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Intensive Care Medicine Feb 2020Postoperative abdominal infections are an important and heterogeneous health challenge in intensive care units (ICU) and encompass postoperative infectious processes... (Review)
Review
Postoperative abdominal infections are an important and heterogeneous health challenge in intensive care units (ICU) and encompass postoperative infectious processes developing within the abdominal cavity that may be caused by either bacterial or fungal pathogens. In this narrative review, we discuss postoperative bacterial and fungal abdominal infections, covering also multidrug-resistant (MDR) pathogens. We also cover clinically preeminent aspects such as the definition of postoperative abdominal infections, which still remains difficult owing to their heterogeneity in patient characteristics, clinical presentation, ecology and antimicrobial treatment. With regard to treatment, modifiable factors such as source control and antimicrobial therapy play a key role in influencing the prognosis of postoperative abdominal infections, but several conditions may hamper their correct application; thus efforts should necessarily be devoted towards improving their appropriateness and timing. Hot topics regarding the characteristics and management of postoperative abdominal infections are discussed in this narrative review.
Topics: Abdominal Abscess; Anti-Infective Agents; Humans; Intensive Care Units; Outcome Assessment, Health Care; Peritonitis; Postoperative Complications; Postoperative Period
PubMed: 31701205
DOI: 10.1007/s00134-019-05841-5 -
The New England Journal of Medicine Aug 2021
Topics: Abdominal Abscess; Diabetes Mellitus, Type 2; Endophthalmitis; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Lung Abscess; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 34415687
DOI: 10.1056/NEJMicm2101602 -
Gastroenterology Clinics of North... Jun 2021Intra-abdominal and anorectal abscesses are common pathologies seen in both inpatient and outpatient settings. To decrease morbidity and mortality, early diagnosis and... (Review)
Review
Intra-abdominal and anorectal abscesses are common pathologies seen in both inpatient and outpatient settings. To decrease morbidity and mortality, early diagnosis and treatment are essential. After adequate drainage via a percutaneous or incisional approach, patients need to be monitored for worsening symptoms or recurrence and evaluated for the underlying condition that may have contributed to abscess formation.
Topics: Abdominal Abscess; Abscess; Crohn Disease; Drainage; Humans; Recurrence; Retrospective Studies
PubMed: 34024453
DOI: 10.1016/j.gtc.2021.02.014 -
BMJ Case Reports Oct 2020A 43-year-old woman with Crohn's disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient...
A 43-year-old woman with Crohn's disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.
Topics: Abdominal Abscess; Adult; Anti-Bacterial Agents; Crohn Disease; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Syndrome; Tomography, X-Ray Computed
PubMed: 33122231
DOI: 10.1136/bcr-2020-236437 -
Diseases of the Colon and Rectum Sep 2021A 46-year-old man with no significant medical or surgical history presented to the emergency department with a 1-week history of worsening constipation, abdominal...
A 46-year-old man with no significant medical or surgical history presented to the emergency department with a 1-week history of worsening constipation, abdominal distension, nausea, and nonbloody, nonbilious emesis. Workup included a CT scan that was notable for a 5.3 × 3.9 cm "apple core-type" mass located within the sigmoid colon with proximal large-bowel dilation. Carcinoembryonic antigen was 1.4. No metastatic disease was seen on chest, abdominal, or pelvic CT scans. Flexible sigmoidoscopy identified a sigmoid colon mass 30 cm from the anal verge with near complete obstruction. Biopsies of the mass did not show evidence of dysplasia or malignancy. The Gastroenterology service declined to place a stent without a malignancy diagnosis. The patient subsequently underwent exploratory laparotomy, sigmoid colectomy, and end colostomy. Recovery was uneventful. Final pathology showed diverticulitis with abscess formation and no evidence of malignancy. A completion colonoscopy was unremarkable, and the patient underwent colostomy reversal 3 months later.
Topics: Abdominal Abscess; Algorithms; Biopsy; Colectomy; Colon, Sigmoid; Constriction, Pathologic; Diagnosis, Differential; Dilatation; Diverticulitis, Colonic; Humans; Male; Middle Aged; Sigmoid Diseases; Sigmoidoscopy; Stents; Tomography, X-Ray Computed
PubMed: 34108366
DOI: 10.1097/DCR.0000000000002179 -
Diseases of the Colon and Rectum Jan 2020A 62-year-old previously healthy man presented with left lower quadrant pain and fever. Physical examination showed left lower quadrant peritonitis. Computed tomography... (Review)
Review
A 62-year-old previously healthy man presented with left lower quadrant pain and fever. Physical examination showed left lower quadrant peritonitis. Computed tomography scan showed a pelvic abscess with extraluminal air (). Intravenous antibiotics were started, and CT-guided percutaneous drainage was performed. The drain was removed 1 week after discharge. One week later, he presented with dysuria and pneumaturia and was started on antibiotics. Colonoscopy confirmed diverticulosis with no other mucosal abnormalities. He underwent a successful laparoscopic sigmoidectomy with colovesical fistula takedown.
Topics: Abdominal Abscess; Administration, Intravenous; Anti-Bacterial Agents; Colonoscopy; Diverticulitis, Colonic; Drainage; Humans; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 31804267
DOI: 10.1097/DCR.0000000000001552 -
The New England Journal of Medicine Sep 2021
Topics: Abdominal Abscess; Abdominal Pain; Actinomyces; Actinomycosis; Female; Fever; Humans; Intrauterine Devices; Middle Aged; Tomography, X-Ray Computed; Uterus
PubMed: 34469649
DOI: 10.1056/NEJMicm2102632 -
The American Journal of Emergency... Sep 2020An 85-year-old cachectic man was found unconscious in his home. He had no specific medical history. On arrival, he was in a deep coma and hypothermic state. He had a...
An 85-year-old cachectic man was found unconscious in his home. He had no specific medical history. On arrival, he was in a deep coma and hypothermic state. He had a soft mass the size of his fist in the right lower abdomen without redness or heat. Truncal computed tomography revealed subcutaneous fluid collection with gas formation. A test puncture for right lower abdominal subcutaneous fluid collection revealed pus, so an open incision was performed, with the administration of broad-spectrum antibiotics. Unfortunately, the patient died of sepsis-induced multiple organ failure. The results of abscess culture later revealed Proteus mirabilis, Escherichia coli, and Prevotella melaninogenica. This is the first report of a cold abscess induced by mixed bacteria.
Topics: Abdominal Abscess; Aged, 80 and over; Coma; Fatal Outcome; Humans; Male; Tomography, X-Ray Computed
PubMed: 32444294
DOI: 10.1016/j.ajem.2020.04.096 -
The New England Journal of Medicine Apr 2020
Topics: Abdominal Abscess; Humans; Male; Middle Aged; Neck; Sweet Syndrome
PubMed: 32294348
DOI: 10.1056/NEJMicm1911025 -
United European Gastroenterology Journal Dec 2022Management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging. After initial drainage and antibiotherapy treatment, surgery with delayed... (Review)
Review
Management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging. After initial drainage and antibiotherapy treatment, surgery with delayed intestinal resection is often recommended but new data suggests efficacy of biotherapies in this context. This review aims to summarize new data regarding efficacy and safety of anti-TNF in the management of intra-abdominal abscesses complicating CD. We performed a review of the literature on medical management of intra-abdominal abscesses complicating CD. After effective drainage of abscess, treatment with anti-TNF can allow resolving of abscess. In some patients and at a specific timing, the use of biotherapies could avoid delayed surgery and long-term abscess recurrence.
Topics: Humans; Crohn Disease; Biological Products; Abscess; Tumor Necrosis Factor Inhibitors; Treatment Outcome; Abdominal Abscess
PubMed: 36479929
DOI: 10.1002/ueg2.12342