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World Journal of Clinical Cases May 2024Human cystic echinococcosis (CE) is a life-threatening zoonosis caused by the (sensu lato). Hepatocellular carcinoma (HCC) is a leading cause of cancer-related...
BACKGROUND
Human cystic echinococcosis (CE) is a life-threatening zoonosis caused by the (sensu lato). Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in the world. The coexistence of CE and HCC is exceedingly rare, and only several well-documented cases have been reported. In addition to this coexistence, there is no report of the coexistence of CE, HCC, and liver abscess to date. Herein, we aimed to report a case of coexistence of liver abscess, hepatic CE, and HCC.
CASE SUMMARY
A 65-year-old herdsman presented to the department of interventional therapy with jaundice, right upper abdominal distension and pain for 10 d. Laboratory test showed that he had positive results for HBsAg, HBeAb, HBcAb, and echinococcosis IgG antibody. The test also showed an increased level of alpha fetoprotein of 3400 ng/mL. An abdominal computed tomography (CT) scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver. In addition, CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images, the diagnoses of hepatic CE (CE4 subtype) and HCC were established. Initially, transarterial chemoembolization was performed for HCC. In the follow-up, liver abscess occurred in addition to CE and HCC; thus, percutaneous liver puncture drainage was performed. In the next follow-up, CE and HCC were stable. The liver abscess was completely resolved, and the patient was discharged with no evidence of recurrence.
CONCLUSION
This is the first reported case on the coexistence of liver abscess, hepatic CE, and HCC. Individualized treatment and multidisciplinary discussions should be performed in this setting. Therefore, treatment and diagnosis should be based on the characteristics of liver abscess, hepatic CE, and HCC, and in future clinical work, it is necessary to be aware of the possibility of this complex composition of liver diseases.
PubMed: 38765738
DOI: 10.12998/wjcc.v12.i14.2404 -
Medicine May 2024Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to... (Observational Study)
Observational Study
Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.
Topics: Humans; Male; Retrospective Studies; Female; Tomography, X-Ray Computed; Sepsis; Middle Aged; Aged; Length of Stay; Emergency Service, Hospital; Liver Abscess; Adult; Pyelonephritis; Cholangitis; Aged, 80 and over; Fever of Unknown Origin
PubMed: 38758906
DOI: 10.1097/MD.0000000000038114 -
International Journal of Surgery Case... Jun 2024Primary breast sarcoma (PBS), excluding phyllodes tumors, is an extremely rare and heterogeneous group of cancers, accounting for <1 % of all breast cancers. PBS is...
INTRODUCTION
Primary breast sarcoma (PBS), excluding phyllodes tumors, is an extremely rare and heterogeneous group of cancers, accounting for <1 % of all breast cancers. PBS is typically diagnosed in the fifth or sixth decades of life. There are no pathognomonic clinical or radiological features. Diagnosis is generally established through a microbiopsy. For young women, the diagnosis can be confused with a benign pathology.
CLINICAL PRESENTATION
Our patient was 27 years old, with no family or personal history of breast cancer, which was initially brought to the emergency department with a breast abscess. The clinical diagnosis of abscessed mastitis was made. The patient underwent tissue excision with evacuation of blood clots and necrotic tissue. Histopathological examination revealed a primary breast sarcoma. An MRI showed locally advanced retro-glandular tumor. An abdominal and pelvic CT scan performed showed no evidence of secondary locations. Therefore, the patient was referred for neoadjuvant radiotherapy and chemotherapy. After the third course of chemotherapy, the patient died following cardiogenic shock.
DISCUSSION
The PBS in younger women is extremely rare. The etiopathogenesis remains undetermined. The clinical and radiological characteristics of PBS mimic breast adenocarcinoma. Mastectomy is the treatment of choice but in the case of locally advanced tumor, the use of neoadjuvant chemotherapy can be indicated. PBS presents a significantly poorer prognosis.
CONCLUSION
Breast sarcomas are rare malignant tumors for which treatment protocols are not well-established. Further research efforts are needed to improve the understanding and treatment of PBS.
PubMed: 38749389
DOI: 10.1016/j.ijscr.2024.109587 -
Surgical Neurology International 2024Ventriculoperitoneal (VP) shunt placement is one of the most performed procedures in neurosurgery to treat various types of hydrocephalus (HC). Immediate or late...
BACKGROUND
Ventriculoperitoneal (VP) shunt placement is one of the most performed procedures in neurosurgery to treat various types of hydrocephalus (HC). Immediate or late postoperative complications may quite commonly occur, especially in immunosuppressed patients, who are predisposed to develop rare and difficult-to-treat conditions.
CASE DESCRIPTION
Herein, we report the case of a 41-year-old female patient with a prior history of acute myeloid leukemia, followed by a tetra-ventricular acute HC due to a spontaneous non-aneurysmal subarachnoid hemorrhage. After an urgent external ventricular drainage placement, she underwent careful testing of "shunt dependency," which ended with a VP shunt placement. After 2 months, she presented at the emergency department with worsening abdominal pain and fever. She underwent a computed tomography scan with contrast administration, which has shown abscesses in the abdominal cavity. An urgent surgical revision of the VP shunt and antibiotics administration followed this. After inflammatory markers normalization, due to the high risk of post-infective peritoneal adherence and consequent impairment of cerebrospinal fluid absorption, a ventriculoatrial shunt was considered the most appropriate solution.
CONCLUSION
Abdominal abscesses are a rare but subtle complication after VP shunt placement. Their management depends on etiology, patient clinical characteristics, and manifestations. Prompt interventions have been shown to improve clinical outcomes and optimize quality of life in such delicate patients.
PubMed: 38742012
DOI: 10.25259/SNI_151_2024 -
BMC Infectious Diseases May 2024Pyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger....
BACKGROUND & AIMS
Pyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS).
METHODS
The study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group (n = 91) and the non-BS group (n = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n = 22) and non-bilioenteric anastomoses group (non-BEA, n = 69). Clinical characteristics were recorded and analyzed.
RESULTS
The percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities (P = 0.009 and P = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus (P < 0.001) and solitary abscesses (P = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures (P = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history (P = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%).
CONCLUSIONS
Patients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.
Topics: Humans; Liver Abscess, Pyogenic; Male; Female; Middle Aged; Retrospective Studies; Aged; Biliary Tract Surgical Procedures; Adult; Anti-Bacterial Agents; Escherichia coli; Drainage
PubMed: 38730338
DOI: 10.1186/s12879-024-09378-x -
Journal of Minimal Access Surgery May 2024Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and...
INTRODUCTION
Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and post-operative complications of laparoscopic interventions in the treatment of perforated appendicitis.
PATIENTS AND METHODS
One hundred and ten patients (50 men and 60 women) diagnosed with perforated appendicitis based on history, physical examinations, laboratory and computed tomography findings between January 2016 and May 2022 were analysed retrospectively. Preoperative laboratory and radiological findings, surgical methods and post-operative complications were evaluated.
RESULTS
Abdominal pain defence and rebound were present in all patients. In terms of radiological findings, intra-abdominal free fluid was present in all patients and abscess in 42. Post-operative abdominal surgical site infection developed in six patients. No intra-abdominal abscess or incisional hernia was observed during follow-ups.
CONCLUSION
As a diagnostic tool, permitting better visualisation of the abdominal cavity, entailing fewer post-operative complications and obviating the need for large incisions, laparoscopy can represent the approach of choice in the treatment of perforated appendicitis.
PubMed: 38726968
DOI: 10.4103/jmas.jmas_241_23 -
Journal of Clinical Medicine Research Apr 2024Pancreatoduodenectomy (PD) is a very complex and highly challenging operation for surgeons worldwide. It is the surgical procedure of choice for the management of benign...
Pancreatoduodenectomy (PD) is a very complex and highly challenging operation for surgeons worldwide. It is the surgical procedure of choice for the management of benign and malignant diseases of the periampullary region. Although mortality rate following this complicated surgery has fallen to 1-3%, morbidity rate following PD remains high, with almost 30-40% of patients developing at least one complication. Postoperative pancreatic fistula (POPF) is one of the most common complications following PD. Therefore, Pancreatico-enteric anastomosis has been regarded as the "Achilles heel" of the modern, one-stage PD procedure. According to the International Study Group of Pancreatic Surgery (ISGPS), three types of POPF are recognized nowadays: biochemical leak, previously known as grade A POPF, grade B and grade C, with the latter being the most dangerous. Most POPFs, especially of the biochemical leak and grade B heal with non-operative management to recur later and present as an intra-abdominal abscess or pseudocyst, necessitating management by means of interventional radiology, endoscopy or surgery. These types of fistulas are undefined and occasionally intractable. Herein, we present two patients who presented with the aforementioned type of pancreatic fistula following duct occlusion PD. The first patient, a 53-year-old female patient, suffered from intolerance to oral feeding, severe weight loss and recurrent hospital admission, while the second patient, a 72-year-old patient, suffered from recurrent bouts of abdominal sepsis. Their management involved step-up approach, starting with non-operative management, followed by percutaneous drainage and operative treatment in the form of Puestow-like procedure (longitudinal pancreatojejunostomy), as a recourse due to the inadequacy of preceding therapeutic modalities.
PubMed: 38715561
DOI: 10.14740/jocmr5123 -
Cureus Apr 2024Deep-tissue extension of perianal and perirectal abscesses, while rare, requires timely diagnosis and emergent surgical intervention to prevent serious secondary...
Deep-tissue extension of perianal and perirectal abscesses, while rare, requires timely diagnosis and emergent surgical intervention to prevent serious secondary complications. This report evaluates a case of intra-abdominal and extraperitoneal extension of a persistent perirectal abscess that required comprehensive irrigation, drainage, and debridement of multiple abscess-associated cavities. This report follows the case of a 24-year-old African-American female presenting to the ED with mild fevers, nausea, abdominal distension, and lower abdominal pain following a persistent perirectal abscess that had not resolved following conservative outpatient antibiotic management one week prior. Clinical examination revealed abdominal guarding with CT imaging demonstrating extraluminal air pockets in multiple intra-abdominal and extraperitoneal compartments. The patient underwent emergent surgical irrigation, drainage, and debridement of multiple abscess cavities extending from the original perirectal abscess. This report provides a comprehensive overview of the diagnosis, surgical approach, and postoperative management in a patient presenting with a complex tunneling perirectal abscess forming intra-abdominal and extraperitoneal abscesses.
PubMed: 38711725
DOI: 10.7759/cureus.57688 -
Journal of the American College of... Jun 2024
PubMed: 38707983
DOI: 10.1002/emp2.13177 -
Clinical Case Reports May 2024In the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as...
KEY CLINICAL MESSAGE
In the setting of Fournier's gangrene, atypical clinical manifestations and complications in an immunocompetent patient warrant consideration of perineal tuberculosis as a potential underlying cause.
ABSTRACT
is a rare form of extrapulmonary tuberculosis that affects the perianal region. Fournier's gangrene is an aggressive necrotizing fasciitis that primarily involves the perianal area and external genitalia. A previously healthy 38-year-old man presented with a left perianal abscess. His condition deteriorated, leading to septic shock and multiorgan dysfunction syndrome. A CT scan displayed extensive necrotizing fasciitis. Treatment included broad-spectrum antibiotics, numerous surgical perineal debridements, a transverse loop colostomy, and hyperbaric oxygen therapy. We believe the patient had pre-existing asymptomatic, non-diagnosed perianal tuberculosis, and a subsequent bacterial superinfection resulted in a perineal local abscess that progressed to severe Fournier's gangrene. The diagnosis of tuberculosis was confirmed through positive cultures and molecular identification in perineal biopsies. The patient experienced a complex clinical course with complications such as myocardial necrosis, acute respiratory distress syndrome, rhabdomyolysis with severe critical illness polyneuromyopathy and internal jugular thrombosis. Fournier's gangrene resulted in air dissection throughout the perineal fasciae, extending to the abdominal wall muscles resulting in an infected extraperitoneal spontaneous hematoma, probably caused by therapeutic anticoagulation. An extraperitoneal surgical drainage was performed. This case emphasizes the complexities in diagnosing and managing both perianal tuberculosis and Fournier's gangrene.
PubMed: 38707606
DOI: 10.1002/ccr3.8882