Factores de riesgo para la aparición de abscesos intrabdominales tras la apendicectomía / Risk factors for the appearance of intra-abdominal abscesses after appendectomy

RESUMEN Introducción: Los abscesos intrabdominales son las complicaciones posapendicectomía que más frecuentemente provoca ingresos hospitalarios. Objetivo: Estudiar los factores de riesgo para la aparición de abscesos intrabdominales posapendicectomía. Métodos: Se realizó un estudio retrospectivo de pacientes mayores de 14 años, intervenidos por sospecha de apendicitis aguda mediante apendicectomía laparoscópica, desde el 1 de enero de 2007 al 31 de diciembre de 2010. Se utilizaron los tests estadísticos Chi cuadrado, Prueba exacta de Fisher, T de Student y regresión logística. Resultados: Durante los 4 años del estudio, 672 pacientes padecieron con síntomas y signos compatibles con apendicitis aguda. Apareció un absceso intrabdominal en 35 casos (5,2 por ciento). En el análisis multivariante mediante regresión logística se constataron como posibles factores de riesgo: las formas avanzadas de apendicitis (p < 0,0001), las cuales aumentaron el riesgo en unas 6 veces (IC 95 por ciento 2,2-14,9) y el sexo masculino (p = 0,033), también podrían aumentar el riesgo unas 2,5veces (IC 95 por ciento 1-6). Conclusiones: Los posibles factores de riesgo para la aparición de abscesos intrabdominales tras apendicectomía son el sexo masculino y el estadio avanzado, siendo este último el factor más influyente(AU)

ABSTRACT Introduction: Intra-abdominal abscesses are the post-appendectomy complications that most frequently cause hospital admissions. Objective: To study the risk factors for the appearance of post-appendectomy intra-abdominal abscesses. Methods: A retrospective study of patients over 14 years of age, operated on for suspected acute appendicitis by laparoscopic appendectomy, was performed from January 1, 2007 to December 31, 2010. Chi-square statistical tests, Fisher's exact test were used. Student's t and logistic regression. Results: During the 4 years of the study, 672 patients suffered with symptoms and signs compatible with acute appendicitis. An intra-abdominal abscess appeared in 35 cases (5.2 percent). In the multivariate analysis using logistic regression, the following possible risk factors were found: advanced forms of appendicitis (p < 0.0001), which increased the risk by about 6 times (95 percent CI 2.2-14.9) and male sex (p = 0.033), could also increase the risk about 2.5 times (95 percent CI 1-6). Conclusions: Possible risk factors for the appearance of intra-abdominal abscesses after appendectomy are male sex and advanced stage, the latter being the most influential factor(AU)

Current management of spontaneous intra-abdominal abscess in Crohn's disease / Tratamento atual de abscesso intra-abdominal espontâneo na doença de Crohn

ABSTRACT Crohn's disease (CD) is a chronic transmural disease process with approximately 10% of patients developing spontaneous intra-abdominal abscess during the first 5 years after the diagnosis. The symptoms are often nonspecific. The treatment modalities include the use of wide-spectrum antibiotics, imaging-guided percutaneous drainage (PD) and surgical drainage with or without resection. The best initial treatment strategy has not been settled controversial, as there are only retrospective studies with small sample sizes available in the literature. The majority of the patients would eventually need surgery. However a highly selected patient population with small abscess in the absence of fistulas or bowel strictures, especially those naive to immunomodulators or biologics, may respond to medical treatment alone with wide-spectrum antibiotics. The increased use of PD drainage in the last few years has been shown to reduce postoperative morbidities and risk of fecal diversion, allowing for subsequent elective surgery. Varied success rates of PD drainage have been reported in the literature. The initial surgical intervention of CD-related spontaneous abdominal sepsis is mandatory in patients with diffuse peritonitis due to free perforation. Surgery is also indicated in those with failed initial medical treatment and/or PD. This review article was aimed to evaluate the treatment modalities for spontaneous intra-abdominal abscess in CD patients and propose an algorithm for the best management of this complication.

RESUMO A doença de Crohn (DC) é um processo patológico transmural crônico, em que aproximadamente 10% dos pacientes desenvolvem um abscesso intra-abdominal espontâneo durante os primeiros 5 anos após o diagnóstico. Com frequência os sintomas são inespecíficos. As modalidades terapêuticas são o uso de antibióticos de amplo espectro, drenagem percutânea (DP) orientada por imagem, e drenagem cirúrgica com ou sem ressecção. A melhor estratégia terapêutica inicial ainda não ficou estabelecida e há controvérsias, visto que a literatura conta apenas com estudos retrospectivos com pequenas amostras. Em sua maioria, os pacientes acabarão necessitando de cirurgia. Mas uma população altamente selecionada de pacientes, com pequeno abscesso na ausência de fístulas ou constrições intestinais, especialmente aqueles que jamais foram medicados com imunomoduladores ou agentes biológicos, podem responder exclusivamente ao tratamento clínico com antibióticos de amplo espectro. Foi demonstrado que o uso mais frequente da DP nos últimos anos diminui as morbidades pós-operatórias e o risco de desvio fecal, o que possibilita uma subsequente cirurgia eletiva. Na literatura, têm sido relatados percentuais de sucesso variados com a DP. A intervenção cirúrgica inicial para a sepse abdominal espontânea relacionada à DC é obrigatória em pacientes com peritonite difusa, devido à perfuração livre. Também há indicação cirúrgica naqueles pacientes que não conseguiram obter sucesso com o tratamento clínico inicial e/ou DP. Esse artigo de revisão teve por objetivo avaliar as modalidades terapêuticas para o abscesso intra-abdominal espontâneo em pacientes com DC; além disso, propõe um algoritmo para o melhor tratamento dessa complicação.

Ultrasound guided percutaneous drainage of intra-abdominal abscesses and fluid collections

Percutaneous image-guided drainage is the first-line treatment for infected or symptomatic fluid collections in the abdomen and pelvis, in the absence of indications for immediate surgery and considered potentially a life saving therapeutic surgical procedure in high risk patients . To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and fluid collections. Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound [US] guide were studied prospectively in the Gastro-enterology and hepatology hospital in baghdad from April 2008-Sept 2009. The procedure done under local anesthesia and aseptic technique, needle access obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study. There were 43 patients [29 females and 14 males], Age ranging 8-67 years. The collections diagnosed basically on US in 33 patients [76.7%] and US and CT-scanning needed in 10 [23.3%]. These collections were post-operative in 36 patients [83.7%] and primary [spontaneous] in 7 [16.3%]The post-operative cases were as follow:18 patients [50%] operated on for gall bladder diseases, 6 [16.7%] for abdominal trauma, 4 [11%] for acute abdomen, 4 [11%]for Hydatid cyst, 2 [5.6%] colonic surgery and one patient [2.8%] operated on for acute appendicitis and one [2.8%] after ERCP. Twenty three [53.5%] of the collections were single and 20 [46.5%] were multiple. The single collections were located as: Right Hypochondrial[Right subphrenic,Subhepatic and Hepatic] in 15 patients [65.2%], Epigastric in 4[17.4%],2 of them were pancreatic, Pelvic in 3 [13%], and paracolic in one patient [4.4%]. Six patients[14%] have hepatic collections, 4 of which were following Hydatid Cyst Surgery, the remainder were Pyogenic hepatic abscesses. Material drained was Bile in 24 patients [56%],Pus in 17[39.5%] and blood and urine in one patient [2.25%] for both, Fourteen patients [32.6%] underwent more than single drainage procedure, nine of them [64.3%] twice, three [21.4%] three times and two [14.3%]more than 3 re-interventions. The operations has been avoided in 26 patients [60.5%] but was not avoidable in 17 [39.5%], because of the ultimate need of the condition for operation in 15 patients [88%]and failure of drainage in 2 patients [4.7%] US guided drainage is an efficacious therapy for intra-abdominal collections and have become the treatment of choice for a wide variety of collections. It helps to obviate or delay a major surgery

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost Gallstones

Laparoscopic Cholecystectomy [LC] is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed

value of computed tomography and ultrasound guided needle aspiration in suspected thoraco-abdominal abscess

The purpose of this study is to evaluate retrospectively the usefulness of computed tomography [CT] and/or ultrasound [US] guided interventions in patients with suspected thoracic/abdominal sepsis. Between January 2000 and May 2002, 135 patients [mean age 37 years [range 9-78]] underwent CT [GE Light Speed QXI Helical CT] and/or ultrasound [GE Logic 700] guided puncture, aspiration and drainage involving a mostly one-step Trocar and Seldinger technique. Most interventions were within the abdominal cavity and yielded fluid collections pyogenic in nature. Periappendicular abscesses were treated in 24 patients. There were 35 patients with suspected liver abscesses, two being found to consist of sterile haemtoma. In 11 patients abscesses were confirmed to be amoebic in origin. Percutaneous cholecytostomy was performed in 16 patients. Pleurocentesis was carried out in 21 patients with different pyogenic infections; in 4 patients tuberculosis [TB] was identified. In addition, TB was diagnosed in two of 8 patients with psoas abscesses. In 10 patients with septicaemia, considered to be at high surgical risk, our intervention was believed to be life saving. No serious complications were observed [two patients required additional analgesia for severe pain following percutaneous cholecystostomy]. CT guided interventions were especially suitable in complicated abscesses, allowing 2 and 3D, and other suitable projections for an optimal approach

Retroperitoneal Abscess Complicated by Acupuncture: Case Report

With acupuncture treatment becoming an increasingly popular analgesic, there have been increasing reports on its associated complications. Although pneumothorax is the most frequently reported injury caused by acupuncture needles, infectious complications may not be uncommon. Most infectious complications show less serious clinical manifestations than pneumothorax, but retroperitoneal or intraabdominal abscess caused by acupuncture may be much more serious conditions. We experienced a 56-yr-old male diabetic patient presenting with serious retroperitoneal abscess after acupuncture treatments. Emergency operative drainage with adequate antibiotic therapy was performed. Bacterial culture of blood and closed pus specimens recovered Klebsiella pneumoniae. In addition to application of better knowledge on anatomy, appropriate antiseptic practice by practitioners will reduce many serious complications associated with acupuncture.

Retroperitoneal cold abscess with tuberculosis of sacro-iliac joint and pubic bone: a case report of unusual presentation of osteo-articular tuberculosis.

Tuberculosis involving sacro-iliac joint and pubic bone presenting with massive retroperitoneal abscess is a rare entity. A 29-year-old female presented with history of discharging sinus in the sacrococcygeal region of 2 months duration. Plain x-ray revealed osteolytic lesion in right pubic bone and left sacro-iliac joint. Computed tomography scan revealed massive pus collection in the retroperitoneal region. Pus was drained extraperitoneally. Biopsy of the scraping of the abscess wall showed granulation tissue with foreign body type of giant cell. On follow-up the patient was doing well.