Impact of robotic and open surgery on patient wound complications in gastric cancer surgery: A meta-analysis

This meta-analysis is intended to evaluate the effect of both robotic and open-cut operations on postoperative complications of stomach carcinoma. From the earliest date until June 2023, a full and systemic search has been carried out on four main databases with keywords extracted from 'Robot', 'Gastr' and 'Opene'. The ROBINS-I instrument has been applied to evaluate the risk of bias in nonrandomized controlled trials. In these 11 trials, a total of 16 095 patients had received surgical treatment for stomach cancer and all 11 trials were nonrandomized, controlled trials. Abdominal abscesses were reported in 5 trials, wound infections in 8 trials, haemorrhage in 7 trials, wound dehiscence in 2 trials and total postoperative complications in 4 trials. Meta-analyses revealed no statistically significantly different rates of postoperative abdominal abscesses among patients who had received robotic operations than in those who had received open surgical procedures (OR, 0.91; 95% CI, 0.25, 3.36; p = 0.89). The incidence of bleeding after surgery was not significantly different from that in both groups (OR, 1.37; 95% CI, 0.69, 2.75; p = 0.37). Similarly, there was no significant difference between the two groups (OR, 0.78; 95% CI, 0.52, 1.18; p = 0.24). No significant difference was found between the two groups (OR, 1. 28; 95% CI, 0.75, 2.21; p = 0.36). No significant difference was found between the two groups of patients who had received the robotic operation and those who had received the surgery after the operation (OR, 1.14; 95% CI, 0.78, 1.66; p = 0.49). Generally speaking, this meta-analysis suggests that the use of robotics does not result in a reduction in certain postsurgical complications, including wound infections and abdominal abscesses. Thus, the use of a microinvasive robot for stomach carcinoma operation might not be better than that performed on the surgical site after the operation. This is a valuable guide for the surgeon to select the operative method.

Intra-Abdominal Abscess and Bacteremia Due to Stenotrophomonas maltophilia After Total Gastrectomy: A Case Report and Literature Review

Stenotrophomonas maltophilia (S. maltophilia) is increasingly recognized as a pathogen responsible for nosocomial infections, particularly in immunocompromised patients. The most common types of S. maltophilia infections are pneumonia and catheter-related bloodstream infection, and clinical cases of intra-abdominal abscesses due to S. maltophilia are rare. We present a rare case of intra-abdominal abscess and bacteremia as a surgical site infection (SSI) caused by S. maltophilia in a patient following total gastrectomy. We also reviewed previous literature to elucidate the clinical characteristics of intra-abdominal abscess due to S. maltophilia. The patient, a 75-year-old man with diabetes and polymyositis (treated with prednisolone), developed a fever 17 days after undergoing a total gastrectomy for gastric cancer. Abdominal computed tomography revealed a hypodense solid mass at the esophagojejunostomy site, which appeared to be an intra-abdominal abscess. The culture of both blood and drained abscess pus confirmed only S. maltophilia. Treatment with intravenous trimethoprim-sulfamethoxazole and abscess drainage led to complete resolution. The patient recovered and was discharged and did not experience a recurrence. We reviewed the English literature and found only two additional case reports of intra-abdominal abscesses caused by S. maltophilia. As in our case, the intra-abdominal abscess occurred after abdominal surgery and the source was suspected to be deep SSI. This case highlights the importance of considering S. maltophilia as a potential pathogen in patients with atypical post-surgical abdominal infections. Physicians should be aware that S. maltophilia has the potential to cause intra-abdominal abscesses secondary to SSI, in addition to Enterobacteriaceae, a major causative pathogen of SSI. Further studies are required to elucidate the etiology, epidemiology, and risk factors for SSI caused by S. maltophilia.

Adenocarcinoma of the Transverse Colon Presenting as Anterior Abdominal Wall Abscess

Introduction

Locally invasive colon carcinoma comprises a small fraction of the incidence of colon carcinoma. Complications, such as perforation and obstruction, can occur in less than 0.5% of cases and often present differently based on location.

Case Presentation

We present a case of an 85-year-old woman who presented with an acute abdominal wall abscess which was caused by perforation of transverse colon carcinoma.

Conclusion

En-bloc resection increases 5-year survival, and adjuvant chemotherapy reduces the risk of recurrence in patients with stage II resectable colon carcinoma.

[Spontaneous cholecysto-cutaneous fistula: about two cases]

Cholecysto-cutaneous fistula (CCF) is a rare complication of untreated biliary pathology, with fewer than 100 cases documented in the literature. Most are secondary to bacterial infection, although it has also been described in gallbladder adenocarcinoma and post trauma. Its clinical presentation is variable, being able to present systemic affection, and its most frequent external drainage site is in the right hypochondrium. Due to the low incidence of this pathology, and the variety of forms of presentation, its management does not have, to date, standardized bases. We present two cases of patients who consulted in the emergency room at the Hospital Nacional de Clínicas for presenting cholecysto-cutaneous fistula. The treatment of both was surgical.

[Hepato-splenic involvement, an unusual finding secondary to cat-scratch disease: a clinical case]

The infection by Bartonela henselae (BH), the cause of cat scratch disease, it could be asymptomatic or produce local and multisystem illness. The objective of this case report is to document that the hepato-splenic involvement is unusual in BH infection, and the treatment is discussed and individualized in each patient. This case is about an eleven-year girl who presented with findings in abdominal tomography and ultrasound of hepato-splenic abscesses, with later positive serology for BH. In this way, a bibliographic review is carried out to show the low prevalence and incidence of hepato-splenic involvement where the anamnesis and the physical examination are essential to make an early diagnosis and treatment.

Peripancreatic Fluid Collections After Pancreas Transplant: Safety and Efficacy of Percutaneous Drainage

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of percutaneous drainage of peripancreatic fluid collections after pancreas transplant and to determine factors predicting a successful clinical outcome. MATERIALS AND METHODS. This single-center retrospective study included 28 patients who underwent percutaneous drainage for peripancreatic collections after transplant between January 2008 and December 2018. Clinical success was defined as drainage resulting in resolution of symptoms. Primary clinical success was defined as symptom resolution after the initial drainage procedure, and secondary success was defined as symptom resolution after additional drainage procedures. Operative intervention or death was considered clinical failure. Patient, collection, and procedural factors were assessed for their potential impact on the clinical outcome. RESULTS. Clinical success was achieved in 23 of 28 drainage procedures (82.1%), with primary success in 15 procedures. Of the five patients with failed drainage procedures, three required pancreatectomies, one required surgical washout, and one died from a disseminated infection. The median duration of drainage in the clinical success group was 25 days (range, 3-136 days), and patients with longer drainage periods had more successful outcomes (p = .04). Graft pancreatitis was diagnosed in five patients (17.9%) and was not associated with drainage outcome (p = .21). Collections were positive for bacterial growth in 13 patients (46.4%) and were high in amylase in 12 (42.9%). We observed drainage failure in collections with polymicrobial growth and in the presence of fistulas (p = .05 and p = .07, respectively). Patients with successful outcomes had smaller collection volumes (p = .045). No complications attributed to drainage were encountered. CONCLUSION. Percutaneous drainage is safe and effective for management of peripancreatic fluid collections after pancreas transplant.

Conservative management of spontaneous intra-abdominal abscess in Crohn's disease: Outcome and prognostic factors

OBJECTIVE

To compare the outcomes of different treatments for spontaneous intra-abdominal abscesses (IAA) in active Crohn's disease (CD).

METHODS

A retrospective analysis of patients with CD between January 2007 and December 2018 was performed in two Belgian inflammatory bowel disease centers. Successful conservative management was defined as complete resolution of abscesses without the need for bowel resection. The primary outcome was suboptimal evolution, defined as a composite outcome of recurrence of abscess, postoperative complications or the need for a non-elective resection.

RESULTS

Forty CD patients presenting with 43 independent episodes of spontaneous IAA development were included. One underwent immediate bowel resection. In all other 42 cases a conservative approach was taken, which led to a complete abscess resolution rate of 28.6% (12/42). The remaining abscesses required bowel resection. Anti-tumor necrosis factor (TNF) agent use was associated with successful conservative management (odds ratio [OR] 13.36, 95% confidence interval [CI] 11.19-15.52, P = 0.006), while the opposite trend was found for corticosteroids (OR 0.14, 95% CI 0.02-1.26, P = 0.055). There was a trend towards suboptimal evolution in case of previous bowel resection (OR 4.77, 95% CI 0.77-29.66, P = 0.094) or in patients aged above 50 years (OR 5.17, 95% CI 0.86-30.91, P = 0.072).

CONCLUSIONS

Bowel resection appears to be inevitable in most CD patients presenting with IAA. An attempt at conservative treatment may be particularly successful with anti-TNF agents in younger patients who have not undergone previous bowel resection. Large-scale prospective studies are needed to confirm these findings.

Types and implications of abdominal fluid collections following gastric cancer surgery

Background: Little data are available for abscess and non-abscess abdominal fluid collections (AFCs) after gastric cancer surgery and their clinical implications. We sought to analyse the natural history of such collections in a population of patients subject to routine postoperative imaging.Methods: From 1996 to 2012, 1381 patients underwent gastric resections and routine postoperative monitoring with abdominal ultrasound. As a unit protocol, examinations were carried out in all patients prior to drain removal, immediately before discharge, and at follow-up visits.Results: AFCs were diagnosed in 134 (9.7%) patients after a median time from surgery of seven days (interquartile range (IQR) 5-11 days). Sixty-four of the 134 AFCs (48%) were asymptomatic and resolved spontaneously after a median follow-up of 26.5 days (IQR 14-91 days). Seventy (52%) AFCs required interventional drainage. A stepwise logistic regression model demonstrated that interventional treatment was much more likely among patients with enteric fistula (odds ratio (OR) 9.542, 95% CI 1.418-46.224, p=.003) and pancreatic fistula (OR 7.157, 95% CI 1.340-39.992, p=.012).Conclusions: About one half of AFCs after gastric surgery were asymptomatic and eventually resolved spontaneously without any intervention. However, the need for interventional drainage was significantly increased by coexisting pancreatic or enteric fistula.

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children-A Single-Center Randomized Control Trial

PURPOSE

To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses.

METHODS

A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs).

RESULTS

Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group (P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains (P = .14), drain size (P = .19), primary outcome (P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA.

CONCLUSION

No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.

Gossypiboma: A Case Series and Literature Review

Background

Gossypiboma (retained surgical sponge) is a rare medical event. It could cause a serious complication that can threaten patients' life. Its diagnosis is usually difficult because the clinical symptoms are nonspecific and the imaging findings are often inconclusive.

Case Presentations

We present two cases, a 32 years old woman who passed a retained surgical sponge via rectum 5 months after cesarean section and a 30 years old lady presented with an acute abdomen that later found to have localized right lower quadrant abscess with a retained surgical sponge.

Conclusion

The most important approach to reduce the incidence of gossypiboma is prevention. At the end of the surgery, a correct count is always the gold standard safeguard against it. Although errors are not to be completely avoided, continuous CPD and strict adherence to rules of the operating room will reduce its incidence to a minimum.

Haemophilus parainfluenza bacteremia post-ERCP and cholecystectomy in a pediatric patient: A case report

Haemophilus parainfluenzae is a species that is commonly found in the human respiratory tract. It is an uncommon cause of gastrointestinal infection and bacteremia. Here, we present the case of a 17-year-old boy who developed H. parainfluenzae bacteremia and intraabdominal abscess after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy followed by elective cholecystectomy within 3 days. The patient was successfully treated with IV ceftriaxone with improvement in symptoms and progressive resolution of his abscess. We report a pediatric case of H. parainfluenzae infection occurring post-ERCP and cholecystectomy, and describe the convergence of two major risk factors for H. parainfluenzae bacteremia in the same pediatric patient.

Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses

BACKGROUND AND AIM

Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra-abdominal abscesses has been reported, although there is limited evidence.

METHODS

We carried out a single-center retrospective cohort study comparing percutaneous drainage (PCD) and EUS-D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates.

RESULTS

We included 18 EUS-D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS-D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen-apposing metal stents and eight self-expandable metal stents), coaxial double-pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS-D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS-D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS-D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS-D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91).

CONCLUSIONS

EUS-D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.

Neutropthil-to-Lymphocyte Ratio as a Predictor of Postsurgical Intraabdominal Abscess in Children Operated for Acute Appendicitis

Aim of the study: Postoperative intra-abdominal abscess (PIAA) is a frequent and severe complication of acute appendicitis (AA) with peritonitis. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that has been related to the development of peritonitis; however, its diagnostic role in predicting PIAA has not been evaluated. This is the first study that analyzes the usefulness of NLR as a predictor of PIAA in children operated for AA. Material and Methods: Retrospective observational study in children operated for AA in our institution during 2017-2018. Patients aged under 5 years or with incomplete laboratory determinations at hospital admission (blood count, C-reactive protein, and fibrinogen) were excluded. Demographic and laboratory parameters and the development of PIAA were analyzed. NLR was calculated by dividing the absolute number of neutrophils by the absolute number of lymphocytes. By means of ROC curves, we determined the sensitivity and specificity of the different laboratory parameters to predict the development of PIAA. Results: A total of 388 patients aged 10.5 ± 2.9 year were included. Twenty (5.2%) developed PIAA. NLR presented an area under the curve (AUC) of 0.85, significantly higher than the determination of leukocytes (AUC 0.69, p < 0.001), neutrophils (AUC 0.74, p < 0.001), fibrinogen (AUC 0.68, p < 0.001) and C-reactive protein (AUC 0.73, p < 0.001). We estimated the optimal cut-off point of NLR > 10.5, with a sensitivity of 85% and a specificity of 75.2%. Conclusions: NLR is the laboratory parameter with the highest sensitivity and specificity for predicting the development of PIAA in children operated for AA. It can be useful as a predictor of worse postoperative course.

Spilled Gallstones Silent for a Decade: A Case Report and Review of Literature

Laparoscopic cholecystectomy is associated with complications such as gallbladder perforation and spillage of gallstones. While these shortcomings are common, the occurrence of the resultant nuisances, such as intra-abdominal abscesses, is infrequent. We present the case of an individual who developed an intra-abdominal abscess following a spillage of gallstones, which occurred after a laparoscopic cholecystectomy that was performed more than a decade ago. Herein, we also discuss the findings of a literature review that highlights the clinical presentations of an intra-abdominal abscess formed due to gallstone spillage after a decade of the laparoscopic intervention. We also discuss the underlying pathophysiology leading to abscess formation, the imaging modalities used to visualize the abscess, as well as the therapeutic strategy used to treat this rare clinical entity.

Unusual case of rapid growing intraabdominal abscess caused by Stenotrophomonas maltophilia after laparoscopic appendectomy due to perforated appendicitis: A case report

INTRODUCTION

An intraabdominal abscess due to Stenotrophomonas maltophilia (S maltophilia) infection is a very rare clinical manifestation. S maltophilia is a glucose nonfermentative, aerobic, gram-negative, mobile, and biofilm-forming bacterium. It is an opportunistic pathogen and uncommon cause of infection. Respiratory tract infections (pneumonia) and bloodstream infections (bacteremia) are the most common clinical manifestations of S maltophilia infection.

CONCLUSIONS

This case report describes an unusual case of a rapidly growing, extremely large intraabdominal abscess (within 1 week during antibiotic therapy), which was detected 2 weeks after a laparoscopic appendectomy was performed for perforated appendicitis and was caused by multidrug-resistant S maltophilia infection.

Primary gastrointestinal stromal tumour of the ileum pre-operatively diagnosed as an abdominal abscess

The present case report described the acute presentation, diagnosis and management of a primary gastrointestinal stromal tumour (GIST) of the ileum. A male patient (age, 51 years) was admitted to Maggiore Hospital (Parma, Italy) due to presenting with fever, dysuria and lower abdominal pain. Ultrasonography and computed tomography showed a 7,5×5,5-cm pelvic mass containing air and purulent fluid indicative of an intraperitoneal abscess. The patient was subjected to diagnostic laparoscopy, which revealed a huge, soft cystic mass arising from the small bowel. The procedure was then converted to an open exploration through a midline incision. Ileal resection including a Meckel's diverticulum was performed. Macroscopic examination revealed that the cystic mass was filled with a large amount of pus, probably due to communication between the tumour mass and the small bowel lumen. In fact, the surgical specimen showed enteric leakage from the ileal mucosal ulcer into the tumour mass. Histopathology and immunohistochemistry of the abscess wall identified a spindle-cell mesenchymal-type, c-KIT-positive neoplasm. The post-operative course was uneventful and adjuvant imatinib mesylate was administered for 1 year. Follow-up by computed tomography demonstrated no tumour recurrence at 72 months after surgery.

Nonvascular Interventional Procedures in an Urban General Hospital: Analysis of 2001-2010 with Comparison to the Previous Decade

RATIONALE AND OBJECTIVES

To determine trends in nonvascular image-guided procedures at an urban general hospital over a 10-year period and to compare utilization of nonvascular interventional radiology (IR) over the decade 2001-2010 to a previously reported analysis for 1991-2000.

METHODS

With institutional review board approval, a 20-year quality assurance database verified against the radiology information system was queried for procedure location (eg, pleura, liver, bowel, and abdomen) and type (eg, biopsy, catheter insertion, and transient drainage), demographics, and change over time. Yearly admissions and new hospital numbers assigned each year served to normalize for overall hospital activity.

RESULTS

A total of 50,195 IR procedures were performed in 24,309 distinct patients (male:female, 12,625:11,684; average age, 60 years), 940 procedures performed in age <20 years, and 571 procedures performed in patients aged ≥90 years. A total of 15345, 4377, and 1754 patients had one, two, or three procedures, respectively; 470 had ≥10 procedures. Twenty-seven supervising radiologists and 277 individuals participated as operators, double the previous decade. Biopsy (4.8% average yearly increase), abdominal drainage (7.3%), paracentesis (12.9%), tube manipulation (13.0%), suprapubic bladder tube insertion (21.0%), and gastrostomy (44.6%) all increased strongly (P < .001) over 120 months but not biliary drainage, nephrostomy, or chest tubes. Procedures increased faster than either admissions or new hospital numbers (P < .001). For each 1000 new hospital numbers, IR service performed 48 procedures versus 31 the previous decade (P < .0005).

CONCLUSIONS

Referrals for nonvascular IR procedures have doubled over 2 decades, outpacing growth in new hospital patients and requiring increased resource allocation.

Failure of gastroenterologists to apply intestinal ultrasound in inflammatory bowel disease in the Asia-Pacific: a need for action

Intestinal ultrasound (IUS) is a cheap, noninvasive, risk-free procedure that is significantly underutilized in the diagnosis and management of patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. More cost-effective methods of monitoring disease activity are required in light of the increasing global burden of IBD (especially in Asia), the advent of personalized medicine, and the rising cost of healthcare. IUS is a prime example of a technique that meets these needs. Its common clinical applications include assessing the activity and complications of IBD. In continental Europe, countries such as Germany and Italy use this imaging tool as the standard of care and have integrated it into management protocols. There are formal training programs in these countries to train gastroenterologists in IUS, and it is used in an outpatient setting during patient consultations. Barriers to its use in the Asia-Pacific region include lack of experience and research data, and there are few established centers with active training programs. These concerns can be addressed by investing more in IUS service provision and by increasing allocation of resources toward local research and training. Increased uptake of IUS will ultimately benefit patients with IBD.

The Complex Surgical Abdomen: What the Nonsurgeon Intensivist Needs to Know

Intensivists are often called upon to help care for patients who develop severe sepsis syndrome and septic shock where the primary source is an enterocutaneous fistula (ECF). The purpose of this article is to describe to the nonsurgeon intensivist how these complex surgical situations arise in the first place and provide the reader with a detailed understanding of the potentially devastating complications of ECF. In addition, we will describe a structured algorithm regarding the management of this often highly challenging surgical situation.

Comparison of the long-term outcome of two therapeutic strategies for the management of abdominal abscess complicating Crohn's disease: percutaneous drainage or immediate surgical treatment

AIM

The management of abdominal abscesses complicating Crohn's disease is complex and involves a difficult choice between medical, radiological and surgical procedures. The long-term outcome was compared for two strategies for the management of abdominal abscess: percutaneous drainage (PD) followed by rescue surgery in the case of failure vs direct immediate surgery (IS). We also compared the results of IS with surgery performed after PD failure.

METHODS

We retrospectively identified 44 patients with Crohn's disease with an abdominal abscess from January 2000 to December 2009. Therapeutic success was defined as abscess resolution and no reappearance within 1 year of follow-up.

RESULTS

The first therapeutic approach was PD in 22 cases and IS in the other 22 cases. IS had a higher therapeutic success rate than PD (95.5% vs 27.2% respectively; P < 0.001). PD was the only independent variable related to treatment failure in the multivariate analysis after adjustment for possible confounders such as abscess size, multilocularity, presence of fistula and corticosteroid use (OR 88.26, 95% CI 7.38-1055.36; P < 0.001). Surgery after failure of PD (n = 16) was associated with longer total hospitalization (56.12 ± 35.89 vs 27.52 ± 15.11 days; P = 0.017) and longer postoperative stay (44.0 ± 83.7 vs 14.3 ± 30 days; P = 0.179) and needed a second operation more often (5/16, 31% vs 1/22, 4.5%; P = 0.065) than IS.

CONCLUSIONS

Percutaneous drainage provided durable abscess resolution in only one-third of the patients compared with more than 90% of those treated with IS. In addition, surgery performed after PD failure results in a poorer outcome than IS.

Treatment of intra-abdominal abscesses in Crohn's disease: a nationwide analysis of patterns and outcomes of care

BACKGROUND

Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single-center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses.

METHODS

We identified all adult CD-related non-elective hospitalizations from the Nationwide Inpatient Sample 2007 that were complicated by an intra-abdominal abscess. Treatment modality was categorized into 3 strata-medical treatment alone, percutaneous drainage, and surgery. We analyzed the nationwide patterns in the treatment and outcomes of each treatment modality and examined for patient demographic, disease, or hospital-related disparities in treatment and outcome.

RESULTS

There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD. Approximately 39 % were treated by medical treatment alone, 29 % with percutaneous drainage, and 32 % with surgery with a significant increase in the use of percutaneous drainage since 1998 (7 %). Comorbidity burden, admission to a teaching hospital, and complicated Crohn's disease (fistulae, stricture) were associated with non-medical treatment. Use of percutaneous drainage was more common in teaching hospitals. Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days, respectively, and early intervention was associated with significantly shorter hospitalization.

CONCLUSIONS

We describe the nationwide pattern in the treatment of abdominal abscesses and demonstrate an increase in the use of percutaneous drainage for the treatment of this subgroup. Early treatment intervention was predictive of shorter hospitalization.

In situ aortic thrombosis secondary to intra-abdominal abscess

BACKGROUND

Abdominal aortic mural thrombus is uncommon in the absence of aneurysm or atherosclerosis.

CASE REPORT

We report the case of a 46-year-old man who presented to our institution with perforated appendicitis for which he initially declined surgery. Four days after admission he ultimately consented to appendectomy and abdominal washout. Follow-up imaging to evaluate for intra-abdominal abscess revealed mural thrombus of the infra-renal abdominal aorta extending into the left iliac artery. This thrombus was not present on the admission CT scan. The patient had no clinical signs of limb ischemia. Conservative treatment with therapeutic anticoagulation resulted in resolution of the thrombus.

CONCLUSIONS

While portal, mesenteric, and major retroperitoneal venous thrombosis are well associated with major intra-abdominal infection and inflammatory bowel disease, aorto-iliac arterial thrombus formation in the absence of associated aneurysm, atherosclerosis or embolic source is exceedingly rare. We are unaware of other reports of in-situ aorto-iliac arterial thrombus formation secondary to perforated appendicitis.