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Journal of Crohn's & Colitis Apr 2024Intra-abdominal abscesses complicating Crohn's disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear.
Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn's Disease: A National, Multicentre Study Based on ENEIDA Registry.
INTRODUCTION
Intra-abdominal abscesses complicating Crohn's disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear.
METHODS
Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression.
RESULTS
In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed.
CONCLUSIONS
Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.
Topics: Humans; Crohn Disease; Abdominal Abscess; Male; Female; Drainage; Adult; Registries; Anti-Bacterial Agents; Recurrence; Spain; Middle Aged; Secondary Prevention
PubMed: 37930823
DOI: 10.1093/ecco-jcc/jjad184 -
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 -
BMJ Case Reports Nov 2022Klebsiella invasive syndrome is a rare condition that typically presents as a liver abscess with metastatic infection, with mortality rates as high as 14% potentially...
Klebsiella invasive syndrome is a rare condition that typically presents as a liver abscess with metastatic infection, with mortality rates as high as 14% potentially due to diagnostic delay by clinicians. Here, we present a case of a woman in her 60s, who presented with symptoms and signs consistent with meningitis, imaging findings suggestive of possible leptomeningeal carcinomatosis a long with areas of lung consolidation and abdominal nodules and lymphadenopathy, presumably metastatic malignancy. We diagnosed Klebsiella invasive syndrome and treated it conservatively with medical management, including a long course of intravenous antibiotic therapy and supportive care. This is an infrequently encountered clinical entity with potentially fatal consequences, and we hope to add to the existing literature on the subject and drive home the point that it should be considered in the differential diagnoses in the appropriate clinical scenario.
Topics: Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Klebsiella; Delayed Diagnosis; Liver Abscess; Syndrome
PubMed: 36368733
DOI: 10.1136/bcr-2022-251977 -
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 -
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 -
The Journal of Surgical Research Jan 2021Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to...
BACKGROUND
Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT.
METHODS
The (2012-2015) National Readmission Database was queried for all adult (age ≥18 y) trauma patients with penetrating injuries who underwent exploratory laparotomy and were readmitted within 6 mo of index hospitalization discharge. Patients were stratified by firearm injuries (FIs) and stab injuries (SIs). Primary outcomes were rates of MAC: intra-abdominal abscesses (IAAs), superficial surgical site infection (SSI), and fascial dehiscence within 6 mo after discharge. Secondary outcomes were both nonabdominal complications and mortality, postdischarge, and 6-mo readmission. Regression analysis was performed.
RESULTS
A total of 4473 patients (FI, 2326; SI, 2147) were included in the study; the mean age was 32 ± 14 y, the Injury Severity Score was 19 (15-25), and 23% underwent damage control laparotomy (DCL). The rate of MAC within 6 mo was 22% (IAA 19%, SSI 7%, and fascial dehiscence 4%). Patients with FIs had a higher rate of IAA (27% versus 10%; P < 0.01), SSI (11% versus 3%; P < 0.01), fascial dehiscence (5% versus 3%; P = 0.03), nonabdominal complications (54% versus 24%; P < 0.01), and postdischarge mortality (8% versus 6%; P < 0.01) compared with patients with SIs . On regression analysis, DCL (P < 0.01), large bowel perforation (P < 0.01), biliary-pancreatic injury (P < 0.01), hepatic injury (P < 0.01), and blood transfusion (P = 0.02) were predictors of MAC.
CONCLUSIONS
MAC developed in one in five patients after PAT. FIs have a higher potential for hollow viscus injury and peritoneal contamination, and are more predictive of MAC and nonabdominal complications, especially after DCL.
LEVEL OF EVIDENCE
Level III Prognostic.
Topics: Abdomen; Abdominal Abscess; Abdominal Injuries; Adolescent; Adult; Female; Humans; Injury Severity Score; Laparotomy; Male; Middle Aged; Patient Readmission; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Wounds, Gunshot; Wounds, Penetrating; Wounds, Stab; Young Adult
PubMed: 32818786
DOI: 10.1016/j.jss.2020.07.060 -
Surgery Jul 2022Intra-abdominal abscess, the most common complication after perforated appendicitis, is associated with considerable economic burden. However, costs of intra-abdominal...
BACKGROUND
Intra-abdominal abscess, the most common complication after perforated appendicitis, is associated with considerable economic burden. However, costs of intra-abdominal abscesses in children are unknown. We aimed to evaluate resource utilization and costs attributable to intra-abdominal abscess in pediatric perforated appendicitis.
METHODS
A single-center retrospective analysis was performed of children (<18 years) who underwent appendectomy for perforated appendicitis (2013-2019). Hospital costs incurred during the index admission and within 30 postoperative days were obtained from the hospital accounting system and inflated to 2019 USD. Generalized linear models were used to determine excess resource utilization and costs attributable to intra-abdominal abscess after adjusting for confounders.
RESULTS
Of 763 patients, 153 (20%) developed intra-abdominal abscesses. Eighty-one patients with intra-abdominal abscesses (53%) underwent percutaneous abscess drainage. Intra-abdominal abscess was independently associated with a nearly 8-fold increased risk of 30-day readmission (adjusted risk ratio, 7.8 [95% confidence interval, 4.7-13.0]). Patients who developed an intra-abdominal abscess required 6.1 excess hospital bed days compared to patients without intra-abdominal abscess (95% confidence interval, 5.3-7.0). Adjusted mean hospital costs for patients with intra-abdominal abscess totaled $27,394 (95% confidence interval, $25,688-$29,101) versus $15,586 (95% confidence interval, $15,102-$16,069) for patients without intra-abdominal abscess. Intra-abdominal abscess was associated with an incremental cost of $11,809 (95% confidence interval, $10,029-$13,588). Hospital room costs accounted for 66% of excess costs.
CONCLUSION
Postoperative intra-abdominal abscess nearly doubled pediatric perforated appendicitis costs, primarily due to more hospital bed days and associated room costs. Intra-abdominal abscesses resulted in estimated excess costs of $1.8 million during the study period. Even small reductions in intra-abdominal abscess rates or hospital bed days could yield substantial health care savings.
Topics: Abdominal Abscess; Appendectomy; Appendicitis; Child; Humans; Postoperative Complications; Retrospective Studies
PubMed: 35279294
DOI: 10.1016/j.surg.2022.01.042 -
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 -
Deutsche Medizinische Wochenschrift... Jan 2023An 88-year-old man presented with recurrent fever, weakness, and nausea without emesis for more than four months. Multiple hospital admissions followed, but the reason...
ANAMNESIS
An 88-year-old man presented with recurrent fever, weakness, and nausea without emesis for more than four months. Multiple hospital admissions followed, but the reason remained unclear. Eleven years previously, a laparoscopic cholecystectomy had been performed.
EXAMINATION
Routine blood tests revealed leukocytosis and elevated C-reactive protein. A CT-scan of the abdomen revealed a big abscess extending from the intra-abdominal cavity to the subcutaneous tissue near the lumbovertebral column L2 to L5.
DIAGNOSIS
We postulated an intra-abdominal abscess due to a lost gallstone after laparoscopic cholecystectomy 11 years ago.
TREATMENT AND FOLLOW UP
The patient underwent surgery and was treated with antibiotics Postoperatively, he suffered from delirium. After prolonged secondary wound healing and antibiotic therapy, the patient was free of infection and could be discharged to his home after rehabilitation.
CONCLUSION
Diagnosis was complicated by the clinical presentation, which is often atypical for geriatric patients. Diagnostic delays and recurrent hospitalizations increase the risk of morbidity and mortality. Although the gallstone was never retrieved, another cause of his symptoms was unlikely, as the patient has remained infection-free ever since.
Topics: Male; Humans; Aged; Aged, 80 and over; Gallstones; Abdominal Abscess; Abscess; Cholecystectomy, Laparoscopic; Tomography, X-Ray Computed; Anti-Bacterial Agents
PubMed: 36592633
DOI: 10.1055/a-1961-3597 -
ANZ Journal of Surgery Oct 2020
Topics: Abdominal Abscess; Appendectomy; Drainage; Humans
PubMed: 33710733
DOI: 10.1111/ans.16134