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SAGE Open Medical Case Reports 2024Primary psoas abscess is an uncommon yet critical factor contributing to postpartum sepsis. This report is of a case of postpartum primary psoas abscess in a 24-year-old...
Primary psoas abscess is an uncommon yet critical factor contributing to postpartum sepsis. This report is of a case of postpartum primary psoas abscess in a 24-year-old Moroccan woman. After an uncomplicated vaginal delivery, a 24-year-old primiparous Moroccan woman presented to our hospital with a 3-week history of severe left-sided lower abdominal pain that radiated to the anterior aspect of the left thigh. She had been taking ciprofloxacin, metronidazole, and paracetamol for a week without any improvement. On examination, she was febrile and pale. The laboratory analysis revealed the presence of microcytic anemia, an elevated erythrocyte sedimentation rate, and an increased level of C-reactive protein. Computed tomography scans of the abdomen, and pelvis were conducted, revealing a substantial left psoas abscess. Under the guidance of computed tomography, anterior abdominal percutaneous drainage of the abscess was successfully performed. A pan-sensitive strain was identified through culture of the specimen. The patient showed a favorable response to treatment with amoxicillin/clavulanate and gentamicin. This case illustrates that primary psoas abscess should be considered in cases of any postpartum infectious presentation.
PubMed: 38854677
DOI: 10.1177/2050313X241260184 -
Langenbeck's Archives of Surgery Jun 2024The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses...
INTRODUCTION
The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis.
MATERIALS AND METHODS
In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed.
RESULTS
The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4-21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2-29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4-20.0), p = 0.016) were identified as independent risk factors for wound infections.
CONCLUSION
The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.
Topics: Humans; Appendectomy; Appendicitis; Male; Female; Retrospective Studies; Abdominal Abscess; Anti-Bacterial Agents; Adult; Surgical Wound Infection; Middle Aged; Incidence; Risk Factors; Postoperative Complications
PubMed: 38850459
DOI: 10.1007/s00423-024-03367-z -
Abdominal Radiology (New York) Jun 2024The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the... (Review)
Review
PURPOSE
The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks.
METHODS
A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article.
RESULTS
214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG.
CONCLUSION
Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
PubMed: 38849536
DOI: 10.1007/s00261-024-04381-x -
Injury Jun 2024Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever,...
Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever, tachycardia, tachypnea, and/or leukocytosis. We hypothesize this diagnostic modality is low-yield in the postoperative period when surgery-related sequelae are more probable. Methods This is a single-center retrospective cohort study of patients who underwent trauma laparotomy and had subsequent CT for CD from March 19, 2019 to June 30, 2022. Descriptive statistics and multiple logistic regression were performed. The primary outcome was saddle and lobar PE incidence. Results 1032 adult patients underwent trauma laparotomy with 434 undergoing CT for CD: 137 CT abdomen and pelvis only, 30 CTPE, 265 both. The majority (80.2 %) was male, age 33[interquartile range (IQR) 24-45], suffered penetrating mechanism (57 %), and had ISS 23[IQR16-30]. Injuries at laparotomy included 47 % solid organ, 62 % GI tract, 7 % biliary, 11 % vascular, and 42 % other. 176 (41 %) required damage control laparotomy. Median time to CT post-laparotomy was 174 h [111-235] with saddle and lobar PE in 3 (1 %), peripheral PE 18 (5 %), and abdominal abscess, leak, fluid, or pseudoaneurysm in 222 (51 %). Clinical management was altered (40 %) by antibiotics, therapeutic anticoagulation, drainage, aspiration, filter, thrombectomy, or surgical operation. Patients for whom CT findings changed management were more likely to have had GI tract surgery (69% vs 57 %, p = 0.021), higher white blood cell (WBC) (16.4 [13.1-20.5] vs 15.1 [9.9-19.5], p = 0.002), more hours between CT and laparotomy (184 [141-245] vs 162 [89-230], p = 0.002), and lower mortality (2% vs 8 %, p = 0.008). In-hospital mortality was 5 %; none were PE-related. Predictors of clinical intervention required based on CT imaging were GI tract injury (AOR: 1.65, p = 0.0182), and elevated WBC (AOR: 1.038, p = 0.010 Conclusion Saddle and lobar PE incidence post-trauma laparotomy is low. SIRS-type symptoms prompting postoperative CT commonly have no procedural or antibiotic requirement. Postoperative decompensation is more likely related post-operative complications, and less likely a PE.
PubMed: 38849214
DOI: 10.1016/j.injury.2024.111651 -
Medicine Jun 2024Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains... (Review)
Review
RATIONALE
Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application.
PATIENT CONCERNS
A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 × 8 × 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed.
INTERVENTION AND OUTCOMES
Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged.
DISCUSSION AND CONCLUSION
Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.
Topics: Humans; Female; Adult; Appendectomy; Drainage; Laparoscopy; Appendicitis; Ileum; Intestinal Perforation; Postoperative Complications
PubMed: 38847709
DOI: 10.1097/MD.0000000000038405 -
International Journal of Surgical... Jun 2024Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum.
BACKGROUND
Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum.
CASE PRESENTATION
A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining.
DISCUSSION
Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis.
CONCLUSION
Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection.
PubMed: 38847130
DOI: 10.1177/10668969241256116 -
Annals of Medicine and Surgery (2012) Jun 2024Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different...
INTRODUCTION AND IMPORTANCE
Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different specialties leading to delays in diagnosis and management.
CASE PRESENTATION
The authors present a 47-year-old woman with complaint of vague abdominal pain, fever, and raised inflammatory markers who underwent CT examination. On CT, a collection was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. The psoas abscess was drained.
CLINICAL DISCUSSION
Our case presents a number of rare and intriguing features. Notably, the patient, who was immunocompetent, experienced a primary Staphylococcus infection that swiftly progressed to a sizable pulmonary abscess, a phenomenon uncommon in such hosts. The rarity further extends to the source of infection, originating abdominally but culminating in thoracic complications through contiguous spread from a retroperitoneal site. Despite the potential severity, the patient's outcome was remarkably positive.
CONCLUSION
This case underscores the potential rapidity of pulmonary involvement in psoas abscesses, emphasizing the need for heightened awareness and consideration of respiratory signs during preoperative assessments.
PubMed: 38846815
DOI: 10.1097/MS9.0000000000002071 -
Cureus May 2024Mesh placement remains the standard of care for inguinal hernioplasty, whether through the classic open approach or the transabdominal preperitoneal (TAPP) approach....
Mesh placement remains the standard of care for inguinal hernioplasty, whether through the classic open approach or the transabdominal preperitoneal (TAPP) approach. Though both techniques are generally safe, they can occasionally result in visceral injuries, albeit infrequently. Mesh migration into the intestines is a morbid situation requiring emergency treatment. We present two male patients who developed mesh-enterocutaneous fistula several years after inguinal hernia repair. The first patient with a history of a bilateral TAPP hernia repair was admitted to the emergency department and underwent bilateral complete mesh removal, limited right colectomy, and wedge resection of the sigmoid colon, due to mesh erosion. The second patient, with a history of a left inguinal hernia treated by open mesh repair, presented to the emergency department complaining of intense pain in his left inguinal area. Erosion of the prosthetic mesh into the sigmoid and a colo-cutaneous fistula was identified, with sigmoidectomy and en bloc excision of the adherent mesh and end-colostomy being performed. Mesh erosion into the intestinal tract is a rare but serious condition. In patients presenting with a subcutaneous abscess in the inguinal region, clinicians should maintain a high level of suspicion for intrabdominal inflammation arising from mesh erosion into adjacent viscera. Surgical management becomes necessary in symptomatic cases or instances of fistulization.
PubMed: 38846192
DOI: 10.7759/cureus.59842 -
Medecine Tropicale Et Sante... Mar 2024Accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, however the development of hepatic abscesses secondary to digestive perforation...
Accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, however the development of hepatic abscesses secondary to digestive perforation by a foreign body is rare. We report the case of pyogenic hepatic abscesses secondary to gastric perforation by a fishbone complicated by acute peritonitis. A 53-year-old patient was admitted to our hospital with the main complaints: diffuse abdominal pain with vomiting in a context of fever and physical asthenia. A painful febrile hepatomegaly with jaundice was objectified, as well as a non-specific biological inflammatory syndrome. An initial abdominopelvic CT scan revealed multifocal liver abscesses. Faced with the initial therapeutic failure associating parenteral antibiotic therapy and abscess drainage, a second abdominal CT scan identified a foreign body straddling the antropyloric wall and segment I of the liver.A xypho-pelvic midline laparotomy was performed with nearly 200 cc of peritoneal fluid coming out. A fishbone approximately 5 cm long was extracted by laparotomy, followed by gastric closure with omentum, peritoneal cleansing and drainage. Symptomatic adjuvant treatment was initiated, including a proton pump inhibitor (Pantoprazole). He also benefited from transfusion support in the face of anemia. Antibiotic therapy was continued for a total of 2 weeks after surgery. The evolution was favorable with follow-up imaging at 3 months, showing complete resorption of the hepatic abscesses.
Topics: Humans; Middle Aged; Peritonitis; Male; Liver Abscess, Pyogenic; Foreign Bodies; Acute Disease; Senegal; Stomach
PubMed: 38846121
DOI: 10.48327/mtsi.v4i1.2024.390