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Medicine Dec 2019There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups.
METHODS
We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3.
RESULTS
We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26).
CONCLUSION
Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.
Topics: Abdominal Abscess; Appendectomy; Appendicitis; Child; Humans; Intraoperative Period; Laparoscopy; Peritoneal Lavage; Postoperative Complications
PubMed: 31852066
DOI: 10.1097/MD.0000000000018047 -
Andes Pediatrica : Revista Chilena de... Apr 2022Kidney abscess is an unusual entity in childhood with few studies about its clinical characteris tics.
UNLABELLED
Kidney abscess is an unusual entity in childhood with few studies about its clinical characteris tics.
OBJECTIVE
To report the clinical presentation, diagnosis, and therapy used in a cohort of 20 children with kidney abscess.
PATIENTS AND METHOD
retrospective study of cases of kidney abscess during a 10-year period at the Hospital Roberto del Río. The analysis of clinical, laboratory, and imaging characteristics were evaluated as well as the treatment usedfor this condition.
RESULTS
20 cases were reported among which 65% were women with a median age of 3.6 years. The most com mon clinical presentation was fever, vomit, and dysuria. Eighty percent of patients presented an increase of inflammatory parameters, 88% presented positive urine culture, and the most common organism identified was Escherichia Coli (77.8%). The diagnosis was mostly made through kidney ultrasound (75%) followed by an abdominal CT scan (35%). 93% of abscesses were unilateral. About 95% of the patients only required antibiotic treatment. Vesicoureteral reflux was diagno sed in 28% of the patients with no sphincter control, and only one of them presented high-grade reflux. In patients with sphincter control, bladder and bowel dysfunction (BBD) was diagnosed in 90% of the cases. Forty four percent of the patients with late DMSA renal scintigraphy presented renal scarring.
CONCLUSIONS
In this series, pediatric kidney abscess appears with persistent fever despite the treatment, requiring prolonged antibiotic therapy and rarely surgical drains. We su ggest a study aimed at detecting modifiable factors, such as vesicoureteral reflux in patients with no sphincter control and BBD in patients with sphincter control, as well as identifying renal paren chymal sequels in all patients.
Topics: Abdominal Abscess; Abscess; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Kidney Diseases; Male; Retrospective Studies; Urinary Tract Infections; Vesico-Ureteral Reflux
PubMed: 35735301
DOI: 10.32641/andespediatr.v93i2.3765 -
PloS One 2020Perioperative oral management has been reported to be effective for preventing postoperative infectious complications. In addition, severe periodontal disease was...
BACKGROUND
Perioperative oral management has been reported to be effective for preventing postoperative infectious complications. In addition, severe periodontal disease was identified as the significant risk factor for complications after gastrointestinal surgery. We investigated the bacteriological association between the periodontal pocket, stomach mucosa and drainage fluid to determine whether oral bacteria directly cause intra-abdominal infection after gastrectomy.
METHODS
Patients who were scheduled to undergo surgery for gastric cancer were prospectively enrolled. We evaluated the similarity of bacterial strains in periodontal pocket, stomach mucosa and fluid from drainage tube. Gingival crevicular fluid and dental plaque were collected from the periodontal pocket and cultured to detect bacteria. Specimens from the resected stomach were collected and used for bacterial culturing. Drainage fluid from the abdominal cavity was also cultured.
RESULTS
All of 52 patients were enrolled. In the periodontal pocket, α-Streptococcus spp., Neisseria sp., and Prevotella sp. were mainly detected. Bacterial cultures in the stomach mucosa were positive in 26 cases. In 20 cases (76.9%), the detected strains were the same as those in the periodontal pocket. Six patients had the postoperative intra-abdominal infection after gastrectomy, and the same bacterial strains was detected in both of drainage fluid and periodontal pocket in two patients with severe periodontal disease.
CONCLUSIONS
We found the bacteriological association that same strain detected in periodontal pocket, stomach and in intra-abdominal drainage fluid after gastrectomy in patients with periodontal disease.
Topics: Abdominal Abscess; Aged; Female; Gastrectomy; Gastric Mucosa; Humans; Male; Mouth Mucosa; Neisseria; Periodontitis; Postoperative Complications; Prevotella; Streptococcus
PubMed: 33166362
DOI: 10.1371/journal.pone.0242091 -
BMJ Case Reports Oct 2019We present a very rare case of concurrent empyema and liver abscess caused by Fusobacterium. Our patient presented with 3-month history of subtle abdominal discomfort... (Review)
Review
We present a very rare case of concurrent empyema and liver abscess caused by Fusobacterium. Our patient presented with 3-month history of subtle abdominal discomfort and cough leading to eventually presenting with marked chest pain, dyspnoea and septic shock. CT revealed a liver abscess and large right-sided pleural effusion. Drainage of the pleural effusion yielded gross pus with the growth of , while drainage of the liver abscess yielded The patient responded to drainage and antibiotic therapy with resolution of symptoms and decrease in the size of empyema and abscess on follow-up imaging. We also include a review if literature of related fusobacterial infections.
Topics: Empyema, Pleural; Fusobacterium; Fusobacterium Infections; Humans; Liver Abscess, Pyogenic; Male; Middle Aged
PubMed: 31615779
DOI: 10.1136/bcr-2019-231994 -
Disease Markers 2022Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic...
BACKGROUND
Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic patients with BLA have higher rates of related adverse events than patients without diabetes.
AIM
To explore the clinical characteristics of BLA complicated with diabetes and nondiabetes-related BLA.
METHODS
From January 2019 to June 2020, 61 diabetic patients with BLA were included as the study group, and 61 BLA patients without diabetes were included as the control group. Clinical manifestations, laboratory examination index (prothrombin activity (PTA), albumin (propagated), white blood cell count (WBC), red blood cell count (RBC), plasma fibrinogen (FIB), C-reactive protein (CRP), neutrophil percentage (NEUT), and prealbumin (PA)) levels, blood cultivation, and fester situation in the two groups were analyzed.
RESULTS
No differences of Fever, right upper abdominal pain, jaundice, vomiting and nausea, liver tenderness, and liver pain upon percussion were observed between the study and control groups. However, chill, cough and expectoration, and liver pain upon percussion were higher in the study group, while abdominal distension was lower. WBC, RBC, PA, PTA, FIB, and CRP were higher than the control group. NEUT was higher in the study group than in the control group and Alb was lower than that in the control group. There was no significant difference between the positivity of blood bacterial culture in the study and control groups. The positivity rate of in Gram-negative aerobic bacteria in the study group was higher than that in the control group. There was no significant difference between the positivity of fester culture of the two groups. The positivity of in Gram-negative aerobic bacteria in the study group was higher than that in the control group. The positivity of was lower in the study group than in the control group.
CONCLUSION
Clinical manifestations and laboratory results of BLA patients with and without diabetes mellitus were significantly different. The symptoms of diabetics with BLA were serious.
Topics: Bacteria; C-Reactive Protein; Diabetes Mellitus; Escherichia coli; Humans; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Pain
PubMed: 35521637
DOI: 10.1155/2022/7512736 -
BMJ Case Reports Jun 2015A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain...
A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain settled with analgaesia and he was discharged with a course of oral co-amoxiclav. He was readmitted to the hospital 7 days later reporting cough and shortness of breath. His chest X-ray showed a raised right hemi-diaphragm, presumed consolidation and a right-sided effusion. As a result, he was treated for pneumonia. Despite antibiotic therapy his C reactive protein remained elevated, prompting an attempt at ultrasound-guided drainage of his effusion. Finding only a small amount of fluid, a CT of the chest was performed, and this showed a subphrenic abscess and free air under the diaphragm. A CT of the abdomen was then carried out, showing a perforated appendix. An emergency laparotomy was performed, the patient's appendix was removed and the abscess drained.
Topics: Abdominal Pain; Adult; Appendectomy; Appendicitis; Cough; Diagnostic Errors; Drainage; Humans; Laparotomy; Male; Pneumonia; Subphrenic Abscess; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26055585
DOI: 10.1136/bcr-2014-207588 -
Revista Espanola de Enfermedades... Feb 2023Liver abscesses are an entity that sets out a diagnostic challenge with a severe clinical course and non-negligible mortality. Their origin is usually bacterial (>80%),...
Liver abscesses are an entity that sets out a diagnostic challenge with a severe clinical course and non-negligible mortality. Their origin is usually bacterial (>80%), parasitic, mixed or, more rarely, fungal. We present the case report of a 45-year-old man, native of Ghana, with no relevant medical-surgical history, was admitted for septic shock with multiple organ dysfuntion syndrome. Complementary imaging tests revealed a liver abscess in segments IV and VII measuring 60x45x54 mm, so antibiotic treatment with piperacillin-tazobactam was started and a pigtail drainage was placed. In blood cultures, the microorganism parvimonas micra (anaerobic gram-positive cocci) was isolated with high degree of sensitivity rates to penicillin, clindamycin and metronidazole. Treatment was de-escalated to clindamycin until completing 4 weeks of intravenous treatment. Control CT showed a decrease in the size of the abscess and pigtail drainage was removed.
Topics: Male; Humans; Middle Aged; Clindamycin; Anti-Bacterial Agents; Firmicutes; Liver Abscess
PubMed: 35315681
DOI: 10.17235/reed.2022.8751/2022 -
International Surgery 2014Treatment of complicated acute appendicitis is controversial. The dilemma is further complicated by presence of free fecalith in a well-circumscribed abscess, which has...
Treatment of complicated acute appendicitis is controversial. The dilemma is further complicated by presence of free fecalith in a well-circumscribed abscess, which has been repeatedly demonstrated to be a major predicting factor of treatment failure of nonoperative treatment of acute appendicitis complicated with appendiceal abscess. If left behind after drainage of the abscess, further operations for removal of retained fecalith or recurrence of abscess might be required. However, little had been stressed over the significance of removal of the free fecalith when it was first encountered. We report our experience of drainage of appendiceal abscess and removal of free fecalith by taking an extraperitoneal approach. Both of our cases made a smooth recovery without any complication or recurrence after a 2-year follow-up. Treatment with this approach avoids many of the complications associated with formal laparotomy. Unlike image-guided drainage or laparoscopic drainage, this procedure is relatively simple and straightforward and can be performed in any level of hospital, including private practitioners and in less well-developed areas and countries. With proper case selection, we recommend this approach as one of the alternatives in the treatment of late-presenting appendiceal abscess with free fecalith.
Topics: Abdominal Abscess; Adolescent; Aged; Appendectomy; Appendicitis; Diagnosis, Differential; Drainage; Fecal Impaction; Female; Humans; Male; Tomography, X-Ray Computed
PubMed: 25058769
DOI: 10.9738/INTSURG-D-13-00040.1 -
World Journal of Gastroenterology Jul 2014With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have... (Review)
Review
With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have increased. Pancreaticoduodenectomy, one type of pancreatic resection, is a complex surgery with the loss of pancreatic integrity and various anastomoses. Complications after pancreaticoduodenectomy such as pancreatic fistulas and anastomosis leakage are common and significantly associated with patient outcomes. Pancreatic fistula is one of the most important postoperative complications; this condition can cause intraperitoneal hemorrhage, septic shock, or even death. An effective way has not yet been found to avoid the occurrence of pancreatic fistula. In most medical centers, the frequency of pancreatic fistula has remained between 9% and 13%. The early detection and routine drainage of anastomotic fistulas, pancreatic fistulas, bleeding, or other intra-abdominal fluid collections after pancreatic resections are considered as important and effective ways to reduce postoperative complications and the mortality rate. However, many recent studies have argued that routine drainage after abdominal operations, including pancreaticoduodenectomies, does not affect the incidence of postoperative complications. Although inserting drains after pancreatic resections continues to be a routine procedure, its necessity remains controversial. This article reviews studies of the advantages and disadvantages of routine drainage after pancreaticoduodenectomy and discusses the necessity of this procedure.
Topics: Abdominal Abscess; Drainage; Humans; Pancreatic Fistula; Pancreaticoduodenectomy; Risk Factors; Treatment Outcome; Unnecessary Procedures
PubMed: 25009383
DOI: 10.3748/wjg.v20.i25.8110 -
International Journal of Surgery... Jul 2023Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD). However, its risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD). However, its risk factors are still unclear. This meta-analysis aimed to identify the potential risk factors of DGE among patients undergoing PD or PPPD.
MATERIALS AND METHODS
We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrial.gov for studies that examined the clinical risk factors of DGE after PD or PPPD from inception through 31 July 2022. We pooled odds ratios (ORs) with 95% CIs using random-effects or fixed-effects models. We also performed heterogeneity, sensitivity, and publication bias analyses.
RESULTS
The study included a total of 31 research studies, which involved 9205 patients. The pooled analysis indicated that out of 16 nonsurgical-related risk factors, three risk factors were found to be associated with an increased incidence of DGE. These risk factors were older age (OR 1.37, P =0.005), preoperative biliary drainage (OR 1.34, P =0.006), and soft pancreas texture (OR 1.23, P =0.04). On the other hand, patients with dilated pancreatic duct (OR 0.59, P =0.005) had a decreased risk of DGE. Among 12 operation-related risk factors, more blood loss (OR 1.33, P =0.01), postoperative pancreatic fistula (POPF) (OR 2.09, P <0.001), intra-abdominal collection (OR 3.58, P =0.001), and intra-abdominal abscess (OR 3.06, P <0.0001) were more likely to cause DGE. However, our data also revealed 20 factors did not support stimulative factors influencing DGE.
CONCLUSION
Age, preoperative biliary drainage, pancreas texture, pancreatic duct size, blood loss, POPF, intra-abdominal collection, and intra-abdominal abscess are significantly associated with DGE. This meta-analysis may have utility in guiding clinical practice for improvements in screening patients with a high risk of DGE and selecting appropriate treatment measures.
Topics: Humans; Pancreaticoduodenectomy; Gastroparesis; Pylorus; Pancreatic Fistula; Risk Factors; Postoperative Complications; Abdominal Abscess; Gastric Emptying
PubMed: 37073540
DOI: 10.1097/JS9.0000000000000418