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The Journal of Craniofacial Surgery May 2023A nasal septal abscess is a rare lesion that usually results from a nasal septal hematoma after nasal trauma or surgery, although it can occur unexpectedly. Nasal septal... (Review)
Review
A nasal septal abscess is a rare lesion that usually results from a nasal septal hematoma after nasal trauma or surgery, although it can occur unexpectedly. Nasal septal abscesses should be prevented and treated immediately. The authors describe 2 unusual cases: 1 caused by sudden loosening of the quilting suture of the nasal septum and the other by a nasopharyngeal swab test for coronavirus disease-2019. The authors also provide an intraoperative video and a literature review.
Topics: Humans; Abscess; COVID-19; Nasal Septum; Paranasal Sinus Diseases; Nasal Surgical Procedures
PubMed: 36284368
DOI: 10.1097/SCS.0000000000009086 -
International Journal of Environmental... Feb 2023Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe... (Observational Study)
Observational Study
BACKGROUND
Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed.
METHODS
An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I "Sapienza" with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections.
RESULTS
Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, "Sapienza" University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis.
CONCLUSIONS
Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.
Topics: Humans; Abscess; Retrospective Studies; Mediastinitis; Neck; Communicable Diseases
PubMed: 36834169
DOI: 10.3390/ijerph20043469 -
Ultrasound in Medicine & Biology Mar 2021Infected abscesses are walled-off collections of pus and bacteria. They are a common sequela of complications in the setting of surgery, trauma, systemic infections and...
Infected abscesses are walled-off collections of pus and bacteria. They are a common sequela of complications in the setting of surgery, trauma, systemic infections and other disease states. Current treatment is typically limited to antibiotics with long-term catheter drainage, or surgical washout when inaccessible to percutaneous drainage or unresponsive to initial care efforts. Antibiotic resistance is also a growing concern. Although bacteria can develop drug resistance, they remain susceptible to thermal and mechanical damage. In particular, short pulses of focused ultrasound (i.e., histotripsy) generate mechanical damage through localized cavitation, representing a potential new paradigm for treating abscesses non-invasively, without the need for long-term catheterization and antibiotics. In this pilot study, boiling and cavitation histotripsy treatments were applied to subcutaneous and intramuscular abscesses developed in a novel porcine model. Ultrasound imaging was used to evaluate abscess maturity for treatment monitoring and assessment of post-treatment outcomes. Disinfection was quantified by counting bacteria colonies from samples aspirated before and after treatment. Histopathological evaluation of the abscesses was performed to identify changes resulting from histotripsy treatment and potential collateral damage. Cavitation histotripsy was more successful in reducing the bacterial load while having a smaller treatment volume compared with boiling histotripsy. The results of this pilot study suggest focused ultrasound may lead to a technology for in situ treatment of acoustically accessible abscesses.
Topics: Abscess; Animals; Disease Models, Animal; Female; High-Intensity Focused Ultrasound Ablation; Pilot Projects; Swine; Ultrasonography, Interventional
PubMed: 33250219
DOI: 10.1016/j.ultrasmedbio.2020.10.011 -
BMC Surgery Dec 2021This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety...
BACKGROUND
This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management.
METHODS
This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05.
RESULTS
The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4-24 weeks) and was uneventful.
CONCLUSION
Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.
Topics: Abscess; Adult; Humans; Retrospective Studies; Tertiary Care Centers
PubMed: 34922528
DOI: 10.1186/s12893-021-01424-8 -
Australian Journal of General Practice Sep 2020Dental abscess as an end stage of dental disease is common in the community, and patients with dental abscesses are likely to seek care from their primary health...
BACKGROUND
Dental abscess as an end stage of dental disease is common in the community, and patients with dental abscesses are likely to seek care from their primary health provider. Once the infection has spread beyond the confines of the jaws, there is an increasing risk of airway obstruction and septicaemia. If treated with antibiotics alone, the infection will not resolve and will become progressively worse.
OBJECTIVE
This article reviews the pathophysiology, demographics and management of severe odontogenic infections. It includes evidence-based studies of a large number of cases treated at a single tertiary hospital.
DISCUSSION
Prompt assessment and referral to a tertiary hospital is required for cases at risk of airway compromise. The morbidity and mortality of cases is presented in this article, with discussion of risk factors and the financial burden on the health system.
Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Morbidity; South Australia; Stomatognathic Diseases; Tomography, X-Ray Computed
PubMed: 32864666
DOI: 10.31128/AJGP-02-20-5254 -
Annals of the Royal College of Surgeons... Jun 2022Orbital cellulitis is a condition with a high risk of morbidity, including visual loss. It commonly originates from the paranasal sinuses. We present a case of...
Orbital cellulitis is a condition with a high risk of morbidity, including visual loss. It commonly originates from the paranasal sinuses. We present a case of multifocal intraorbital abscesses secondary to viral sinusitis in an adolescent with SARS-CoV-2 infection. This patient presented with classic symptoms of orbital cellulitis, but did not display classical symptoms of COVID-19. The patient initially underwent endoscopic drainage, followed by a combined approach which yielded no pus. He recovered without complication. This is the second report of its type showing a causative link between SARS-CoV-2 and orbital cellulitis.
Topics: Abscess; Adolescent; Anti-Bacterial Agents; COVID-19; Cellulitis; Humans; Male; Orbital Cellulitis; Retrospective Studies; SARS-CoV-2
PubMed: 35196179
DOI: 10.1308/rcsann.2021.0306 -
Journal of the American Veterinary... Nov 2021To describe and compare the results of preoperative CT and surgical findings in dogs with sublumbar abscesses and investigate potential associations between these...
OBJECTIVE
To describe and compare the results of preoperative CT and surgical findings in dogs with sublumbar abscesses and investigate potential associations between these variables and the outcome of abscess recurrence.
ANIMALS
51 client-owned dogs.
PROCEDURES
A retrospective, records-based study was performed of dogs undergoing surgery for treatment of sublumbar abscesses diagnosed by use of CT between January 2010 and December 2018. Signalment, clinical signs, clinicopathologic data, CT findings, surgical techniques and findings, duration of hospitalization, postoperative treatment, and complications were recorded. Long-term follow-up was performed through telephone interviews. Logistic regression analysis was used to investigate associations between the variables of interest and abscess recurrence.
RESULTS
51 dogs met the study inclusion criteria; 48 were included in outcome analysis. The CT findings agreed with surgical findings for identification of a migrating vegetal foreign body for 39 of 51 (77%) dogs. All dogs survived to hospital discharge; 1 dog died of hemoabdomen 3 days after surgery, and 6 had minor (surgical wound) complications reported. Abscess recurrence developed in 12 of 48 (25%) dogs with a median time to recurrence of 6 months. Identification of diskospondylitis on CT examination was the only investigated factor significantly associated with recurrence; odds of recurrence in dogs with this finding were 8.4 times those for dogs without this finding.
CONCLUSIONS AND CLINICAL RELEVANCE
Our results suggested dogs with sublumbar abscesses have a good prognosis after surgery, although recurrence can develop. Preoperative identification of diskospondylitis was significantly associated with abscess recurrence in this study sample.
Topics: Abscess; Animals; Dog Diseases; Dogs; Foreign Bodies; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34727061
DOI: 10.2460/javma.20.07.0403 -
European Review For Medical and... Nov 2023In clinical practice, identifying abscesses in tonsillar infections is crucial for early therapeutic management. Diagnosis of a peritonsillar abscess is usually based on...
OBJECTIVE
In clinical practice, identifying abscesses in tonsillar infections is crucial for early therapeutic management. Diagnosis of a peritonsillar abscess is usually based on clinical symptoms. Complementary examination procedures, such as laboratory parameters and imaging, are available for confirmation.
PATIENTS AND METHODS
A retrospective analysis was carried out of data for 752 patients who presented with acute tonsillar infection and were hospitalized between January 2012 and February 2021. The data analyses involved evaluating the patient's clinical symptoms, inflammatory parameters, and previous medical history in relation to the predictive power of these factors for the presence of an abscess.
RESULTS
Predictor analysis for the presence of an abscess showed significant values for trismus (OR 2.392; 95% CI, 1.305 to 4.383; p=0.005) and palatal arch protrusion (OR 29.679; 95% CI, 17.460 to 50.447; p=0.000). The inflammatory parameter C-reactive protein and the leukocyte count were not statistically significant as predictors.
CONCLUSIONS
The presence of a tonsillar abscess can be diagnosed from the clinical presentation alone if the findings are clear. Further diagnostic procedures are indicated in case of inconclusive findings, and ultrasound should be the primary noninvasive method. Computed tomography is only required in selected cases. Inflammatory parameters can be assessed in order to monitor therapy, but do not predict the presence of an abscess. However, if defined action sequences are being considered, tonsillar abscesses can be differentiated at an early point.
Topics: Humans; Retrospective Studies; Tonsillitis; Peritonsillar Abscess; Leukocyte Count; C-Reactive Protein
PubMed: 37975394
DOI: 10.26355/eurrev_202311_34349 -
Scientific Reports Sep 2022Perianal abscesses are frequent diseases in general surgery. Principles of standard patient care are surgical drainage with exploration and concomitant treatment of...
Perianal abscesses are frequent diseases in general surgery. Principles of standard patient care are surgical drainage with exploration and concomitant treatment of fistula. Antiinfective therapy is frequently applied in cases of severe local disease and perianal sepsis. However, the role of microbiologic testing of purulence from perianal abscesses is disputed and the knowledge concerning bacteriology and bacterial resistances is very limited. A retrospective cohort study was performed of consecutive patients (≥ 12 years of age) from a tertiary care hospital, who underwent surgical treatment for perianal abscess from 01/2008 to 12/2019. Subdividing the cohort into three groups regarding microbiological testing results: no microbiological testing of purulence (No_Swab, n = 456), no detection of drug resistant bacteria [DR(-), n = 141] or detection of bacteria with acquired drug resistances from purulence [DR(+), n = 220]. Group comparisons were performed using Kruskall-Wallis test and, if applicable, followed by Dunn´s multiple comparisons test for continuous variables or Fishers exact or Pearson's X test for categorical data. Fistula persistence was estimated by Kaplan Meier and compared between the groups using Log rank test. Corralation analysis between perioperative outcome parameters and bacteriology was performed using Spearman´s rho rank correlation. Higher pretherapeutic C-reactive protein (p < 0.0001) and white blood cell count (p < 0.0001), higher rates of supralevatoric or pararectal abscesses (p = 0.0062) and of complicated fistula-in-ano requiring drainage procedure during index surgery (p < 0.0001) reflect more severe diseases in DR(+) patients. The necessity of antibiotic therapy (p < 0.0001), change of antibiotic regimen upon microbiologic testing results (p = 0.0001) and the rate of re-debridements during short-term follow-up (p = 0.0001) were the highest, the duration until definitive fistula repair was the longest in DR(+) patients (p = 0.0061). Escherichia coli, Bacteroides, Streptococcus and Staphylococcus species with acquired drug resistances were detected frequently. High rates of resistances against everyday antibiotics, including perioperative antibiotic prophylaxis were alarming. In conclusion, the knowledge about individual bacteriology is relevant in cases of complex and severe local disease, including locally advanced infection with extended soft tissue affection and perianal sepsis, signs of systemic inflammatory response as well as the need of re-do surgery for local debridements during short-term and fistula repair during long-term follow-up. Higher rates of acquired antibiotic resistances are to be expected in patients with more severe diseases.
Topics: Abscess; Anti-Bacterial Agents; Anus Diseases; Bacteria; Humans; Retrospective Studies; Sepsis; Skin Diseases; Treatment Outcome
PubMed: 36050427
DOI: 10.1038/s41598-022-19123-6 -
Acta Otorhinolaryngologica Italica :... Apr 2019
Review
Topics: Adolescent; Anti-Bacterial Agents; Brain Abscess; Child; Child, Preschool; Databases, Factual; Female; Humans; Male; Oral Health; Periodontal Abscess
PubMed: 31097823
DOI: 10.14639/0392-100X-2281