PubMed · 4612295
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J D Thorley, S R Jones, J P Sanford. 1974. Perinephric abscess.. https://doi.org/10.1097/00005792-197411000-00004
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Spinal epidural abscess usually arises by hematogenous, lymphatic or venous spread. The frequent use of invasive procedures at the spinal cord such as epidural injections to produce analgesia has led to an increased incidence of iatrogenic abscesses. We describe 8 patients who developed iatrogenic spinal epidural abscesses after paravertebral or intragluteal punctures respectively intravenous catheters to produce analgesia. Deep paravertebral or intragluteal injections were the cause of abscess formation in five, a contaminated intravenous line in two and a peridural catheter in one case. Pain of the affected vertebral column and malaise were the leading symptoms and Staphylococcus aureus was isolated in all cases. Diagnosis was made by means of magnetic resonance (n = 7) or Computed tomography (n = 1). Outcome was excellent with early therapy consisting of laminectomy and/or antibiotic treatment in the six patients treated within two days of appearance of symptoms. Invasive procedures at the spinal cord can lead to iatrogenic spinal epidural abscesses. Physicians dealing with deep punctures and catheter procedures should be aware of early symptoms and signs of an epidural abscess, since early diagnosis and specific therapy are the most important factors for a good outcome.
A diagnosis of hospital discharges shows splenic abscess to be a rare condition, with one case per 10,000 discharges. Haematogenous seeding to the spleen from an infection at a distant site, most often endocarditis, has been the most common predisposing condition but an increase has been observed in immuno-suppressed patients too. Fever, leukocytosis and left upper quadrant pain are suggestive, but the signs and symptoms of splenic abscesses are often non-specific. Ultrasound and computed tomography are reliable diagnostic tools. Splenectomy and antibiotics have been the treatments of choice, with increasing use of percutaneous drainage as an alternative, in order to preserve splenic function. We describe a patient with a salmonella splenic abscess that was treated with percutaneous drainage and ciprofloxacin.