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PubMed1996

[Surgical treatment of intra-abdominal abscesses].

To define the role of operative treatment of intraabdominal abscesses, we retrospectively reviewed 106 patients, who were operated for intraabdominal abscesses between January 1988 and October 1994. 49 patients had had a primary abscess, 57 patients had an anteceding operation. In both groups appendix and bilio-pancreatic tract were the mostly involved organs. 81 (76,4%) abscesses were single, whereas 17 patients had 2 and 8 patients had 3 synchronous abscesses. All abscesses fulfilled the criteria of complicated abscesses. Successful drainage was achieved in 83%, 17% of cases had to be reoperated or percutaneously drained for recurrence of abscess or abscess related complications. The procedure related morbidity was 37,7% (40/106), half of these were minor complications. 5 patients died, conferring to a mortality of 4,7%. We conclude, that operative drainage plays an important role in the therapeutic regimes of intraabdominal complicated abscesses and can be performed with low morbidity and mortality.

Abdominal Abscess↗
PubMed1999

Inflammatory processes in a murine model of intra-abdominal abscess formation.

Abscess formation has been viewed as a host defense strategy to contain the spread of infection. However, abscesses are also serious and life-threatening manifestations of persisting microbial infection. The initiation of abscess formation, both clinically and experimentally, involves the release of bacteria and an abscess-potentiating agent (e.g., fecal fiber or an analog) into a sterile site, with host defense mechanisms being unable to eliminate the infecting organisms. Abscess formation is aided by a combination of factors that share a common feature: impairment of phagocytic killing and hence clearance of microorganisms. These include bacterial virulence factors (e.g., capsule formation, succinic acid production); complement activation by the abscess potentiating agent; fibrin deposition; and microbial sequestration within abscess neutrophils. Recruitment of cells into the peritoneal cavity follows mast cell activation in the pathogenesis of infection: histamine and tumor necrosis factor alpha can be detected in the peritoneal cavity within minutes of challenge with an abscess-inducing mixture. However, the role of mast cells in host defense is made less clear by the finding of diminished abscess formation (but no mortality or increased morbidity) in mast-cell-depleted mice. This may indicate that mast cell products have a role in not only the initiation of an inflammatory response but also the promotion of fibrin deposition and abscess formation.

Abdominal Abscess↗
PubMed1996

[The pathophysiology and treatment of severe intra-abdominal abscess].

Formation of an abscess within the peritoneal cavity is a dynamic process, representing the body's success at localizing the contamination but its ultimate failure to completely destroy the bacteria and neutralize their toxic products. In most instances, the origin of the microbial insult is from bacteria which colonize the intestinal lumen. The therapeutic means are prompt surgical drainage and appropriately administered antimicrobial agents. Surgical drainage of abscess are accompanied by either (1) an extraperitoneal approach, (2) an intra-abdominal exploration, or (3) ultrasound-guided needle aspiration of the abscess. Choice of antimicrobial agents is frequently based upon prediction of pathogens from normal flora of bowel contents contaminating a normally sterile area, or from knowledge of pathogens expected in certain conditions, rather than on results of cultures and susceptibility tests. This selection frequently calls for the choice of agents effective against multiple organisms. Patients with prolonged septic courses die from a combination of the infection itself and the malnutrition resulting from the associated hypercatabolism and starvation. Nutritional therapy also of clinical importance in halting the progression toward a fatal outcome.

Abdominal Abscess↗
PubMed1998

Surgical management of an abdominal abscess in a Malayan tapir.

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

Abdominal Abscess↗
PubMed1998

[CT-controlled percutaneous drainage of intra-abdominal abscesses with basket catheters].

Today, CT-guided percutaneous drainage for intraabdominal abscesses of various origin and location is well accepted. With this method open surgery and its complications can be often avoided. We report results of such treatment in 47 patients with intraabdominal abscess formation. 66 "basket" catheters were placed into abscess formations of differing sizes and locations. 27 patients had developed abscess formation after surgery, in 2 patients abscesses after tumorembolisation were drained. In 18 cases there was no previous surgery. No complications occurred. Mean drainage time was 8.5 days. Surgical intervention was avoided in 34/47 patients. 9 of 47 patients received only percutaneous drainage. 25 of 47 patients required concomitant antibiotics for successful treatment. Antibiotics were selected according to bacterial culture with resistance determination. 13/47 cases required secondary surgery. About 80% of intraabdominal abscesses are curable with CT guided percutaneous drainage and systemic antibiotic medication. If a percutaneous drainage fails and signs of infection still remain, the procedure can be repeated. If secondary surgery after failing of percutaneous drainage should become necessary, the extent of the surgical intervention can be reduced. Surgery is necessary, if CT guided percutaneous drainage could not reach the abscess formation, if drainage failed or if an additional illness exists, which requires an operation.

Abdominal Abscess↗
PubMed2000

[Intra-abdominal abscess as presentation of colonic cancer].

Splenic abscess and retroperitoneal abscess are uncommon, although severe diseases, with a high mortality rate that has been attributed to delayed diagnosis, due to the unspecificity of clinical symptoms. We report two patients with a splenic and a retroperitoneal abscess, respectively, in both cases as an onset of colon cancer. The two patients complained of abdominal pain and fever as onset symptoms. Abdominal ultrasonography was normal in the case of retroperitoneal abscess and abnormal in the case of splenic abscess. CT Scan was diagnostic in both cases. In the patient with splenic abscess. CT Scan established a further diagnostic suspect of colon cancer, which was confirmed by colonoscopy. In the patient with retroperitoneal abscess, diagnosis of colon carcinoma was made during the surgical act. In spite of an adequate, combined medical and surgical therapy, both patients died within a short time after surgery.

Abdominal Abscess↗
PubMed1997

[Interventional therapy of intra-abdominal abscess: outcome and limits].

The postoperative course following digestive surgical procedures was prospectively analysed in 2985 patients between 6/92 and 12/96. A CT-guided percutaneous drainage of intraabdominal abscesses was performed in 144 patients (4.8%). In 123 patients (85.4%) percutaneous abscess drainage (PAD) was successful, additional surgery was not required. Twenty-one patients (14.6%) underwent additional surgery. Reasons for drainage failure were abscesses caused by internal fistulas (8 patients), pancreas involvement of the abscesses (5 patients), infected clots impossible to drain (3 patients), multiple abscesses (3 patients) and persistent abscess formation despite drainage (2 patients). Puncture-related complications were seen in 8 patients (5.5%). Puncture-related mortality was 0.7%.

Abdominal Abscess↗
PubMed2000

Ultrasonographic detection of abdominal abscess in two guinea pigs.

Two guinea pigs (Cavia porcellus) with clinical signs of anorexia, weight loss, depression and abdominal enlargement were examined. During ultrasound examination, a fluid-filled anechogenic structure 3-4 cm in diameter, with echogenic spots and a highly echogenic thick wall, was found in the pelvic region in one case and connected to the liver in the other case. An abscess or a cyst was suspected and surgical treatment including laparotomy was performed. By histopathological examination performed after surgery, a liver abscess was diagnosed in one guinea pig and an abscess in the pelvic region in the other animal.

Abdominal Abscess↗
PubMed2000

Gonococcal meningitis and intra-abdominal abscess in the presence of a ventriculoperitoneal shunt.

We report a case of gonococcal meningitis with an intraabdominal abscess in a 19-y-old woman, who had a ventriculoperitoneal shunt after craniotomy for astrocytoma. Percutaneous drainage was performed for the intraabdominal abscess. Ceftriaxone was administered with the ventriculoperitoneal shunt removal. The clinical course improved, but visual impairment last for 3 months following treatment.

Abdominal Abscess↗
PubMed1988

Prevention of intra-abdominal abscesses by fibrinolysis using recombinant tissue plasminogen activator.

We studied whether intraperitoneal fibrinolysis using recombinant tissue plasminogen activator (t-PA) could prevent abscess formation in the rat model of intra-abdominal infection caused by fibrin clots. Single-dose administration of t-PA at concentrations greater than 0.005 mg/mL at surgery or delivered by open lavage within 1 h of surgery completely obviated abscess formation induced by Bacteroides fragilis-infected clots without altering mortality (approximately 0.6%). With mixed Escherichia coli-B. fragilis clots, t-PA increased the mortality rate from the control level of 43.8% to 81.3% but prevented abscesses in survivors. This increased mortality rate was probably due to an acute E. coli bacteremia. Antibiotics plus t-PA prevented both mortality and abscess formation. Intraperitoneal fibrinolysis may be a useful adjunct to antibiotics and appropriate surgery in the management of intra-abdominal infection.

Abscess↗
PubMed2002

Intra-abdominal abscess in Crohn's disease: a case report.

Inflammatory bowel disease is uncommon in Thailand. The authors report a case of Crohn's disease in a 47-year-old Thai female. The patient presented with a three-week history suggestive of an appendiceal abscess requiring an operation. The intra-operative findings of a lesion involving the terminal ileum and cecum, necessitated a right hemicolectomy to rule out reliably the presence of malignancy. Pathologic examination of the specimen suggested Crohn's disease.

Abdominal Abscess↗