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British Medical Bulletin Dec 2019Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The... (Review)
Review
INTRODUCTION
Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings.
SOURCES OF DATA
We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'.
AREAS OF AGREEMENT
Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics.
AREAS OF CONTROVERSY
In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings.
GROWING POINTS
As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced.
AREAS TIMELY FOR DEVELOPING RESEARCH
The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.
Topics: Anti-Bacterial Agents; Humans; Liver Abscess; Liver Abscess, Amebic; Liver Abscess, Pyogenic; Medically Underserved Area; Prognosis
PubMed: 31836890
DOI: 10.1093/bmb/ldz032 -
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 -
Emergency Medicine Practice Dec 2022Pelvic inflammatory disease is associated with complications that include infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The... (Review)
Review
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.
Topics: Pregnancy; Female; Humans; Pelvic Inflammatory Disease; Oophoritis; Abdominal Abscess; Emergency Service, Hospital; Pregnancy, Ectopic
PubMed: 36378827
DOI: No ID Found -
Journal of Crohn's & Colitis Feb 2020This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of...
This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of previous guidelines.
Topics: Abdominal Abscess; Crohn Disease; Humans; Intestinal Obstruction; Intestine, Small; Rectal Fistula
PubMed: 31742338
DOI: 10.1093/ecco-jcc/jjz187 -
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 -
Revue Medicale de Liege Nov 2020Liver abscess is a rare condition. There are multiple etiologies and mortality linked to the infections or local complications is high. The rapid diagnosis and the... (Review)
Review
Liver abscess is a rare condition. There are multiple etiologies and mortality linked to the infections or local complications is high. The rapid diagnosis and the implementation of an adequate and effective treatment are essential to allow healing without sequels. We report the case of a monofocal bacterial hepatic abscess in a 61-year-old patient with an iatrogenic origin. A review of the literature is proposed in order to address the incidence, the different microorganisms, the different etiologies and the different possibilities of treatment. It should be noted that mycotic abscess, which is extremely rare outside the immunocompromised patient, will not be discussed in this article.
Topics: Humans; Liver Abscess; Middle Aged
PubMed: 33155447
DOI: No ID Found -
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 -
Medical Archives (Sarajevo, Bosnia and... Oct 2019Colorectal Cancer (CRC) is the third most common malignant disease and the fourth most common cause of death associated with malignancy. Adenocarcinomas account for 95%... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Colorectal Cancer (CRC) is the third most common malignant disease and the fourth most common cause of death associated with malignancy. Adenocarcinomas account for 95% of all cases of colon cancer. Treatment usually includes a surgical resection which is preceded or followed by chemotherapy and radiotherapy depending on the stage. There is constant interest in the microbiological ecosystem of the intestine, which is considered to be crucial for the onset and progression of the disease as well as the development of postoperative complications. Iatrogenic factors associated with the treatment of CRC may result in pronounced expression of virulence of the bacterial intestinal flora and fulminant inflammatory response of the host which ultimately leads to adverse treatment results. The modulation of intestinal microflora by probiotics seems to be an effective method of reducing complications in surgical patients. The question is whether ordering probiotics can lead to more favourable treatment outcomes for our patients who are operated due to colorectal adenocarcinoma, and whether this should become common practice.
AIM
To demonstrate the clinical significance of probiotic administration in patients treated for colorectal adenocarcinoma and the results compared with relevant studies.
PATIENTS AND METHODS
In a randomized controlled prospective study conducted at the Clinic of General and Abdominal Surgery of the UCCS in the period of 01 January 2017 until 31 December 2017, there were a total of 78 patients with colorectal adenocarcinoma. Patients were divided into two groups: a group treated with oral probiotics (n = 39) according to the 2x1 scheme starting from the third postoperative day lasting for the next thirty days, followed by 1x1 lasting for two weeks in each subsequent month to one year, and the control group (n = 39) which was not routinely treated with probiotics.
RESULTS
A statistically significant difference in the benefit of using probiotics was found during postoperative hospitalization and the occurrence of fatal outcome in the first six months. All complications were more present in the group of patients untreated with probiotic, with statistical significance shown only in the case of ileus. Probiotic has a statistically significant reduction in postoperative complications in the localization of tumours on the rectum -33.3% and the ascending colon -16.7%.
CONCLUSION
There is a significant benefit of administering probiotics in surgically treated patients for colorectal adenocarcinoma.
Topics: Abdominal Abscess; Adenocarcinoma; Anastomotic Leak; Bifidobacterium; Colectomy; Colon, Ascending; Colorectal Neoplasms; Humans; Ileus; Lactobacillus; Neoplasm Staging; Postoperative Care; Postoperative Complications; Probiotics; Rectal Neoplasms; Streptococcus thermophilus; Surgical Wound Infection
PubMed: 31819304
DOI: 10.5455/medarh.2019.73.316-320 -
Revue Medicale Suisse Sep 2020Pyogenic-liver abscess is a relatively rare entity in Europe. Due to unspecific clinical and biological findings, the diagnosis can be difficult. Imaging by ultrasound,... (Review)
Review
Pyogenic-liver abscess is a relatively rare entity in Europe. Due to unspecific clinical and biological findings, the diagnosis can be difficult. Imaging by ultrasound, CT-scan or MRI is important to confirm the diagnosis and to determine further investigations and treatment. According to the characteristics of the abscess, a surgical intervention may be necessary, particularly is the abscess diameter is bigger than 5 cm. This can be done either by surgery or by percutaneous drainage (needle aspiration versus catheter drainage). Obtaining adequate microbiologic cultures is important to identify the responsible pathogens and their resistance profile before starting broad spectrum antibiotics. Antibiotic treatment should be adapted to microbiologic results. The recommended treatment duration is usually between 4 and 6 weeks according to clinical evolution.
Topics: Drainage; Europe; Humans; Liver Abscess, Pyogenic
PubMed: 32997454
DOI: No ID Found