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Annals of Surgery Mar 1921
PubMed: 17864430
DOI: 10.1097/00000658-192103000-00009 -
Journal of Medical Case Reports Apr 2019Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of...
BACKGROUND
Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer.
CASE PRESENTATION
A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae.
CONCLUSIONS
Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.
Topics: Abdomen; Abscess; Acute Disease; Adult; Anti-Bacterial Agents; Drainage; Fasciitis, Necrotizing; Humans; Laparotomy; Male; Mediastinitis; Neck; Thoracotomy; Thorax
PubMed: 31029172
DOI: 10.1186/s13256-019-2036-5 -
Annals of Surgery Apr 1962
Topics: Humans; Subphrenic Abscess
PubMed: 13886470
DOI: 10.1097/00000658-196204000-00005 -
Annals of Surgery Oct 1939
PubMed: 17857471
DOI: 10.1097/00000658-193910000-00006 -
Postgraduate Medical Journal Oct 1974A young female, who presented with acute appendicitis and peritonitis, is described. Following laparotomy she developed a series of intraperitoneal abscesses. After...
A young female, who presented with acute appendicitis and peritonitis, is described. Following laparotomy she developed a series of intraperitoneal abscesses. After drainage of a subphrenic abscess a necrosed gallbladder was discharged several days later through the drainage wound in the abdominal wall.
Topics: Appendicitis; Child; Cholecystectomy; Drainage; Female; Gallbladder; Gallbladder Diseases; Humans; Infarction; Male; Necrosis; Peritonitis; Subphrenic Abscess
PubMed: 4467864
DOI: 10.1136/pgmj.50.588.655 -
BMC Gastroenterology Apr 2018An intra-abdominal abscess can sometimes become serious and difficult to treat. The current standard treatment strategy for intra-abdominal abscess is percutaneous... (Review)
Review
BACKGROUND
An intra-abdominal abscess can sometimes become serious and difficult to treat. The current standard treatment strategy for intra-abdominal abscess is percutaneous imaging-guided drainage. However, in cases of subphrenic abscess, it is important to avoid passing the drainage route through the thoracic cavity, as this can lead to respiratory complications. The spread of intervention techniques involving endoscopic ultrasonography (EUS) has made it possible to perform drainage via the transmural route.
CASE PRESENTATION
We describe two cases of subphrenic abscess that occurred after intra-abdominal surgery. Both were treated successfully by EUS-guided transmural drainage (EUS-TD) without severe complications. Our experience of these cases and a review of the literature suggest that the drainage catheters should be placed both internally and externally together into the abscess cavity. In previous cases there were no adverse events except for one case of mediastinitis and pneumothorax resulting from transesophageal drainage. Therefore, we consider that the transesophageal route should be avoided if possible.
CONCLUSIONS
Although further studies are necessary, our present two cases and a literature review suggest that EUS-TD is feasible and effective for subphrenic abscess, and not inferior to other treatments. We anticipate that this report will be of help to physicians when considering the drainage procedure for this condition. As there have been no comparative studies to date, a prospective study involving a large number of patients will be necessary to determine the therapeutic options for such cases.
Topics: Aged; Colectomy; Colonic Neoplasms; Drainage; Endosonography; Female; Humans; Male; Middle Aged; Postoperative Complications; Sigmoid Neoplasms; Subphrenic Abscess
PubMed: 29699494
DOI: 10.1186/s12876-018-0782-2 -
Quantitative Imaging in Medicine and... Nov 2022Subphrenic jujube foreign body can cause perforation, abscess, peritonitis and other complications. Computed tomography (CT) is considered to be a sensitive tool for...
BACKGROUND
Subphrenic jujube foreign body can cause perforation, abscess, peritonitis and other complications. Computed tomography (CT) is considered to be a sensitive tool for small or faintly opaque foreign body (e.g., jujube pits, toothpicks, fish bones, acrylics and plastics) detection. The present study aimed to investigate the clinical and imaging features of subphrenic jujube pits and explore the potential of CT for detecting and monitoring subphrenic jujube pits.
METHODS
Patients with subphrenic jujube pits who were treated at our institution were retrospectively reviewed along with published studies. A total of 10 types of commercially available jujube pits were analyzed with CT, then another 40 jujube pits (≥2.5 cm) were randomly selected and soaked in a series of solutions to mimic the gastrointestinal tract processes, following which CT was performed at serial time points with conventional and dual-energy protocols.
RESULTS
All jujube pits could be detected by CT, presenting spindle-shape high-density. The length of jujube pits based on clinical cases and that of the commercially available types were 1.38 to 3.50 cm and 1.35 to 3.95 cm, respectively. After analysis, the mean attenuation values derived from the clinical cases [77.67 Hounsfield unit (HU), range: -89.92 to 153.13 HU, SD 64.70 HU] were higher than those of the 10 commercially available types of jujube pits in boiled (73.57 HU, range: 2.29 to 94.96 HU, SD 20.48 HU) and raw state (-274.28 HU, range: -400.12 to -168.12 HU, SD 72.75 HU); statistically significant differences were found in mean attenuation values between raw jujube pits and boiled jujube pits (P<0.05). After soaking, the radiodensity of raw jujube pits showed an upward trend over immersion time, and water (-hydroxyapatite) overlay images enhanced the visualization of jujube pit water content as the percentage of blue area increased over time.
CONCLUSIONS
CT plays an important role in evaluating and tracing subphrenic jujube pits.
PubMed: 36330181
DOI: 10.21037/qims-22-53 -
California Medicine Jul 1967Roentgen findings in subphrenic abscess, in the order of their specificity and clinical value, are subphrenic air-fluid level, elevation and restriction of motion of the...
Roentgen findings in subphrenic abscess, in the order of their specificity and clinical value, are subphrenic air-fluid level, elevation and restriction of motion of the diaphragm, pleural reaction with congestion, segmental atelectasis or pneumonitis at the lung base and upper abdominal mass. Less frequently there may be empyema or bronchopleural fistula. Suppression of the infection by antibiotics may protract the course and obscure the clinical findings. Serial x-ray and fluoroscopic studies are recommended when a patient who has had rupture of a viscus or previous abdominal operation does not completely recover or has a persistent lowgrade fever.
Topics: Adult; Child; Diagnosis, Differential; Humans; Male; Middle Aged; Pneumonia; Radiography; Subphrenic Abscess
PubMed: 6045484
DOI: No ID Found -
BMJ Case Reports Jun 2015A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain...
A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain settled with analgaesia and he was discharged with a course of oral co-amoxiclav. He was readmitted to the hospital 7 days later reporting cough and shortness of breath. His chest X-ray showed a raised right hemi-diaphragm, presumed consolidation and a right-sided effusion. As a result, he was treated for pneumonia. Despite antibiotic therapy his C reactive protein remained elevated, prompting an attempt at ultrasound-guided drainage of his effusion. Finding only a small amount of fluid, a CT of the chest was performed, and this showed a subphrenic abscess and free air under the diaphragm. A CT of the abdomen was then carried out, showing a perforated appendix. An emergency laparotomy was performed, the patient's appendix was removed and the abscess drained.
Topics: Abdominal Pain; Adult; Appendectomy; Appendicitis; Cough; Diagnostic Errors; Drainage; Humans; Laparotomy; Male; Pneumonia; Subphrenic Abscess; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26055585
DOI: 10.1136/bcr-2014-207588 -
The Western Journal of Medicine Nov 1974The bacteriology of the gastrointestinal tract is rapidly changing in laboratory techniques and clinical correlations. The flora is found to be very complex,... (Review)
Review
The bacteriology of the gastrointestinal tract is rapidly changing in laboratory techniques and clinical correlations. The flora is found to be very complex, predominantly anaerobic, and importantly dependent on diet. An etiologic role for colon bacteria in colon cancer is suggested by correlations between epidemiologic data and prevalent dietary patterns and stool culture findings. Cultures from aspiration pneumonia, subphrenic abscess, and other intra-abdominal sepsis all yield anaerobes, and for best results antibiotic therapy should combat them as well as aerobes.
Topics: Adolescent; Adult; Aged; Anaerobiosis; Anti-Bacterial Agents; Bacteria; Child; Clostridium; Colonic Neoplasms; Diet; Eubacterium; Feces; Female; Humans; Intestines; Japan; Jejunum; Lung Abscess; Male; Middle Aged; Pneumonia, Aspiration; Sepsis; Stomach Neoplasms; Streptococcus; Subphrenic Abscess; United States
PubMed: 4617971
DOI: No ID Found