapse
|
34
|
Wei G, Wu Y, Gao Q, Shen C, Chen Z, Wang K, Yu J, Li X, Sun X. Gallic Acid Attenuates Postoperative Intra-Abdominal Adhesion by Inhibiting Inflammatory Reaction in a Rat Model. Med Sci Monit 2018; 24:827-838. [PMID: 29429982 PMCID: PMC5815494 DOI: 10.12659/msm.908550] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
Background Intra-abdominal adhesion is one of the most common complications after abdominal surgery. The efficacy of current treatments for intra-abdominal adhesion is unsatisfactory. In this study, we investigated the effect of gallic acid on the prevention and treatment of intra-abdominal adhesions after abdominal surgery using an intra-abdominal adhesion rat model. Material/Methods The experimental rats were randomly divided into the sham operation group, the control group, the chitosan group, and 3 gallic acid groups of different concentrations. All rats except those in the sham operation group received cecal abrasion to induce adhesion. From the first postoperative day, the rats in the gallic acid groups were administered different concentrations of gallic acid in a 2-ml gavage daily. All rats were sacrificed on postoperative day 7, and the degree of intra-abdominal adhesion was evaluated by the naked eye. The amount of collagen deposited between the injured peritoneal tissues was assessed by Sirius red staining. Serum levels of interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and transforming growth factor-β (TGF-β) were measured by ELISA. Western blot was used to detect the level of NF-κB phosphorylation in the injured peritoneal or adhesion tissues of the rats. Results Compared with the control group, the scores of intra-abdominal adhesions in the rats treated with larger doses of gallic acid were significantly decreased, and the degree of inflammation and fibrosis was also significantly decreased. Gallic acid significantly reduced IL-6, TNF-α, and TGF-β1 serum levels. NF-κB phosphorylation in the higher gallic acid groups was significantly reduced. Conclusions Gallic acid inhibits the formation of postoperative intra-abdominal adhesions in rats by inhibiting the inflammatory reaction and fibrogenesis. Gallic acid is a promising drug for preventing intra-abdominal adhesions.
Collapse
Affiliation(s)
- Guangbing Wei
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Yunhua Wu
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Qi Gao
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Cong Shen
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Zilu Chen
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Kang Wang
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Junhui Yu
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| |
Collapse
|
35
|
He X, Zheng X, Lian L, Zhou C, He X, Wu X, Lan P. [Risk factors of early surgical intervention in Crohn's disease patients with spontaneous intra- abdominal abscess]. Zhonghua Wei Chang Wai Ke Za Zhi 2016; 19:1379-1383. [PMID: 28000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the risk factors of early surgical intervention in Crohn's disease (CD) patients with spontaneous intra-abdominal abscess. METHODS Clinical data of 94 CD patients with spontaneous intra-abdominal abscess admitted to The Sixth Affiliated Hospital of Sun Yat-sen University between May 2008 and Dec 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate the early surgery risk of CD patients with spontaneous intra-abdominal abscess using logistic regression model. RESULTS A total of 94 eligible patients were identified from our registry, including 70 males and 24 females. The mean age at the diagnosis of CD and at development of abscess was 28.4 years and 30.4 years old, respectively. The median duration of CD between the diagnosis and development of an abscess was 3 years. According to the Montreal classification, L3 (ileocolonic) was the most common disease location (81.9%) in these patients. Most of the patients(76.6%) developed a single abscess, while multiple abscesses were detected in 22 patients(23.4%). Forty-four patients(46.8%) underwent surgery within 60 days after hospitalization due to spontaneous intra-abdominal abscess complicating CD. Multivariate logistic regression analysis revealed that history of abdominal surgery(OR=3.23, 95%CI:1.12 to 9.31, P=0.030), concomitant intestinal stenosis (OR=3.52, 95%CI:1.26 to 9.85, P=0.017) and concomitant intestinal fistula (OR=4.31, 95%CI:1.25 to 14.80, P=0.020) were the independent risk factors of early surgical intervention, while enteral nutrition (OR=0.18, 95%CI:0.05 to 0.62, P=0.007) was the independent protective factor. CONCLUSIONS Nearly half of CD patients with spontaneous intra-abdominal abscess will undergo early surgical intervention. Patients with history of abdominal surgery, concomitant intestinal stenosis and concomitant intestinal fistula have higher risk of early surgical intervention, and appropriate application of enteral nutrition may reduce the risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ping Lan
- Department of Colorectal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.
| |
Collapse
|
36
|
Singh S, Raidoo S, Kuo K, Resnick K. Wandering Spleen. A Case of Spontaneous Hemoperitoneum in an HIV-positive Patient with Recurrent Tuboovarian Abscess. J Reprod Med 2015; 60:359-361. [PMID: 26380497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Wandering spleen is a rare and potentially devastating condition that can present in a variety of ways. Here we present a case that led to acute abdomen and hemoperitoneum in a young woman. CASE A 27-year-old woman with a history of human immunodeficiency virus (HIV), pelvic inflammatory disease, and tuboovarian abscess was readmitted to the hospital for intravenous antibiotic treatment. When her clinical picture did not improve, she underwent placement of a pelvic drain for abscess drainage. Overnight she developed an acute abdomen and hemorrhagic shock. She was taken to the operating room for an exploratory laparotomy, which revealed a ruptured spleen with a single, elongated vascular pedicle. CONCLUSION Wandering spleen is a rare diagnosis, more common in reproductive-aged women, with potentially fatal complications. It is a necessary component of a differential diagnosis for acute abdomen in reproductive-aged women.
Collapse
|
37
|
Kucuk GO. Technical and social challenges of laparoscopic appendectomy performed in a rural setting. Ann Ital Chir 2015; 86:344-348. [PMID: 26343775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The current study reports technical and social details aiming to evaluate difficulties faced while performing laparoscopic appendectomy (LA) in a rural hospital as well as providing solutions. METHODS Patients who underwent LA with a diagnosis of acute appendicitis between April 2009 and December 2010 were included in this study. Demographic details, operative findings and postoperative outcomes were analyzed. RESULTS Fifty-one consecutive patients (28 male and 23 female) underwent LA. The median age was 23 years (range, 13-74); the median operative time was 45 minutes (range, 20-75). Appendiceal base securing was performed either endoloops in 4 (7.8%), or via intracorporeal knot tying in 46 (90.2%) patients and 1 was sutured. Complicated/technically difficult appendicitis was faced in 20 (39.2%) patients. One patient underwent conversion to open procedure (2%). Mean postoperative hospital stay was 2.4 ± 0.8 days. Postoperative intra-abdominal abscess occurred in 1 (2%) patient. CONCLUSION LA can be performed safely in a rural hospital, even for complicated cases. In this study, we have discussed some technical and social difficulties encountered and the solution methods adopted when performing LA in rural settings.
Collapse
|
38
|
Taher MA, Khan ZR, Chowdhury MM, Nur-E-Elahi M, Chowdhury AK, Faruque MS, Wahiduzzaman M, Haque MA. Pylorus Preserving Pancreaticoduodenectomy vs. Standard Whipple's Procedure in Case of Carcinoma head of the Pancreas and Periampullary Carcinoma. Mymensingh Med J 2015; 24:319-325. [PMID: 26007260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pancreatic carcinoma is a life threatening condition. Surgical resection is the only hope of cure. Advances in surgical technique have reduced the mortality rate. Nevertheless, operative complications related with morbidity still remains high. Two operation techniques in the treatment of periampullary and pancreatic head cancer: the Standard Whipple operation (SW) and Pylorus Preserving Pancreaticoduodenectomy (PPPD) are performed predominantly. This study was performed to compare the results of Pylorus Preserving Pancreaticoduodenectomy (PPPD) with that of the Standard Whipple's (SW) procedure. This prospective study was carried out in the Department of General Surgery, BSMMU in two years duration. All admitted patient's with periampullary carcinoma and carcinoma of the head of the pancreas were included and randomized for a SW or a PPPD resection. Data regarding patients demographics, preoperative assessment, intraoperative and postoperative findings were collected and analyzed. Less blood loss (2.67±0.65 units in Group I and 2.88±0.64 units in Group II), fewer need of blood transfusions and shorter hospital stay in the PPPD group were observed. Gastrointestinal leakage was similar in both groups of patients (1:1). One pancreatic fistula (8.3% in Group I) was observed in PPPD group and one intra-abdominal abscess developed in Standard Whipple's procedure (00.0% in Group I and 12.5% in Group II). Bile leakage was higher in standard Whipple procedure (8.3% in Group I and 37.5% in Group II). Morbidity was more or less similar in both groups (58.0% in Group I and 50.0% in Group II) but one patient (12.5% in Group II) died in standard Whipple's resection. PPPD procedure is more effective treatment for periampullary carcinoma and cancer of the pancreatic head region than the standard Whipple's operation.
Collapse
Affiliation(s)
- M A Taher
- Dr Md Abu Taher, Assistant Professor, Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Ye Z, Yang Y, Luo G, Huang Y. [Management of colonic injuries in the setting of damage control surgery]. Zhonghua Wei Chang Wai Ke Za Zhi 2014; 17:1125-1129. [PMID: 25421774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare the safety of anastomosis and ostomy following 2-stage definitive colonic resection when severe colonic injuries treated in the setting of damage control surgery(DCS). METHODS Clinical data of 67 patients with severely traumatic colonic injuries undergoing DCS at the Third Affiliated Hospital of Sun Yat-sen University between 2005 and 2013 were analyzed retrospectively. Patients were divided into the anastomosis group undergoing colonic resection and anastomosis (n=40), and the ostomy group undergoing anastomosis with a protecting proximal ostomy (n=27). Postoperative complications were compared between these two groups. The risk factors of colonic anastomosis leakage were analyzed. RESULTS Demographics, injury severity, physiological imbalance on admission, transfusion during the first operative procedure were similar in the two groups (all P>0.05). Rates of anastomotic leakage, intra-abdominal abscess, enterocutaneous fistula, and would infection after definitive resection were not statistically different between the two groups (all P>0.05). Colonic anasomotic leakage rates were 15.0% (6/40) in anastomosis group and 11.1% (3/27) in ostomy group without significant difference (P>0.05). Left-sided colon injuries occurred in 7 out of 9 patients with anatomotic leakage, whose proportion was significantly higher than that in those without anastomotic leakage (7/9 vs. 24/58, 77.8% vs. 41.4%, P<0.05). A prolonged peritoneal closure was also observed in patients with anastomotic leakage (median, 10 days vs. 2 days, P<0.05). CONCLUSIONS A strategy of diverting ostomy is not the first choice for patients suffering from severe colonic injuries in the setting of DCS. Peritoneal closure at early stage may decrease the risk of colonic anastomotic leakage.
Collapse
Affiliation(s)
- Zhiqiang Ye
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| | | | | | | |
Collapse
|
40
|
Zhu QQ, Wang ZQ, Wu JT, Wang SA. [Assessment of the diagnostic value of CT and X-ray enterography for small intestinal Crohn disease]. Zhonghua Wei Chang Wai Ke Za Zhi 2013; 16:443-447. [PMID: 23696400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease(CD). METHODS Data of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography. RESULTS CT enterography showed mural thickening(>4 mm) in 34(87.2%) patients, mural gas in 7(17.9%), mural edema in 7(17.9%), mural fat in 4(10.3%), increased enhancement of bowel wall(>10 HU) in 37(94.9%), multiple segmental lesions in 33(84.6%), single segmental lesions in 6(15.4%), mesenteric lymphadenopathy(>5 mm) in 13(33.3%), vascular bundle thickening in 9(23.1%), cellulitis in 12(30.8%), peritoneal abscess in 10(25.6%), phlegmon in 8(20.5%), incomplete intestinal obstruction in 14(35.9%), seroperitoneum in 22(56.4%), and fistulization in 4(10.3%). CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases(82.1%) presented with multiple segmental lesions, 5(17.9%) with single segmental lesions, 18(64.3%) with strip ulcer, 16(57.1%) with cobblestones, 4(14.3%) with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases (72.2%) presented with intestinal fistula, 12(66.7%) with peritoneal abscess, 8(44.4%) with sinus tract. CONCLUSIONS CT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to show the bowel wall and extraintestinal inflammatory mass and abscesses. The sinus tract enterography is easy to demonstrate the intestinal fistula and intra-abdominal abscess. Combination of these methods is more beneficial to guild the diagnosis and treatment.
Collapse
Affiliation(s)
- Qing-Qiang Zhu
- Department of Medical Imaging, Subei People's Hospital, Jiangsu Yangzhou 225001, China.
| | | | | | | |
Collapse
|
41
|
Cartanese C, Carbotta G, Di Candia L, De Marini F, Girau A, Zocchi G. A rare case of colon cancer with splenic abscess. Ann Ital Chir 2013; 84:201-204. [PMID: 22615043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cancer of the colon does not always present with the familiar symptoms. Perforation and penetration of adjacent organs, with abscess formation as the initial presentation, is uncommon. Splenic abscess is a rare clinical entity. The four causes of a splenic abscess described are: primary pyogenic infection, splenic trauma, hemoglobinopathies and contiguous disease. In this paper we report a case of splenic abscess from colon cancer in an 50-year-old man who had a left lower chest contusion two-week before and review pertinent literature. Only 11 reported cases of splenic abscess from colorectal cancer were found in Medline.
Collapse
|
42
|
Hensey N, Ahmed S, Minchin J, Athavale N, Abdelhafiz A. Intra- abdominal abscess in older patients: two atypical presentations to the Acute Medical Unit. Acute Med 2012; 11:226-230. [PMID: 23364107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An abscess is a localised collection of necrotic tissue, white cells and bacteria, collectively forming pus. Intra-abdominal abscesses can occur viscerally (e.g. hepatic abscess), retroperitoneally (e.g. psoas abscess) or intraperitoneally (e.g. subphrenic abscess).(1, 2) Clinical presentation is variable and largely depends on the site of abscess. Fever and abdominal pain are the classic symptoms although in older people presentation can be non-specific. Prompt diagnosis and early intervention are vital for good outcomes.(3) We present two cases of older women whose presentation with atypical symptoms resulted in a delay in diagnosis.
Collapse
|
43
|
|
44
|
Kaafarani HMA, Itani KMF. Classification versus valuation and grading of surgical complications. J Am Coll Surg 2009; 209:290-1; author reply 291-2. [PMID: 19632618 DOI: 10.1016/j.jamcollsurg.2009.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 05/22/2009] [Indexed: 12/01/2022]
|
45
|
de Hingh IHJT, Gouma DJ. [Diagnostic image (345). A woman with abdominal pain and purulent vaginal discharge]. Ned Tijdschr Geneeskd 2007; 151:2271. [PMID: 17987895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 41-year-old woman presented with abdominal pain and purulent vaginal discharge several months after a complicated laparoscopic cholecystectomy. MRI revealed a rectovaginal pouch abscess which at laparotomy contained 41 gallstones that had been spilled.
Collapse
Affiliation(s)
- I H J T de Hingh
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Chirurgie, Amsterdam.
| | | |
Collapse
|
46
|
|
47
|
Affiliation(s)
- Jay B Prystowsky
- Division of Gastrointestinal and Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | |
Collapse
|
48
|
Affiliation(s)
- Dean A Le
- Neurology Service, Saddleback Memorial Medical Center, Laguna Hills, CA, USA.
| | | | | |
Collapse
|
49
|
Conze J, Böhm G, Niggemann P, Steinau G, Schumpelick V. Venocutaneous fistula. Surg Endosc 2004; 17:2028-31. [PMID: 14973752 DOI: 10.1007/s00464-003-4221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 04/16/2003] [Indexed: 10/26/2022]
Abstract
This is the first description of venocutaneous fistula, a late complication of elective laparoscopic cholecystectomy that arose 18 months after the initial operation. Postoperatively, the patient twice developed an abscess in the abdominal wall at the former site of the umbilical trocar. The first abscess occurred on the 6th postoperative day; the second, after 14 months. After an additional 4 months, a fistula opening appeared just below the umbilicus. Fistulography revealed a connection with the venous system of the omentum majus. During subsequent resection of the fistula, a pigment gallstone was retrieved from the base of the fistula.
Collapse
Affiliation(s)
- J Conze
- Department of Surgery, Rhenisch Westphalian Technical University, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND/PURPOSE pulmonary (PPT) and extrapulmonary pseudotumors (EPPT) are uncommon benign tumors, which, in general, do not recur after complete resection. Recurrence rates for both types of pseudotumors are undocumented in a large population of children, and the salient features of potential recurrences are unspecified. METHODS This is a report of 15 children with PPT and EPPT; 3 children had a recurrence. These pseudotumors recurred despite adequate primary resection of all gross disease at first presentation. The literature was reviewed to determine rate of recurrence for PPT and EPPT and also to document features common to recurrent pseudotumors. RESULTS Overall recurrence rate for pseudotumors was 14%. PPT and EPPT, which were not confined to a single organ, had a high chance of recurrence (46% and 30%, respectively) compared with PPT and EPPT, which were confined to a single organ (1.5% and 8%, respectively). Recurrences have appeared between 3 months and 7 years. Intraabdominal EPPT accounts for more than 75% of the EPPT recurrences. CONCLUSIONS PPT and EPPT recur more frequently than anticipated. All pseudotumors, which on initial presentation extend beyond the confines of a single organ, have a high chance of recurrence despite what appears to be adequate resection. Children with pseudotumors that extend beyond a single organ, require frequent postoperative evaluation for recurrence and may be candidates for chemotherapy or radiotherapy at the time of initial resection.
Collapse
Affiliation(s)
- Joseph S Janik
- Department of Pediatric Surgery, The Children's Hospital, Denver, Co 80218, USA
| | | | | | | | | | | |
Collapse
|