Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.

Gas Forming Bacterial Infection after Total Knee Arthroplasty / 대한정형외과학회잡지

Postoperative gas-forming bacterial infection is very rare. However, it can be a life threatening problem if not properly addressed. Authors treated a patient who was infected with gas forming Escherichia coli after both knee arthroplasty with incision and drainage, as well as arthroscopic synovectomy and antibiotics. Herein, we report a case of postoperative gas-forming bacterial infection with literature review.

Pyogenic liver abscess caused by Salmonella Enteritidis: A rare case report.

Salmonella Enteritidis is one of the most important serovars transmitted from animals to humans and a serovar most commonly reported worldwide. Infection with Enteritidis is mainly limited to the intestinal tract, but under certain circumstances may cross the mucosal barrier to disseminate and get established as some localized infectious focus. Although cited as one of the very uncommon causes, Enteritidis may involve the liver and evolve into an overt abscess. Pyogenic liver abscess by a gas forming organism like Enteritidis usually follow a serious fulminant course and associated morbidity and mortality is unacceptably high unless immediate therapeutic interventions are initiated.

Emphysematous Pyelonephritis

Urinary tract infection is very common and in most cases is self limiting even without treatment. However, in some cases, the infection may progress and leads to serious complication requiring admission and treatment. Emphysematous pyelonephritis is a rare but serious complication of urinary tract infection. The symptoms are similar to those seen in pyelonephritis and without radiological imaging; the diagnosis can be missed with serious consequence. In severe cases, nephrectomy may be indicated. We report a case of emphysematous pyelonephritis in a previously well obese 28 year old lady who was successfully managed with intravenous antibiotic. Her underlying risk factor was undiagnosed diabetes mellitus.

Clinical features of gas-forming liver abscesses: comparison between diabetic and nondiabetic patients / 대한간학회지

BACKGROUND/AIMS: Patients with diabetes mellitus (DM) are more likely to have a pyogenic liver abscess with gas formation, which is associated with higher morbidity and mortality. The morbidity and mortality in pyogenic liver abscess are also higher in DM patients than in non-DM patients. This study evaluated the morbidity, mortality, and clinical features in patients with gas-forming liver abscesses associated with DM. METHODS: Among 379 cases of pyogenic liver abscess excluding malignancy from January 2001 through December 2009, 25 patients treated for pyogenic-gas-forming liver abscesses were reviewed retrospectively. We compared the morbidity, mortality, and clinical findings in patients with pyogenic-gas-forming liver abscesses between DM and non-DM patients. RESULTS: Gas formation was present in 25 (6.6%) of 379 cases with pyogenic liver abscess. DM was combined with gas-forming liver abscesses in 19 cases (76%). The most common organism responsible for the gas formation was Klebsiella pneumoniae (82%). Complications were present in 23 cases (92%) of gas-forming liver abscesses, with pulmonary complications (especially pleural effusion) being the most common (n=14, 61%). Four patients (16%) died of sepsis. CONCLUSIONS: Gas-forming liver abscesses are not uncommon in cases of pyogenic liver abscesses and are associated with high morbidity and mortality rates. The clinical manifestations and complications do not differ significantly between DM and non-DM patients.

Deep Infection Caused by Gas-Forming Bacteria after Total Hip Arthroplasty

A deep infection after total hip arthroplasty is a very severe complication that occurs in about 1~2% of the patients. The major cause of this infection is Staphylococcus aureus in the early stage and Staphylococcus epidermidis in the late stage A nontraumatic gas-forming infection is rare and difficult to diagnose because of its slower clinical course than that of gas gangrene. Therefore, it has a high mortality rate due to delayed treatment. There have been no reports on gas-forming infection by Escherichia coli after total hip arthroplasty. We report here on a patient who was treated by open arthrotomy and the patient expired due to a Escherichia coli, gas-forming infection after undergoing total hip arthroplasty.

Comparison of Liver Abscess between Diabetic Patients and Non-Diabetic Patients / 대한간학회지

BACKGROUND/AIMS: Klebsiella pneumoniae is emerging as the leading cause for liver abscess although the most common pathogen was Escherichia coli in the past. Patients with diabetes mellitus are more likely to have a pyogenic liver abscess with gas forming infection; a gas forming pyogenic liver abscess carries a higher morbidity and mortality than the non-gas forming group. This study was conducted to clarify the clinical presentation and prognostic factors for pyogenic liver abscess in diabetic patients compared with non-diabetic patients. METHODS: Medical records of 140 cases of patients treated for pyogenic liver abscess from January 1995 through January 2004 were reviewed retrospectively in detail. RESULTS: Among 140 cases of pyogenic liver abscess, underlying diabetes was present in 26.4% (37/140). The clinical presentation between the two groups was not significantly different. The most common organism for the pyogenic abscess was K. pneumoniae in both groups. A gas forming liver abscess was discovered in only the diabetic liver abscess group, 6 of 37 patients (16%). CONCLUSIONS: K. pneumoniae was the most common organism cultured in both diabetic and non-diabetic liver abscess. Gas forming liver abscess was more common in diabetic patients than non-diabetic patients. Diabetic patients had more complications than non-diabetic patients.

A Case of Post-Cesarean Endomyometritis Associated with Myometrial Gas Formation / 대한산부인과학회지

Postpartum endomyometritis is an important cause of maternal morbidity, especially after cesarean delivery. The management of postpartum endomyometritis is primarily medical with surgical intervention only occasionally required. But the gas forming abscess rarely happens, making the medical treatment difficult and needing emergency hysterectomy. We present a case of post-cesarean delivery endomyometritis complicated by intrauterine gas formation penetrating myometrium, which could not be managed by medical treatment, so finally needed emergency hysterectomy.

A Case of Gas-forming Pyogenic Liver Abscess in a Diabetic Patient / 감염

Gas-forming pyogenic liver abscess is an uncommon, life-threatening, necrotizing infection that is usually found in poorly-controlled diabetic patients. Herein, we report a case of gas-forming liver abscess caused by Klebsiella pneumoniae, as proven by aspirated pus culture, in a 70-year old woman with diabetes mellitus. The patient was successfully managed with broadspectrum antibiotics and transhepatic percutaneous drainage and was discharged after 3 weeks of hospitalization. In conclusion, strict control of diabetes mellitus is the most important factor in the prevention of gas-forming pyogenic liver abscess.

A Case of Gas-forming Scrotal Wall Abscess / 대한비뇨기과학회지

Gas-forming infections in the genitourinary tract are usually associated with diabetes mellitus, and emphysematous pyelonephritis is a common disease among them. However, gas forming infection occurring in the scrotum is extremely rare. We experienced a case of gas-forming scrotal wall abscess in a 45-year-old diabetic man, who showed clinical symptoms mimicking acute epididymo-orchitis.