Absceso periostomal secundario a perforación intestinal por cuerpo extraño: presentación de un caso / Periostomal abscess secondary to bowel perforation due to foreign body ingestion: a case report

Resumen Objetivo: Reportar un caso de absceso periostomal, su diagnóstico clínico e imagenológico y manejo. Materiales y Método: Paciente de 77 años usuaria de colostomía con dolor abdominal asociado a aumento de volumen y enrojecimiento de la piel alrededor de la colostomía. Una tomografía computada de abdomen muestra un cuerpo extraño perforante de la pared colónica ostomizada, asociado a formación de un absceso. Resultados: Se practica una incisión de la colección, dando salida a gran cantidad de pus y cuerpo extraño correspondiente a tibia de ave. Se inicia cobertura antibiótica y se instala drenaje Penrose. Controles posteriores muestran regresión del absceso y drenaje sin débito. Discusión: 80%-90% de los cuerpos extraños ingeridos son eliminados sin complicación y < 1% producen perforación. Esto es más común en segmentos intestinales angulados o intervenidos quirúrgicamente. La clínica es inespecífica y el diagnóstico requiere una imagen que identifique signos sugerentes. Conclusión: Un absceso periostomal y la perforación intestinal por cuerpo extraño son cuadros infrecuentes. La alta sospecha diagnóstica y una evaluación imagenológica pueden dar una respuesta precisa. Además del manejo quirúrgico, debe asociarse cobertura antibiótica para enteropatógenos y generalmente un sistema de drenaje.

Aim: To report a case of periostomal abscess, its clinical and imaging diagnosis and management. Materials and Method: 77-year-old patient, user of a colostomy with abdominal pain associated to swelling and redness of the skin next to the colostomy. A computed tomography of the abdomen showed a foreign body perforating the ostomized bowel associated to the formation of an abscess. Results: An incision of the gathering was performed, giving out a great quantity of pus and the foreign body, which corresponded to a bird's tibia. Antibiotic therapy was given, and a Penrose drainage installed. Further controls showed regression of the abscess and no flux from drainage. Discussion: 80%-90% of ingested foreign bodies are eliminated without complications and < 1% produce perforation. This is more common in angled intestinal segments or surgically intervened ones. Clinical features are unspecific, and diagnosis requires suggesting imaging signs. Conclusion: Periostomal abscesses and bowel perforation due to foreign body are infrequent. High diagnostic suspicion and an imaging evaluation may give a precise answer. Besides surgical management, antibiotic coverage for enteropathogens must be associated and a drainage system too in most cases.

Anal abscess microbiology as an anal fistula predictor / Microbiologia de abscesso anal como preditivo de fístula anal

ABSTRACT In order to determine the microbiology of anal abscess as a predictor of anal fistulas in patients who attended the external consultation of the Coloproctology unit of the Dr. Antonio María Pineda University Central Hospital, a prospective, descriptive, longitudinal study was conducted from September 2018 to July 2019. In this study, the population consisted of patients with a diagnosis of anal abscess, without associated comorbidities or contraindications for surgery, who agreed to be included in the study. A non-probabilistic, intentional sample consisting of 42 patients was determined. An appointment-based study protocol was applied by outpatient for patients who met the inclusion criteria applied, to perform due medical history through anamnesis, physical examination and culture taking of suppuration from the anal abscess to subsequently establish medical and surgical behavior thereof. The results were expressed in absolute numbers and percentages, a prevalence of ischiorectal abscesses was observed, followed by deep post-anal space abscesses. Anaerobic bacteria were isolated in 100% of the sample. In all fistulized patients, E. Coli was isolated as a predominant germ.

RESUMO Um estudo prospectivo, descritivo e longitudinal foi realizado de setembro de 2018 a Julho 2019 para determinar a microbiologia do abscesso anal como preditivo de fístulas anais em pacientes que compareceram à consulta externa da unidade de Coloproctologia do Hospital Central da Universidade Dr. Antonio María Pineda. Neste estudo, a população foi composta por pacientes com diagnóstico de abscesso anal, sem comorbidades ou contraindicações associadas à cirurgia, que concordaram em participar do estudo. Uma amostra intencional não probabilística, composta por 42 pacientes foi determinada. Um protocolo de estudo com base na consulta em regime ambulatorial foi aplicado aos pacientes que atenderam os critérios de inclusão estabelecidos, para realizar a anamnese, o exame físico e a devida cultura da supuração do abscesso anal para posteriormente estabelecer o comportamento médico e cirúrgico. Os resultados foram expressos em números absolutos e porcentagens, observando-se a prevalência de abscessos isquiorretais, seguidos por abscessos profundos no espaço pós-anal. Bactérias anaeróbias foram isoladas em 100% das amostras. Em todos os pacientes com fístulas, E. Coli foi isolada como um germe predominante.

Unusual abscess masquerading as poorly differentiated adenocarcinoma of the colon showing characteristics of choriocarcinoma

Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient's disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.

Abscesos profundos de cuello en pediatría: experiencia del Hospital Dr. Sótero del Río entre los años 2011 y 2018 / Pediatric deep neck abscesses: Dr. Sótero del Río Hospital 2011-2018 experience

RESUMEN Introducción: Los abscesos profundos de cuello son colecciones de pus alojadas en los espacios profundos cervicales. En la población pediátrica son poco frecuentes, sin embargo, pueden presentar complicaciones potencialmente mortales. Objetivo: Caracterizar a los pacientes que consultan por abscesos profundos del cuello en el Servicio de Urgencia Pediátrico del Hospital Dr. Sótero del Rio. Material y método: Estudio de tipo descriptivo retrospectivo con datos obtenidos de fichas clínicas de pacientes. Se realizó una revisión de fichas clínicas de los pacientes diagnosticados con abscesos profundos de cuello en el Servicio de Urgencia Pediátrica del Hospital Sótero del Río entre los años 2011 y 2018. Se analizaron variables clínicas (anamnesis, examen físico, exámenes de laboratorio generales y específicos y su manejo) y demográficas. Los resultados se analizaron mediante estadística descriptiva con medidas de tendencia central y rango, utilizando Statistical Package for the Social Science (SPSS). Resultados: Se incluyeron 41 pacientes entre 0 y 15 años, con un promedio de edad de 7,2 años. Sesenta y tres por ciento de los pacientes fueron de sexo masculino. Se presentaron 23 (56%) pacientes con abscesos periamigdalinos (PA), 12 (29,2%) con abscesos retrofaríngeos (RF), 5 (12,1%) con abscesos parafaríngeos (PF) y 1 (2,4%) con absceso de tipo mixto (RF- PF). El 60% de los pacientes recibió algún tratamiento médico previo. Se realizó estudio imagenológico en 83% de los pacientes. Todos los pacientes presentaron parámetros inflamatorios elevados. En el 80% de los pacientes se realizó tratamiento médico y algún tipo de drenaje. Conclusiones: Los abscesos profundos del cuello son una entidad relativamente poco frecuente en pediatría, pero potencialmente peligrosa si no se detecta a tiempo, por lo que debemos tener un alto índice de sospecha para evitar las complicaciones.

ABSTRACT Introduction: Deep neck abscesses are pus collections lodged in the deep cervical spaces. They are rare in the pediatric population, however, they can present life-threatening complications. Objective: To characterize the patients who consult for deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital. Material and method: Descriptive retrospective study. A review of clinical records of patients diagnosed with deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital between 2011 and 2018 was made. The clinical (anamnesis, physical exam, general and specific laboratory exams and management) and demographic characteristics were evaluated. The results were analyzed by descriptive statistics with measures of central tendency and range, using Statistical Package for the Social Science (SPSS). Results: Forty-one patients between 0 and 15 years of age were included, with an average age of 7.2 years. 63% of the patients were male. There were 23 (56%) patients with peritonsillar abscesses (PA), 12 (29.2%) with retropharyngeal abscesses (RF), 5 (12.1%) with parapharyngeal abscesses (PF) and 1 (2.4%) with abscess of mixed type (RF-PF). 60% of the patients received some previous medical treatment. An imaging study was performed in 83% of the patients. All the patients presented high inflammatory parameters. In 80% of patients, medical treatment and some type of drainage were performed. Conclusions: Deep abscesses of the neck are a relatively rare entity in pediatrics, but potentially dangerous if not detected in time, so we must have a high index of suspicion to avoid complications.

Absceso óseo en un paciente joven con artritis reumatoide, a propósito de un caso / Bone abscess in a young patient with rheumatoid arthritis, about a case

Introducción: la artritis reumatoide es una enfermedad inflamatoria sistémica y crónica que se caracteriza fundamentalmente por la presencia de dolor, inflamación, deformidad, discapacidad y disminución de la percepción de calidad de vida relacionada con la salud. El propio mecanismo etiopatogénico de la enfermedad y la acción de los fármacos utilizados en su control generan un estado de inmunosupresión que puede ocasionar la proliferación de bacterias y la aparición posterior de abscesos a distintos niveles. Objetivo: dar a conocer los elementos clínicos, de laboratorio e imagenológicos que permiten llegar al diagnóstico de un absceso óseo en un paciente con artritis reumatoide. Caso clínico: se presenta el caso de un paciente masculino, de 31 años de edad con diagnóstico de artritis reumatoide de 7 años de evolución que acude a consulta con manifestaciones clínicas, de laboratorio e imagenológicos que permiten llegar al diagnóstico de un absceso óseo. Conclusiones: los procesos infecciosos óseos constituyen un factor agravante de la calidad ósea, si los mismos se presentan en pacientes con enfermedades reumáticas como la artritis reumatoide, donde existen distintos niveles de afectación ósea, entonces se compromete más aún la salud y funcionamiento articular(AU)

Introduction: rheumatoid arthritis is a systemic and chronic inflammatory disease characterized mainly by the presence of pain, inflammation, deformity, disability and decreased perception of quality of life related to health. The own etiopathogenic mechanism of the disease and the action of the drugs used in its control generate a state of immunosuppression that can cause the proliferation of bacteria and the subsequent appearance of abscesses at different levels. Objective: to present the clinical, laboratory and imaging elements that allow us to reach the diagnosis of a bone abscess in a patient with rheumatoid arthritis. Clinical case: we present the case of a 31-year-old male patient with a 7-year history of rheumatoid arthritis who presented with clinical, laboratory and imaging findings that allow the diagnosis of a bone abscess. Conclusions: bone infectious processes are an aggravating factor of bone quality, if they occur in patients with rheumatic diseases such as rheumatoid arthritis, where there are different levels of bone involvement, then health and joint function are more compromised(AU)

Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Absceso subpectoral como diagnóstico diferencial de hombro doloroso: reporte de un caso / Subpectoral abscess as a differential diagnosis of painful shoulder: a case report

Los síndromes dolorosos del hombro son relativamente comunes en la práctica clínica. Habitualmente son causados por un número limitado de patologías. Dentro de los diagnósticos diferenciales, el pinzamiento subacromial, las lesiones aisladas del manguito rotador, capsulitis adhesiva, tendinitis cálcica, patología degenerativa de las articulaciones glenohumeral y acromioclavicular, y la inestabilidad crónica del hombro, son causas comunes. Causas infrecuentes son la rotura del tendón del bíceps, neuralgias, patología infecciosa articular y tumores del hombro. Un absceso subpectoral sin sintomatología infecciosa clara es una causa extremadamente rara de hombro doloroso en el adulto. Presentamos el caso de un paciente de 60 años, que inicia con un cuadro de hombro doloroso cuya causa se identifica como un absceso subpectoral por staphylococcus aureus que se maneja con drenaje quirúrgico y tratamiento antibiótico endovenoso con buenos resultados.

Painful shoulder syndromes are commonly caused by a limited assortment of pathologies. Differential diagnosis include rotator cuff impingement syndrome, rotator cuff tears, adhesive capsulitis, calcific tendonitis, degenerative disease of the joint including acromio-clavicular and gleno-humeral joints and chronic instability. Less common causes are labral tears, biceps tendon rupture, soft tissue infection, neurologic disease, joint infection and shoulder tumors. A subpectoral abscess without infectious clinical features is a very rare cause of shoulder pain in adults. We present the case of a 52 years old male who develops a painful shoulder syndrome caused by a staphylococcus aureus subpectoral abscess, treated by surgical drainage and intravenous antibiotic therapy with good results.

Management of prostate abscess in the absence of guidelines

ABSTRACT In contemporary practice, the number of patients presenting with prostatic abscess have significantly declined due to the widespread use of antibiotics. However, when faced with the pathology, prostatic abscess tends to pose a challenge to clinicians due to the difficulty of diagnosis and lack of guidelines for treatment. Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage.

Absceso renal neonatal: un desafío diagnóstico y terapéutico. Caso clínico / Neonatal renal abscess: a diagnostic and therapeutic challenge. A clinical case

El absceso renal representa una patología infrecuente en el recién nacido. Puede presentar consecuencias graves: sepsis con alta mortalidad, cicatrices renales y riesgo de enfermedad renal crónica. Se reporta sobre un recién nacido con absceso renal unilateral a Staphylococcus aureus, con cuadro de septicemia, sin otro foco supurativo ni malformación urinaria, que evolucionó adecuadamente con antibióticos endovenosos, sin tratamiento quirúrgico, aunque con cicatrices renales como secuela. A partir de este caso, se analizan las estrategias de diagnóstico, tratamiento y seguimiento del absceso renal en un neonato y se destaca el diagnóstico precoz para evitar cicatrices renales.

Renal abscess is a rare disease in newborn, but severe consequences can occur: sepsis with high mortality, renal scar formation and risk of chronic renal failure. A neonate with unilateral renal abscess due to Staphylococcus aureus is reported, with septicemia, with no other suppurative focus, nor with urinary malformation, with good clinical evolution with intravenous antibiotics and without surgical treatment, but with renal scars sequel. From this case, the strategies of diagnosis, treatment and followup of the renal abscess in a neonate are analyzed, emphasizing the early diagnosis to avoid renal scars.

Abcesos profundos de cuello: Reporte de tres casos pediátricos / Deep neck infections: Report of three pediatric cases

Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. En los últimos años, se ha detectado un aumento de incidencia de estas infecciones, que se debe, principalmente, a una mayor disponibilidad de la tomografía computada y a mayor virulencia de los gérmenes (Streptococcus beta hemolítico del grupo A y Staphilococcus aureus meticilino resistente). Predominan en menores de 5 años. El tratamiento de los abscesos retro y parafaríngeos consiste en antibiótico endovenoso y, eventualmente, drenaje quirúrgico. Serían pasibles de tratamiento quirúrgico aquellos pacientes con abscesos mayores de 2 cm³, con dificultad respiratoria o mala respuesta al tratamiento antibiótico inicial. El objetivo de este reporte es presentar las características clínicas y el tratamiento de tres pacientes con abscesos profundos de cuello que se presentaron en Otorrinolaringología del Hospital de Niños Pedro de Elizalde en el período de un año.

Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. In recent years, there has been an increase in the incidence of these infections, mainly due to a greater availability of computed tomography scan and a greater virulence of the germs (Group A b-hemolytic Streptococcus and methicillin-resistant Staphylococcus aureus). They predominate in children younger than 5 years. Treatment of retropharyngeal and parapharyngeal abscesses consists of an intravenous antibiotic and eventually surgical drainage. Surgical treatment is indicated in patients with abscesses greater than 2 cm³, with respiratory difficulty or poor response to initial antibiotic treatment. The aim of this study is to describe clinical features and treatment of three cases of deep neck abscesses presented at Hospital de Niños Pedro de Elizalde, Otorhinolaryngology Department in the period of one year.

Celulitis orbitaria complicada por absceso subperióstico debido a infección por Streptococcus pyogenes / Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Resumen: Introducción: La celulitis orbitaria es una enfermedad infecciosa muy frecuente en la edad pediátrica que puede provocar el desarrollo de severas complicaciones. Los principales microorganismos involucrados son Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, que juntos corresponden al 95% de los casos. También se pueden presentar Streptococcus beta hemolíticos y microorganismos anaerobios, que corresponden a menos del 5% de los casos. Se presenta un caso poco frecuente de celulitis orbitaria complicada por absceso subperióstico ocasionado por Streptococcus pyogenes (estreptococo beta hemolítico del grupo A). Caso clínico: Paciente masculino de 9 años de edad con antecedente de trastorno por déficit de atención e hiperactividad desde los 5 años de edad. Inició su padecimiento actual por presentar eritema en canto externo del ojo derecho; posteriormente, aumento de volumen periorbicular con limitación de apertura palpebral, progresión a proptosis, dolor a los movimientos oculares y secreción conjuntival purulenta. Los estudios de imagen subperióstico reportaron absceso y preseptal derecho con celulitis extraocular. Se inició manejo empírico con antibióticos, drenaje quirúrgico y cultivo del material purulento. De este, se aisló Streptococcus pyogenes. Conclusiones: Debido a la implementación de los esquemas de vacunación desde la década de los 90 contra H. influenza y S. pneumoniae, los casos por estos patógenos han disminuido, provocando que nuevas bacterias tomen su lugar como causantes de la infección. La importancia de considerar a S. pyogenes como etiología de celulitis orbitaria radica en la rápida progresión para la formación de abscesos, así como los pocos casos descritos en la literatura.

Abstract: Background: Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, which correspond to 95% of cases. Moreover, Streptococcus beta hemolytic and anaerobic microorganisms may also be present corresponding to < 5% of the cases. We present an uncommon case of cellulitis complicated by sub-periosteal abscess caused by Streptococcus pyogenes (Group A beta hemolytic streptococcus). Case report: A 9-year-old male patient with a history of deficit disorder and hyperactivity since 5 years of age. His current condition started with erythema in the external edge of the right eye, increase in peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported subperiosteal abscess and preseptal right with extraocular cellulitis. The patient started with empirical antibiotic treatment, surgical drainage and culture of purulent material from which Streptococcus pyogenes was isolated. Conclusions: Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis is the rapid progression to abscess formation, and the few cases described in the literature.

Hipopituitarismo como debut de absceso hipofisiario / Hypopituitarism as debut of pituitary abscess

We present a case of a 20 years old woman who consults for amenorrhea and mild hyperprolactinemia. Within the functional study hypopituitarism was discover and MRI showed a cystic lesion with “ring” enhancement. Transsphenoidal resection was performed, showing purulent material. Cultures were positive for MSSA and Neisseria cinerea. Antibiotic treatment was started completing 21 days. She evolved without relapse but did not recovered pituitary function.

An Unusual Case of Proctitis and Rectal Abscess due to Irritants by Artemisia asiatica Smoke (Ssukjwahun) / 대한소화기학회지

Proctitis is an inflammatory change of rectal mucosa induced by various agents or stimulus. Among many etiologies, it may be caused by medical treatments such as radiation or antibiotics. Proctitis usually presents with rectal ulcer but abscess formation is uncommon. Therapy using Ssukjwahun exerts its effect by directly applying the smoke around genital area and anus with various medicinal brewed herbs, especially worm-wood. Secondary metabolite of this plant, monoterpene, is known to facilitate circulation, exert anti-inflammatory effect, and help control pain. Herein, we report an unusual case of infectious proctitis presenting with rectal ulcer and abscess formation after perianal application of warm steam made by Artemisia asiatica smoke for treatment of dysmenorrhea.

Espondilodiscitis con absceso intrarraquídeo y paraespinal causada por bacilo de Calmette-Guérin (BCG) / Spondilodyscitis with medullary and spinal abscess caused by Bacillus Calmette-Guérin (BCG)

Intravesical therapy with live-attenuated Mycobacterium bovis strain have demonstrated to be effective in the treatment of recurrent and high-grade superficial bladder tumors. The use of this therapy is widely extended; however spreading of bacillus from the injection site could be one rare complication that may cause infection in different locations. An appropriate anamnesis is very important to establish an etiological diagnostic of possible infections caused by M. bovis BCG. Laboratory diagnosis at species level is difficult because of the high genetic similarity (99.9%) with the other member of Mycobacterium tuberculosis complex. We present a case report who developed tuberculous spondylodiscitis by M. bovis BCG, which had a history of intravesical instillation for treatment of bladder cancer.

Las instilaciones intravesicales con la cepa viva atenuada de Mycobacterium bovis han demostrado su eficacia en el tratamiento de cáncer urotelial de vejiga. Su uso está ampliamente difundido; sin embargo, una reacción adversa infrecuente es la extravasación del bacilo del lugar de acción pudiendo causar infecciones en otras localizaciones. Una correcta anamnesis del paciente ayuda a orientar la etiología de posibles infecciones relacionadas con éste microorganismo. El diagnóstico de laboratorio a nivel de especie es dificultoso ya que comparte un 99,9% de identidad genética con los otros miembros del complejo Mycobacterium tuberculosis. Se presenta el caso de un paciente que desarrolló una espondilodiscitis tuberculosa por M. bovis BCG, el cual tenía antecedentes de instilaciones intravesicales para el tratamiento del cáncer de vejiga.

Absceso hipofisiario como causa de meningitis crónica / Pituitary abscess as cause of chronicle meningitis

Se presenta el caso clínico de una paciente con un cuadro de Meningitis crónica recurrente en que el diagnóstico de absceso selar sólo se logró al operarla con el diagnóstico de Adenoma Hipofisiario. Siendo el absceso hipofisiario una patología de muy baja frecuencia, la presencia de una Meningitis crónica recurrente como forma de presentación es aún más infrecuente. La literatura en general presenta muy pocas series de abscesos hipofisiarios, siendo la mayoría sólo comunicaciones de casos clínicos.

We present the case of a patient with a history of Recurrent Chronic Meningitis, in which the diagnosis of Pituitary abscess was only made after surgery under the diagnosis of Pituitary Adenoma. Given the low frequency of the Pituitary Abscess, the presence of a Recurrent Chronic Meningitis as its presentation is even more infrequent. The common literature presents only a few series of pituitary abscess, which, in most cases, are only case reports.

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Urachal Sinus Presenting with Periumbilicus Abscess / 대한소화기학회지

No abstract available.

Pyogenic Pancreatic Abscess Mimicking Pancreatic Neoplasm: A Four-Case Series / 대한소화기학회지

A pyogenic pancreatic abscess mimicking pancreatic neoplasm in the absence of acute pancreatitis is rare. We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy. In each case, a PET-CT scan showed a mass with a high SUV, indicating possible malignancy. Comorbid diseases were identified in all patients: chronic pancreatitis and thrombus at the portal vein, penetrating duodenal ulcer, distal common bile duct stenosis, and diabetes mellitus. Diagnoses were performed by laparoscopic biopsy in two patients and via EUS fine needle aspiration in one patient. One patient revealed a multifocal microabscess at the pancreatic head caused by a deep-penetrating duodenal ulcer. He was treated with antibiotics and a proton-pump inhibitor. The clinical symptoms and pancreatic images of all the patients were improved using conservative management. Infective causes should be considered for a pancreatic mass mimicking malignancy.