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Takano Y, Tamai N, Yamawaki M, Noda J, Matsubara D, Azami T, Niiya F, Nishimoto F, Maruoka N, Yamagami T, Nagahama M. Endoscopic ultrasound-guided infectious liver cyst drainage associated with autosomal dominant polycystic kidney disease in which percutaneous approach is impossible. DEN Open 2024; 4:e314. [PMID: 37927950 PMCID: PMC10625053 DOI: 10.1002/deo2.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
A man in his 70s on maintenance dialysis for autosomal dominant polycystic kidney disease was admitted with epigastralgia and a fever lasting for 1 week. Computed tomography showed a thickened liver cyst measuring 121 mm in the caudate lobe, suggesting infection. Percutaneous drainage was impossible because multiple liver cysts and ascites entered the puncture route. Endoscopic ultrasound (EUS) revealed a huge liver cyst with debris-like echoes. Transgastric EUS-guided drainage was performed, and internal and external drainage was performed without adverse events. After the procedure, the symptoms quickly improved, and the external drain was removed after 12 days. The internal drainage stent remained in place, and the patient was discharged from the hospital 53 days after the EUS-guided drainage. EUS-guided drainage is an effective alternative treatment for infected liver cysts where a percutaneous approach is impossible.
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Affiliation(s)
- Yuichi Takano
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naoki Tamai
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masataka Yamawaki
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Jun Noda
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Dai Matsubara
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tetsushi Azami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumitaka Niiya
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumiya Nishimoto
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naotaka Maruoka
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tatsuya Yamagami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masatsugu Nagahama
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
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2
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Yoshimoto T, Takajo T, Iijima H, Yamamoto R, Takihara H, Nishimoto F. Comparison of endoscopic ultrasound-guided drainage and percutaneous drainage combined with minocycline sclerotherapy for symptomatic hepatic cysts: A retrospective study. Medicine (Baltimore) 2024; 103:e37677. [PMID: 38552057 PMCID: PMC10977566 DOI: 10.1097/md.0000000000037677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 04/02/2024] Open
Abstract
Simple hepatic cysts (SHC) are generally asymptomatic and incidentally diagnosed using imaging studies. Asymptomatic SHC does not require treatment, but symptomatic SHC warrants treatment using different modalities, including intravenous antibiotic therapy, ultrasound-guided percutaneous catheter drainage (PCD) with sclerotherapy, and surgery. The dissemination of endoscopic ultrasonography (EUS) intervention techniques has enabled the performance of puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses. Despite the development of an EUS-guided drainage method for treating symptomatic SHC, only a few case reports using this method have been reported. This study retrospectively analyzed the safety and feasibility of EUS-guided drainage of symptomatic SHC as well as its clinical outcomes and compared it with combined therapy using PCD and minocycline sclerotherapy. The records of 10 consecutive patients with 11 symptomatic SHCs treated with either EUS-guided drainage or PCD combined with minocycline sclerotherapy at the Musashino Tokushukai Hospital from August 2019 to January 2024 were retrospectively examined. All cases in both groups achieved technical and clinical success, with no reported adverse events. The median reduction rates of the major cyst diameters in the EUS-guided drainage and PCD with sclerotherapy groups were 100% (interquartile range [IQR]: 94%-100%) and 67% (IQR: 48.5%-85%). The length of hospital stay was 7 and 22.5 days in the EUS-guided and PCD with sclerotherapy groups (P = .01). EUS-guided drainage of symptomatic SHC is a safe and effective therapeutic alternative to percutaneous drainage with sclerotherapy and surgery for treating symptomatic SHC.
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Affiliation(s)
- Taiji Yoshimoto
- Department of Gastroenterology, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Takeshi Takajo
- Department of Gastroenterology, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Hirokazu Iijima
- Department of Surgery, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Ryuichi Yamamoto
- Department of Gastroenterology, Tokyo-west Tokushukai Hospital, Tokyo, Japan
| | - Hiroshi Takihara
- Department of Gastroenterology, Uji Tokushukai Hospital, Uji, Kyoto, Japan
| | - Fumiya Nishimoto
- Division of Gastroenterology Department of Internal Medicine Showa University Fujigaoka Hospital Kanagawa Japan
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3
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Agrawal S, Arya A, Gautam AD, Yadav RR, Singh A, Boruah D, Mohindra S, Gupta A, Srivastava A, Gurjar M, Singh RK, Rahul R. Current Utility of Transgastric Percutaneous Drainage for the Management of Pancreatitis-Related Retrogastric Walled-Off Necrotic Collections: A Prospective Observational Study. Cureus 2024; 16:e56443. [PMID: 38638772 PMCID: PMC11024891 DOI: 10.7759/cureus.56443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Pancreatic fluid collection (PFC) is one of the most frequent complications associated with acute pancreatitis. The route of drainage is guided by the size and site of collection. The present study aims to assess the clinical and technical success of transgastric percutaneous drainage (PCD) for managing retrogastric walled-off pancreatic necrosis (WOPN). Materials and methods A total of 44 patients with acute pancreatitis diagnosed with WOPN who underwent transgastric PCD with ultrasound or CT guidance as part of standard clinical management were included in the study. Patients were observed for improvement in clinical parameters, and treatment outcomes were noted in terms of technical success, clinical success, adverse events, need for additional procedures, hospital stay, and duration of placement of all drains. Data for the internalization of transgastric PCD was also observed in the study. Results Technical success during the drain placement was observed in 93% (n=41) of patients.Internalization of the transgastric drain was attempted in 12 patients and successful in 11 (91%). The median duration of hospital stay from the time of placement of the first PCD until discharge and the median duration of all PCDs placed were higher in patients where the transgastric drain was not internalized as compared to patients where the transgastric drain was internalized. Conclusion In WOPN, transgastric drain placement and successful internalization in any form help in the early resolution of peripancreatic and abdominal collections. It also reduces the time to percutaneous catheter removal, which in turn reduces the morbidity and decreases the need for additional interventions or surgery.
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Affiliation(s)
- Sarthak Agrawal
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Asmita Arya
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Avinash D Gautam
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajanikant R Yadav
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashish Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Deb Boruah
- Radiology, All India Institute of Medical Sciences, Guwahati, IND
| | - Samir Mohindra
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Archana Gupta
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Anshu Srivastava
- Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Mohan Gurjar
- Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajneesh K Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rahul Rahul
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
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Hasegawa S, Yokoyama M, Inui T, Ishikawa H, Watanabe H, Kimura M, Yoshida S, Sakamoto T. Giant bullous emphysema successfully treated with percutaneous drainage followed by resection: A case complicated by lung cancer diagnosed by intraoperative biopsy. Respirol Case Rep 2024; 12:e01329. [PMID: 38528946 PMCID: PMC10963133 DOI: 10.1002/rcr2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
We present a case of bilateral giant bullous emphysema (GBE) with rapidly progressive dyspnea. The dyspnea was thought to be due to tension bullae caused by the check valve mechanism in COVID-19 bronchitis. Multiple nodules were also detected on both sides of the lung. As the patient had poor pulmonary reserve for surgical bullectomy, we first performed percutaneous intracavitary drainage. Prior to this procedure, we placed a chest tube in the thoracic cavity to avoid tension pneumothorax. As a result, the patient's remaining lung expanded and respiratory status improved, allowing him to undergo surgical bullectomy. Intraoperatively, needle biopsy of the lung nodule was directly performed, which led to a diagnosis of adenocarcinoma. Despite multiple distant metastases, the patient's general condition improved postoperatively, and chemotherapy was successfully initiated.
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Affiliation(s)
- Sachie Hasegawa
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
| | - Mako Yokoyama
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
| | - Toshihide Inui
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
| | - Hiroaki Ishikawa
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
| | - Hiroko Watanabe
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
| | - Masaki Kimura
- Department of Thoracic SurgeryTsukuba Memorial HospitalTsukubaJapan
| | - Susumu Yoshida
- Department of Thoracic SurgeryTsukuba Memorial HospitalTsukubaJapan
| | - Tohru Sakamoto
- Department of Respiratory MedicineTsukuba Memorial HospitalTsukubaJapan
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5
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Louis M, Kuhn B, Redenius N. Post-cholecystectomy Hepatic Subcapsular Biloma: A Detailed Case Study on Presentation and Management. Cureus 2024; 16:e55966. [PMID: 38601406 PMCID: PMC11004852 DOI: 10.7759/cureus.55966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Hepatic subcapsular biloma is a rare but significant complication following laparoscopic cholecystectomy, characterized by the accumulation of bile beneath the hepatic capsule. Despite its infrequency, recognizing this condition is crucial due to its potential for significant morbidity. This report aims to elucidate the presentation, diagnosis, and management of this complication to enhance clinical outcomes. We present the case of a 59-year-old male with a complex medical history including atrial fibrillation, heart failure with preserved ejection fraction, myocardial infarction, chronic obstructive pulmonary disease, hypertension, and alcohol abuse. The patient presented with acute cholecystitis and underwent an uncomplicated laparoscopic cholecystectomy. Postoperatively, he developed right upper quadrant abdominal pain and nausea, leading to the diagnosis of a hepatic subcapsular biloma. The biloma was managed successfully with percutaneous drainage, illustrating a rare complication managed effectively without the need for endoscopic retrograde cholangiopancreatography (ERCP). This case illustrates the need for heightened awareness and swift imaging to diagnose hepatic subcapsular biloma effectively. The management of this patient demonstrates the effectiveness of percutaneous drainage in resolving bilomas and avoiding more invasive procedures such as ERCP. This case adds to the limited literature on the management of post-cholecystectomy hepatic subcapsular biloma and emphasizes the importance of considering this diagnosis in similar clinical scenarios. In conclusion, hepatic subcapsular biloma is a rare complication post-cholecystectomy that requires early recognition and intervention. This case contributes to the body of knowledge, emphasizing the role of imaging in diagnosis and the effectiveness of minimally invasive management strategies. It highlights the educational value of recognizing early postoperative complications, thereby enhancing patient safety and care.
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Affiliation(s)
- Mena Louis
- General Surgery, Northeast Georgia Medical Center, Gainesville, USA
| | - Bradley Kuhn
- Trauma and Acute Care Surgery, Northeast Georgia Medical Center, Gainesville, USA
| | - Nicole Redenius
- General Surgery, Northeast Georgia Medical Center, Gainesville, USA
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Sharma P, Shah J, Sokkary N. A case of image-guided hematometrocolpos drainage requiring tissue plasminogen activator in a pediatric patient. J Surg Case Rep 2024; 2024:rjae006. [PMID: 38379535 PMCID: PMC10877313 DOI: 10.1093/jscr/rjae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024] Open
Abstract
Hematometrocolpos (HMC) is a rare disorder that occurs when an anatomical anomaly like imperforate hymen causes menstrual blood to be retained in the uterus and vagina. There is no standard of care established for HMC beyond urgent vaginoplasty which requires a demanding post-operative course that may not be suited for all pediatric patients. This is a case report of successful use of image-guided percutaneous drainage of HMC with tissue plasminogen activator (TPA) followed by vaginoplasty in a 13-year-old female with lower vaginal atresia. Additionally, this case explores the role of menstrual suppression and the need for individualized guidelines. It emphasizes the potential of image-guided percutaneous drainage with TPA as a promising, less-invasive treatment option for pediatric HMC as well as the impact on follow-up surgery.
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Affiliation(s)
- Pareena Sharma
- Department of Medicine, Medical College of Georgia of Augusta University, 1120 15th St, Augusta, GA 30912, United States
| | - Jay Shah
- Department of Radiology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
| | - Nancy Sokkary
- Department of Obstetrics and Gynecology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
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7
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Oh CH. Clinical efficacy and safety of percutaneous drainage for post-operative fluid collection in patients with bladder cancer undergoing radical cystectomy and urinary diversion. Medicine (Baltimore) 2023; 102:e36488. [PMID: 38065871 PMCID: PMC10713095 DOI: 10.1097/md.0000000000036488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
To evaluate the success rates of percutaneous drainage for fluid collection after radical cystectomy, with emphasis on factors affecting the clinical success, including lesion, patient, and procedure characteristics. In this retrospective study, 31 percutaneous drainage catheters were placed in 29 consecutive patients between January 2021 and September 2023. Most fluid collections formed near the uretero-ileal anastomosis site in the right pelvic cavity (80.6%). The technical success rate was 100%. The primary and final clinical success was 80.6% and 96.9%, respectively. Lymphoceles notably increased the primary clinical failure risk (odds ratio and 95% confidential interval: 22.667 (1.839-279.366), P = .015). Significant differences were observed between transabdominal and transgluteal approaches in terms of fluoroscopic time, dose, and location. Leakage indications on computed tomography prompted differing interventions, but all achieved final clinical success. Percutaneous drainage for post-operative fluid collection is safe and effective in patients with radical cystectomy and urinary diversion.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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8
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Kim SH, Choi BG, Ok JS, Chun HJ, Lee HG. Policresulen to treat hypergranulation tissue around drainage tubes. J Wound Care 2023; 32:S11-S14. [PMID: 38063298 DOI: 10.12968/jowc.2023.32.sup12.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To evaluate the efficacy of policresulen for the treatment of hypergranulation. METHOD This was a retrospective study of patients with percutaneous catheters. Inpatients from two hospitals and those from outpatient clinics were included. Approximately 2ml of 50% policresulen solution was applied to hypergranulation tissue, which was then immediately pressed with gauze for 1-3 minutes using light pressure. When haemostasis was achieved and the granulation tissue size decreased, the procedure was terminated. RESULTS A total of eight patients (four females and four males) were included in this study. Effective haemostasis was achieved in all patients. The size of the hypergranulation tissue decreased with policresulen treatment, and resolved completely in one patient. There were no complications. Hypergranulation tissue recurred in one patient. Haemostasis was successfully achieved after repeated procedures. CONCLUSION The findings of this study showed policresulen to be an inexpensive, easy treatment for hypergranulation at catheter insertion sites.
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Affiliation(s)
- Su Ho Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Jung Suk Ok
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, Korea
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9
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Khizar H, Zhicheng H, Chenyu L, Yanhua W, Jianfeng Y. Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis. Ann Med 2023; 55:2213898. [PMID: 37243522 DOI: 10.1080/07853890.2023.2213898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND/AIMS Pancreatic fluid collections (PFC) are debris or fluid of the pancreas that needs to be drained out. This may result from surgery or necrotizing pancreatitis. This meta-analysis compared the outcomes of PFC through endoscopic and percutaneous interventions. METHODS A medical database was searched up to June 2022, comparing the outcomes of endoscopic drainage (ED) and percutaneous drainage (PD) for the PFC. Eligible studies reporting clinical and technical success and adverse events were selected. RESULTS Seventeen studies with 1170 patients were included for meta-analysis, of which 543 patients underwent ED and 627 underwent PD. The odd ratio (OR) of technical success was 0.81 (95% confidence interval (CI) 0.31, 2.1) and clinical success was in the favor of the ED group at OR 2.23 (95% CI 1.45, 3.41). Adverse events OR 0.62 (95% CI 0.27, 1.39) and stent migration OR 0.61 (95% CI 0.10, 3.88) were the same in both groups, but hospital stay pooled mean difference of 15.02 days (95% CI 9.86, 20.18), mortality OR 0.24 (95% CI 0.09, 0.67), and re-interventions OR 0.25 (95% CI 0.16, 0.40) favored ED. CONCLUSIONS ED is safe and efficient for PFC with higher clinical success, lower mortality rate, hospital stay, and re-interventions compared with PD.
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Affiliation(s)
- Hayat Khizar
- Department of Gastroenterology, International Education College of Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of medicine, Hangzhou, China
| | - Huang Zhicheng
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le Chenyu
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wu Yanhua
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Jianfeng
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of medicine, Hangzhou, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
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10
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Wang Y, Chang Z, Zheng J, Liu Z, Zhang J. The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization. Front Oncol 2023; 13:1256012. [PMID: 38023156 PMCID: PMC10661366 DOI: 10.3389/fonc.2023.1256012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of these patients. Methods From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Results Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%, respectively. Conclusion Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.
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Affiliation(s)
| | | | | | | | - Jun Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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11
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Liang F, Cao J, Qin L, Zhang X. Giant Prostate Abscess: A Case Report and Literature Review. Am J Mens Health 2023; 17:15579883231219570. [PMID: 38130088 DOI: 10.1177/15579883231219570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Prostate abscess, a rare condition often associated with prostate bacterial infections, often occurs in immunosuppressive individuals and manifests as fever and lower urinary tract symptoms. Clinical practice lacks standardized diagnostic and treatment protocols for prostate abscesses, resulting in predominantly empirical approaches with uncertain outcomes. This study presents a case of a giant prostate abscess, diagnosed in a patient exhibiting fever, lower urinary tract symptoms (including dysuria, urinary frequency, urgency, and weakness), and anal pain. The diagnosis was confirmed through prostate magnetic resonance imaging and transrectal color ultrasound examinations. Treatment included targeted anti-infective therapy (based on the urine culture results), urine flow diversion (suprapubic bladder puncture stomy), ultrasound-guided perineal puncture drainage of the prostatic abscess, intermittent abscess cavity irrigation, and urethral electroprostatectomy. The patient experienced a complete recovery and significantly improved quality of life. This successful case underscores several key points: (1) the importance of targeted anti-infective therapy based on etiological findings in prostate abscess treatment; (2) early urine flow diversion, precise puncture drainage, and intermittent abscess cavity irrigation may be one of crucial elements in abscess management; (3) the potential significance of transurethral prostate resection following abscess resolution in preventing recurrence. It is hoped that this case report offers new valuable insights for diagnosing and treating prostate abscesses. Slightly different from previous treatment experience, we extra used early urine diversion, intermittent abscess cavity irrigation, and etiological electroprostatectomy, which might also hold promise as potential therapies.
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Affiliation(s)
- Fuchao Liang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jun Cao
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Linghui Qin
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xuejun Zhang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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12
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Tsukamoto M, Morimoto T, Kobayashi T, Hirata H, Yoshihara T, Mawatari M. A gigantic iliopsoas abscess in a patient with Alexander's disease. Clin Case Rep 2023; 11:e8118. [PMID: 38028037 PMCID: PMC10658585 DOI: 10.1002/ccr3.8118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case highlights the importance of early diagnosis of iliopsoas abscess in patients with communication difficulties and appropriate treatment to prevent further complications. Abstract We report a case in which the detection of an iliopsoas abscess was delayed due to difficulty in communication but was successfully treated with percutaneous drainage. A 70-year-old man with a 38-39°C fever and 5.69 mg/dL C-reactive protein. Adult-onset Alexander's illness, affected his swallowing, speech, coordination, and motor function. Abdominal computed tomography revealed a big iliopsoas abscess. Antibacterial treatment followed percutaneous draining. Drainage reduced temperature and inflammation. Four months later, the iliopsoas abscess returned, the second drainage eliminated recurrence. Difficulty in communicating was a contributing factor to the delayed diagnosis of a giant iliopsoas abscess. In the treatment of such patients, percutaneous drainage seems effective as an initial therapy.
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Affiliation(s)
- Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
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13
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Fukunaga S, Naito Y, Hoshino Y, Oba M, Kawanishi M, Yoshikane K, Egawa M, Ito T, Tanabe K. Indications for Percutaneous Drainage in Patients with Huang Class 3B Emphysematous Pyelonephritis: A Case Report and Literature Review. Intern Med 2023; 62:2871-2876. [PMID: 36792198 PMCID: PMC10602843 DOI: 10.2169/internalmedicine.0694-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe urinary tract infection common in patients with diabetes. Nephrectomy is recommended when the Huang classification is ≥3B. We herein report a case in which nephrectomy was avoided using antimicrobial agents and percutaneous drainage (PCD). A 59-year-old man was diagnosed with EPN (Huang classification 3B). The causative bacteria were Escherichia coli. Despite high-risk factors, EPN was cured with kidney preservation and PCD because the emphysema and abscess were not extensive. Thus, PCD should be considered in patients with Huang Class 3B EPN and high-risk factors if emphysema and abscess are not extensive.
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Affiliation(s)
| | - Yumi Naito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Yuki Hoshino
- Division of Nephrology, Shimane University Hospital, Japan
| | - Masafumi Oba
- Division of Nephrology, Shimane University Hospital, Japan
| | | | | | - Masahiro Egawa
- Division of Nephrology, Shimane University Hospital, Japan
| | - Takafumi Ito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Kazuaki Tanabe
- Department of Internal Medicine IV, Faculty of Medicine, Shimane University, Japan
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14
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Menendez S, Moriarty SE, Perera I, Rawlins Ii F. Perplexing Tubo-Ovarian Abscess Presentation from an Inflammatory Process in a Patient with an Inconclusive Computed Tomography Scan. Cureus 2023; 15:e46760. [PMID: 37946882 PMCID: PMC10632086 DOI: 10.7759/cureus.46760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
A tubo-ovarian abscess (TOA) is an infectious mass of the adnexa. This article presents a well-documented case of a 27-year-old female presenting to the emergency department with a TOA. Physical exam findings and an initial computed tomography scan (CT) with contrast revealed a right iliopsoas abscess, an inflammatory process in the right lower quadrant, later diagnosed as a TOA with the use of ultrasound (US) without a history of sexually transmitted infection (STI). The clinical decision tree utilized in this patient's case highlights the importance of keeping a TOA high on the list of differential diagnoses while investigating appendicitis and other inflammatory pathologies in the lower abdomen.
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Affiliation(s)
- Sophia Menendez
- Obstetrics and Gynecology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Sydney E Moriarty
- Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Ishan Perera
- Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Frederic Rawlins Ii
- Emergency Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
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15
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Cirocchi R, Duro F, Avenia S, Capitoli M, Tebala GD, Allegritti M, Cirillo B, Brachini G, Sapienza P, Binda GA, Mingoli A, Fedeli P, Nascimbeni R. Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review. J Clin Med 2023; 12:5522. [PMID: 37685590 PMCID: PMC10488020 DOI: 10.3390/jcm12175522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND This systematic umbrella review aims to investigate and provide an analysis of guidelines regarding the treatment of diverticular abscesses. MATERIAL AND METHODS A systematic literature search was performed using the Cochrane Overviews of Reviews model and the 'Clinical Practice Guidelines'; at the end of initial search, only 12 guidelines were included in this analysis. The quality of the guidelines was assessed by adopting the "Appraisal of Guidelines for Research and Evaluation II" (AGREE II). The comparative analysis of these guidelines has highlighted the presence of some differences regarding the recommendations on the treatment of diverticular abscesses. In particular, there are some controversies about the diameter of abscess to be used in order to decide between medical treatment and percutaneous drainage. Different guidelines propose different abscess diameter cutoffs, such as 3 cm, 4-5 cm, or 4 cm, for distinguishing between small and large abscesses. CONCLUSIONS Currently, different scientific societies recommend that diverticular abscesses with diameters larger than 3 cm should be considered for percutaneous drainage whereas abscesses with diameters smaller than 3 cm could be appropriately treated by medical therapy with antibiotics; only a few guidelines suggest the use of percutaneous drainage for abscesses with a diameter greater than 4 cm. The differences among guidelines are the consequence of the different selection of scientific evidence. In conclusion, our evaluation has revealed the importance of seeking new scientific evidence with higher quality to either confirm, reinforce or potentially weaken the existing recommendations from different societies.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Francesca Duro
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | - Matteo Capitoli
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (F.D.); (M.C.)
| | | | | | - Bruno Cirillo
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | - Gioia Brachini
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | - Paolo Sapienza
- Department of Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy;
| | | | - Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (G.B.); (A.M.)
| | | | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
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16
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Kim HG, Lee HK, Park E. Abdominal Actinomycotic Abscess after Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Report. Medicina (Kaunas) 2023; 59:1516. [PMID: 37763634 PMCID: PMC10534873 DOI: 10.3390/medicina59091516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Actinomycosis is a rare, chronic, suppurative, and granulomatous bacterial disease. The Actinomyces species exist as normal flora in the oropharynx, gastrointestinal tract, and the female genital tract. They are incapable of penetrating the normal mucous membranes and become pathogenic only when this barrier has been destroyed by trauma, surgery, immunosuppression, or after viscus perforation. We report the first case of an actinomycotic abscess after laparoscopic sleeve gastrectomy. A 29-year-old man underwent a laparoscopic sleeve gastrectomy with no intra-operative complications. On postoperative day 3, the patient had a fever with elevated inflammatory markers. Abdominal computerized tomography (CT) with oral water-soluble contrast media showed no extra-luminal leakage and no fluid collection adjacent to the resected stomach, other than the fluid collection in the right subhepatic space. Percutaneous drainage was attempted, but the procedure failed due to the patient's thick abdominal wall. After two weeks of weight loss of about 12 kg, percutaneous drainage was successfully performed, and A. odontolyticus was identified through pus culture. After effective abscess drainage and high-dose antibiotics, the patient's symptoms improved and the abscess pocket disappeared. We reported Actinomyces infection after gastric sleeve surgery. In the case of abscess formation after gastric sleeve surgery caused by actinomycete infection, antibiotic treatment and percutaneous drainage are effective together.
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Affiliation(s)
- Ho-Goon Kim
- Department of General Surgery, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea;
| | - Ho-Kyun Lee
- Department of General Surgery, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea;
| | - Eunkyu Park
- Department of General Surgery, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
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17
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Han JH, Cha RR, Kwak JY, Jeon H, Lee SS, Jung JJ, Cho JK, Kim HJ. Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body. Medicina (Kaunas) 2023; 59:1504. [PMID: 37763623 PMCID: PMC10533137 DOI: 10.3390/medicina59091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.
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Affiliation(s)
- Ji-Hee Han
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ra-Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ji-Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Hankyu Jeon
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Sang-Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Jin Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
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18
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Phongphithakchai A, Konwai S, Kanchanasuwan S, Hongsakul K. A Rare Case of Bilateral Renal Abscess from Staphylococcal Infection in a Young Healthy Patient. Indian J Nephrol 2023; 33:304-306. [PMID: 37781555 PMCID: PMC10503570 DOI: 10.4103/ijn.ijn_178_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/06/2022] [Accepted: 07/22/2022] [Indexed: 10/03/2023] Open
Abstract
Bilateral renal abscess is a rare infectious disease. Most patients have some risk factors for comorbidities, such as diabetes or an abnormal urinary tract, causing abscess formation. The incidence of the disease is infrequent in young healthy adults. Here, we report a case of a previously healthy non-diabetic young man who presented with abdominal pain with a high-grade fever. With clinically persistent abdominal pain, computerized tomography of the whole abdomen was done. The result showed bilateral renal abscess. The culture from the abscess reported Staphylococcus aureus. The patient's clinical abdominal pain and fever resolved after receiving antibiotics for 4 weeks.
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Affiliation(s)
- Atthaphong Phongphithakchai
- Division of Nephrology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sirihatai Konwai
- Division of Nephrology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siripen Kanchanasuwan
- Division of Infectious Diseases, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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19
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Pandey A, Rajeshwari K, Kumar D, Gupta G. Assessment of risk factors in pyogenic liver abscesses in children. Afr J Paediatr Surg 2023; 20:218-223. [PMID: 37470559 PMCID: PMC10450120 DOI: 10.4103/ajps.ajps_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. Methodology This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. Results A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Conclusion Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.
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Affiliation(s)
- Anurag Pandey
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - K. Rajeshwari
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Deepak Kumar
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Garima Gupta
- Department of Pediatrics, ESIC Hospital, New Delhi, India
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20
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Chan KS, H’ng MWC, Shelat VG. Is there a role for percutaneous needle aspiration in the multimodal management of pyogenic liver abscess? Ann Transl Med 2023; 11:306. [PMID: 37404991 PMCID: PMC10316104 DOI: 10.21037/atm-23-1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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21
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Ganapathy A, Ballard DH, Bishop GL, Hoegger MJ, Abraham N, D’Agostino HB. Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage. Appl Sci (Basel) 2023; 13:7308. [PMID: 37621554 PMCID: PMC10448541 DOI: 10.3390/app13127308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Grace L. Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark J. Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - Horacio B. D’Agostino
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
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22
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Abstract
A psoas abscess is a rare infection; it is an accumulation of purulent material within the psoas muscle. Common pathogens include Staphylococcus aureus, streptococci, Escherichia coli, and other enteric Gram-negative bacilli and anaerobes. These abscesses are thought to occur by either hematogenous spread, contiguous spread from adjacent organs, trauma, or local inoculation. Pasteurella multocida is a pathogen that usually infects a patient via a bite or scratch from dogs or cats and causes cellulitis at the site of the injury. Pasteurella multocida may also cause infection by the colonization of human respiratory and gastrointestinal (GI) tracts with spontaneous bacteremia seeding remote organs by the bacterial translocation process. Pasteurella multocida is highly susceptible to penicillins, cephalosporins, and other antibiotics. However, psoas abscesses usually require a drainage procedure as well as an extended course of antibiotics. We present a patient presenting with a psoas abscess due to P. multocida, an uncommon presentation of infection by this bacterium.
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Affiliation(s)
- Scott C Everett
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Andrew L Alejo
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
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23
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S SMR, Bakhshi G, Muley GA. Needle Aspiration Versus Catheter Drainage in Medium-Sized (5-10 cm) Liver Abscesses: A Comparative Study in Mumbai, India. Cureus 2023; 15:e38240. [PMID: 37261139 PMCID: PMC10226830 DOI: 10.7759/cureus.38240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/02/2023] Open
Abstract
Background Liver abscess is a disease known to mankind since ancient times and has been treated by various means. The introduction of radiology-guided interventional drainage procedures has reduced the mortality rate, which forms a significant part of management. However, there is still a dilemma regarding the procedure of choice in medium-sized liver abscesses mainly in resource-limited developing countries. Methods The study was conducted on 60 patients with moderate-sized (5-10 cm) liver abscess/abscesses, liquified, drainable and divided randomly into two groups with 30 patients each and subjected to either Ultrasound-guided needle aspiration or catheter drainage with identical medical treatment. Outcomes were compared within both groups concerning the need for analgesics, total duration of hospital stay, total days of leave from work and recurrence or residual collection. Results Both groups were comparable in age, gender, type of abscess and maximal diameter. The success rate was equal (80% and 84%). However, the need for analgesics, total duration of hospital stay and total days of leave from work showed a significant (p<0.05) decrease in the needle aspiration group with a mean stay of 9.3 ± 3.18 days and mean leave of 18.9 ± 5.13 days as compared to catheter drainage group with the mean of 14.8 ±5.95 days and 32.5 ±11.4 days respectively. Conclusion Based on our study's results, we conclude that percutaneous needle aspiration is a primary interventional treatment in moderate-sized (5-10 cm) liver abscesses. More multicentric and randomised trials should be done to confirm the inference of this study.
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Affiliation(s)
| | - Girish Bakhshi
- General Surgery, Grant Government Medical College and Research Institute, Mumbai, IND
| | - Gayatri A Muley
- General Surgery, Grant Government Medical College and Research Institute, Mumbai, IND
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24
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Saukhat O, Mushailov A, Kleinbaum Y, Barash Y, Klang E, Nachmany I, Horesh N. Ultrasound-Tomographic Image Fusion - A Novel Tool for Follow up After Acute Complicated Appendicitis. Surg Innov 2023. [PMID: 36866417 DOI: 10.1177/15533506231161122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Computerized tomography (CT) is an integral part of the follow-up and decision-making process in complicated acute appendicitis (AA) treated non-operatively. However, repeated CT scans are costly and cause radiation exposure. Ultrasound-tomographic image fusion is a novel tool that integrates CT images to an Ultrasound (US) machine, thus allowing accurate assessment of the healing process compared to CT on presentation. In this study, we aimed to assess the feasibility of US-CT fusion as part of the management of appendicitis. MATERIALS AND METHODS We retrospectively collected data of consecutive patients with complicated AA managed non-operatively and followed up with US Fusion for clinical decision-making. Patients demographics, clinical data, and follow-up outcomes were extracted and analyzed. RESULTS Overall, 19 patients were included. An index Fusion US was conducted in 13 patients (68.4%) during admission, while the rest were performed as part of an ambulatory follow-up. Nine patients (47.3%) had more than 1 US Fusion performed as part of their follow-up, and 3 patients underwent a third US Fusion. Eventually, 5 patients (26.3%) underwent elective interval appendectomy based on the outcomes of the US Fusion, due to a non-resolution of imaging findings and ongoing symptoms. In 10 patients (52.6%), there was no evidence of an abscess in the repeated US Fusion, while in 3 patients (15.8%), it significantly diminished to less than 1 cm in diameter. CONCLUSION Ultrasound-tomographic image fusion is feasible and can play a significant role in the decision-making process for the management of complicated AA.
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Affiliation(s)
- Olga Saukhat
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Mushailov
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeruham Kleinbaum
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of General Surgery and Transplantations, 26744Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Pentara NV, Ioannidis A, Tzikos G, Kougias L, Karlafti E, Chorti A, Tsalkatidou D, Michalopoulos A, Paramythiotis D. Subcapsular Biloma following Endoscopic Retrograde Cholangiopancreatography and Endoscopic Biliary Sphincterotomy: A Case Report with a Mini Review of Literature. Diagnostics (Basel) 2023; 13:diagnostics13050831. [PMID: 36899975 PMCID: PMC10000511 DOI: 10.3390/diagnostics13050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
A biloma is a loculated, extrahepatic, intra-abdominal bile collection. It is an unusual condition with an incidence of 0.3-2% and is usually a result of choledocholithiasis, iatrogenic injury or abdominal trauma causing disruption to the biliary tree. Rarely, it will occur spontaneously, resulting in spontaneous bile leak. We herein present a rare case of biloma as a complication of endoscopic retrograde cholangiopancreatography (ERCP). A 54-year-old patient experienced right upper quadrant discomfort, following ERCP, endoscopic biliary sphincterotomy and stenting for choledocholithiasis. Initial abdominal ultrasound and computed tomography revealed an intrahepatic collection. Percutaneous aspiration under ultrasound guidance of yellow-green fluid confirmed the diagnosis, indicated infection and contributed to effective management. Most likely, a distal branch of the biliary tree was injured during the insertion of the guidewire through the common bile duct. Magnetic resonance image/magnetic resonance cholangiopancreatography contributed in the diagnosis of two seperate bilomas. Even though post ERCP biloma is an unusual complication, differential diagnosis of patients with right upper quadrant discomfort following an iatrogenic or traumatic event should always include biliary tree disruption. A combination of radiological imaging for diagnosis and minimal invasive technique to manage a biloma can prove to be successful.
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Affiliation(s)
- Natalia Valeria Pentara
- Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence:
| | - Aristidis Ioannidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Leonidas Kougias
- Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- 1st Propaedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Angeliki Chorti
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Despoina Tsalkatidou
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Koike Y, Kai R, Abe R, Munechika J, Ohgiya Y. Outcomes of C-arm cone-beam CT-guided percutaneous procedures for thoracolumbar spondylodiscitis: a comparison between with and without intradiscal drainage. MINIM INVASIV THER 2023; 32:81-89. [PMID: 36780294 DOI: 10.1080/13645706.2023.2174806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Percutaneous intradiscal drainage had little established evidence to date. We assessed the outcomes of C-arm cone-beam CT-guided (CBCT-guided) procedures for spondylodiscitis and compare procedures with and without intradiscal drainage. MATERIAL AND METHODS A retrospective review was conducted on patients who underwent CBCT-guided procedures for spondylodiscitis with fluid collection in the intradiscal space between January 2010 and September 2021. Included patients were divided into two groups: with and without 'intradiscal drainage' (ID and non-ID, respectively). RESULTS A total of 87 patients with thoracolumbar discitis (mean age 73.4 ± 12.3 years, 35 females) were included. There was no significant difference in clinical outcomes between groups. Although insignificant, a subgroup analysis of patients with discitis and psoas abscess showed a higher infection control success rate (81% (17/21) vs 58% (7/12), p = .23) and faster median C-reactive protein improvement (CRP <3 mg/dL: 12 vs 42 days, p = .11, CRP <1 mg/dL: 27 vs 45 days, p = .097) of ID than of non-ID. CONCLUSIONS Findings did not clarify the role of intradiscal drainage when it was indicated in all cases of spondylodiscitis with fluid collection. Future studies with larger sample sizes of selected discitis cases are expected to demonstrate the superiority of intradiscal drainage.
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Affiliation(s)
- Yuya Koike
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan.,Department of Interventional Radiology, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan
| | - Ryozo Kai
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryosuke Abe
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Jiro Munechika
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
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Belvedere A, Dajti G, Larotonda C, Angelicchio L, Rizzello F, Gionchetti P, Poggioli G, Rottoli M. Percutaneous Drainage vs. Surgery as Definitive Treatment for Anastomotic Leak after Intestinal Resection in Patients with Crohn's Disease. J Clin Med 2023; 12. [PMID: 36835926 DOI: 10.3390/jcm12041392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Anastomotic leak (AL) remains one of the most relevant complications after intestinal resection for Crohn's disease (CD). While surgery has always been considered the standard treatment for perianastomotic collection, percutaneous drainage (PD) has been proposed as a potential alternative. METHODS Retrospective study in consecutive patients treated with either PD or surgery for AL after intestinal resection for CD between 2004 and 2022. AL was defined as a perianastomotic fluid collection confirmed by radiological findings. Patients with generalized peritonitis or clinical instability were excluded. PRIMARY AIM To compare the success rate of PD vs. surgery. Secondary aims: To compare the outcomes at 90 days after the procedures; to identify the variables associated with the indication for PD. RESULTS A total of 47 patients were included, of which 25 (53%) underwent PD and 22 (47%) surgery. The success rate was 84% in the PD and 95% in the surgery group (p = 0.20). There were no significant differences between the PD and surgery group in postoperative medical and surgical complications, discharge, readmission or reoperation rates at 90 days. PD was more likely to be performed in patients with later diagnosis of AL (OR 1.25, 95% CI 1.03-1.53, p = 0.027), undergoing ileo-colic anastomosis alone (OR 3.72, 95% CI 2.29-12.45, p = 0.034) and treated after 2016 (OR 6.36, 95% CI 1.04-39.03, p = 0.046). CONCLUSION The present study suggests that PD is a safe and effective procedure to treat anastomotic leak and perianastomotic collection in CD patients. PD should be indicated in all eligible patients as an effective alternative to surgery.
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Regmi P, Shrestha S, Poddar E, Sharma D. Bilateral Page kidney in a postpartum female: a case report. Ann Med Surg (Lond) 2023; 85:225-7. [PMID: 36845773 DOI: 10.1097/MS9.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/24/2022] [Indexed: 02/28/2023] Open
Abstract
Page kidney results from external compression of the kidney by a subcapsular hematoma and is one of the rare but treatable causes of secondary hypertension. The majority are traumatic or iatrogenic and often unilateral. Spontaneous bilateral Page kidney is rare. Case Presentation A 35-year P1 with gestational hypertension presented with a persistent postpartum elevation of blood pressure (BP). Imaging studies revealed bilateral renal subcapsular hematoma (left>right). She was managed with an angiotensin receptor blocker initially and ultrasound-guided percutaneous drainage of the collection for the optimal control of elevated BP. Clinical Discussion Ultrasonography and computed tomography of the kidneys are the most frequently used for diagnosing a Page kidney. Medical management with antihypertensive and regular follow-ups form the first line of treatment in Page kidneys. Percutaneous drainage, surgical decortication, laparoscopic intervention, and nephrectomy are necessary in cases of organized late hematomas. Conclusion Spontaneous bilateral Page kidney is a rare but potentially treatable and curable form of hypertension. Percutaneous drainage is an effective method to drain the hematoma and control elevated BP.
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Hasegawa T, Arai Y, Sone M, Sugawara S, Itou C, Wada S, Umakoshi N, Kubo T, Kimura S, Kusumoto M. Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis. Asia Pac J Clin Oncol 2023; 19:257-262. [PMID: 35831984 DOI: 10.1111/ajco.13810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/08/2022] [Accepted: 06/13/2022] [Indexed: 01/20/2023]
Abstract
AIM Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. METHODS From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n = 73), apical (n = 23), or left parasternal (n = 17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. RESULTS The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970 ml (range, 140-7635 ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). CONCLUSIONS Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.
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Affiliation(s)
- Tetsuya Hasegawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Wada
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriyuki Umakoshi
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takatoshi Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Liu H, Xu C, Wang W, Chen B, Sun J, Feng X, Zhang Y, Ma F, Du L, Gao Y, Li Y. Case report: Ultrasound-guided percutaneous drainage combined with lavage using urokinase: An economical and effective treatment for muscular hematomas in hemophiliacs. Front Surg 2023; 10:1023329. [PMID: 37035572 PMCID: PMC10079870 DOI: 10.3389/fsurg.2023.1023329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
This was an initial effort to treat hemophiliac hematoma by ultrasound-guided intratumoral drainage and lavage with urokinase after adequate supplementation of coagulation factors. Two patients with severe hemophilia underwent ultrasound-guided percutaneous drainage in combination with lavage using urokinase. After 5-day and 3-day treatments, respectively, intramuscular hematomas in both patients disappeared, compression symptom was relieved, and no obvious adverse reactions or serious complications were observed during the treatment or follow-up. These findings suggest that ultrasound-guided drainage combined with lavage using urokinase is an immediate, safe, effective, and minimally invasive treatment for intramuscular hematomas in hemophiliacs, avoiding potential complications by surgical resection with relatively low treatment cost.
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Affiliation(s)
- Hao Liu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cong Xu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhen Wang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Chen
- Deportment of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoqin Feng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaru Zhang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fei Ma
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lingli Du
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Gao
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingjia Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Yingjia Li
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31
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Hegde G, Sharma P, Lekhadia U, Gopani S, Kandoi N. Entrapped Malecot catheter removal: Our experience. Trop Doct 2023; 53:146-147. [PMID: 36148515 DOI: 10.1177/00494755221125082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Some surgeons use a Malecot catheter for drainage of intra-abdominal or mediastinal collections. These tubes are usually removed after 2-3 weeks. If left later, they may become entrapped due to the ingrowing of tissue, and fibrosis within the flower-like tip of the Malecot's catheter. Its removal then needs careful manipulation to prevent organ damage. We present our experience in ensuring the safe removal of such entrapped Malecot's catheters in liver abscess patients.
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Affiliation(s)
- Ganesh Hegde
- Department of General Surgery, New Civil Hospital, Surat, India
| | - Praveen Sharma
- Department of General Surgery, New Civil Hospital, Surat, India
| | | | | | - Nilay Kandoi
- Department of General Surgery, New Civil Hospital, Surat, India
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Rasslan R, Alves V, Damous SHB, de Santis A, Tarasoutchi F, Menegozzo CAM, Akamine M, Rasslan S, Utiyama EM. Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil. J INVEST SURG 2022; 35:1836-1840. [PMID: 36202396 DOI: 10.1080/08941939.2022.2130481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
INTRODUCTION Splenic abscess secondary to endocarditis is a rare complication with high mortality. The treatment modality, splenectomy versus percutaneous drainage, and the best time, before or after valve replacement, are controversial. In the literature, there are only a few small case series about the subject. The objective of this study is to analyze the experience of a referral center in treating such condition. METHODS Patients with splenic abscesses due to endocarditis from 2006 to 2020 were retrospectively analyzed. RESULTS Thirteen patients (mean age 46 years old, 69% male) were identified. Eight patients (62%) had at least 2 comorbidities and 5 (38%) had a history of cardiac surgery. The diagnosis was incidental in 6 (46%). The mean time of abscess diagnosis after endocarditis definition was 14 days. Six patients (46%) had at least two organ dysfunctions. The median APACHE II score was 12 overall, and 24.5 in patients who died. Six patients (46%) had a valve replacement, and in two the abscess was diagnosed postoperatively. Of the other four patients, splenectomy was performed before the cardiac operation in three and at the same time in one. Splenectomy was performed immediately in 9 (69%) patients while three patients had percutaneous drainage (23%), one of which underwent splenectomy due to drainage failure. Exclusive antibiotic treatment was performed on only one patient. The median length of hospitalization was 24 days and mortality was 46%. CONCLUSION Splenic abscess due to endocarditis is a life-threatening condition with controversial treatment that results in a prolonged length of stay and high mortality.
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Affiliation(s)
- Roberto Rasslan
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Vinicios Alves
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Sergio Henrique Bastos Damous
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Antonio de Santis
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Flavio Tarasoutchi
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Calos Augusto Metidieri Menegozzo
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Masahiko Akamine
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Samir Rasslan
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Edivaldo Massazo Utiyama
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.,Heart Valve Unit, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Chan KS, Chia CTW, Shelat VG. Demographics, Radiological Findings, and Clinical Outcomes of Klebsiella pneumonia vs. Non- Klebsiella pneumoniae Pyogenic Liver Abscess: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Pathogens 2022; 11:pathogens11090976. [PMID: 36145408 PMCID: PMC9505935 DOI: 10.3390/pathogens11090976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Pyogenic liver abscess (PLA) is a common cause of hepatobiliary sepsis. Klebsiella pneumoniae (KP) is the most common organism causing PLA. Evidence is scarce on the demographics, radiological findings, and outcomes of KPPLA versus non-KPPLA (N-KPPLA). PubMed, Embase, The Cochrane Library, and Scopus were systematically searched until 14 May 2022 for studies comparing KPPLA and N-KPPLA. Exclusion criteria were single-arm studies. Primary outcomes were mortality (30-day/in-hospital) and metastatic complications. There were 16 studies, including 5127 patients (KPPLA n = 3305, N-KPPLA n = 1822). Patients with KPPLA were younger (mean difference: −2.04 years, p = 0.02). History of hepatobiliary disease (Odds ratio (OR) 0.30, 95% CI: 0.20, 0.46) and malignancy (OR 0.26, 95% CI: 0.16, 0.42) were less common in KPPLA. KPPLA was associated with lower incidence of multiple abscesses (OR 0.52, 95% CI: 0.35, 0.76, p < 0.001) and bilobar abscesses (OR 0.60, 95% CI: 0.49, 0.74, p < 0.001). KPPLA has higher overall metastatic complications (KPPLA 9.7% vs. N-KPPLA 4.8%, OR 3.16, 95% CI: 2.00, 4.99, p < 0.001), but lower mortality (KPPLA 3.9% vs. N-KPPLA 7.6%, OR 0.51, 95% CI: 0.34, 0.78, p < 0.001). Trial sequential analysis showed conclusive evidence that KPPLA has lower mortality than N-KPPLA. In conclusion, KPPLA has lower mortality than N-KPPLA.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Correspondence: author:
| | - Christopher Tze Wei Chia
- Department of Gastroenterology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd., Singapore 308232, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd., Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr., Singapore 117597, Singapore
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Novikov SV, Rogal ML, Yartsev PA, Teterin YS. [Pancreatic duct stenting in acute severe pancreatitis]. Khirurgiia (Mosk) 2022:18-26. [PMID: 35658132 DOI: 10.17116/hirurgia202206118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of endoscopic retrograde stenting of the pancreatic duct for acute severe pancreatitis. MATERIAL AND METHODS We analyzed 94 patients with acute severe pancreatitis who underwent surgery (n=87, 92.6%) and endoscopic retrograde pancreatic stenting (n=28, 29.8%). The first group included 15 patients (16%) after pancreatic duct stenting in aseptic phase of acute pancreatitis. The second group enrolled 13 patients (13.8%) who underwent pancreatic duct stenting in the phase of sequestration and infection. The third group consisted of 66 patients (70.2%) after open surgery without pancreatic duct stenting. RESULTS In the 1st group, we recanalized the necrosis zone up to distal pancreas via stenting. Infection was detected in 14 out of 15 patients. Surgical treatment was performed in 13 patients (13.8%). In the second group, pancreatic duct stenting was carried out in the phase of infected pancreatitis. We applied stenting to block the area of duct destruction or restore outflow in case of distal defect. No infection was observed in 1 out of 13 patients. Pancreatic duct stenting was not performed in 66 patients of the third group. Surgical treatment was performed in 59 patients (62.8%). In general, 11 of 94 patients (11.7%) were free from infection. CONCLUSION Better postoperative outcomes were observed in patients with damage to pancreatic duct, pancreatic drainage through percutaneous drains installed at the first stage of treatment. Early pancreatic duct stenting did not lead to significant improvement in treatment outcomes.
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Affiliation(s)
- S V Novikov
- Sklifosovsky Clinical and Research Institute for Emergency Care, Moscow, Russia
| | - M L Rogal
- Sklifosovsky Clinical and Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Clinical and Research Institute for Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovsky Clinical and Research Institute for Emergency Care, Moscow, Russia
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Hellinckx H, Mertes H, Vanreusel I, Demedts I, Dutré J. Clostridium perfringens splenic abscess treated with percutaneous drainage and antibiotic therapy: a case report. Acta Clin Belg 2022; 77:688-692. [PMID: 34151751 DOI: 10.1080/17843286.2021.1940606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Splenic abscesses are a rare medical entity with high mortality, with Clostridium perfringens being an exceptional pathogen. We present the first case describing an abscess of the spleen in a patient undergoing treatment with adalimumab, an anti-tumour necrosis factor commonly used in inflammatory bowel diseases. PATIENT We describe the case of a 73-year-old woman, treated with adalimumab therapy, who was found to have a splenic abscess, caused by C. perfringens. RESULT After antibiotic treatment and percutaneous drainage, the patient recovered both clinically and radiographically. DISCUSSION We reviewed literature about C. perfringens splenic abscesses. In all cases identified, a splenectomy was performed. This is the first case description of splenic abscess caused by C. perfringens where a percutaneous drainage was performed, leading to complete recovery in our patient. This seems to indicate that a splenectomy is not necessary in all C. perfringens splenic abscesses.
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Affiliation(s)
- Hanne Hellinckx
- Department of internal medicine, Catholic University of Leuven, Leuven, Belgium
| | - Helena Mertes
- Department of Infectiology, Jan Palfijn Merksem, Merksem, Belgium
| | - Inne Vanreusel
- Department of cardiology, University of Antwerp, Antwerp, Belgium
| | - Ingrid Demedts
- Department of Gastro-enterology, UZ Leuven, Leuven, Belgium
| | - Joris Dutré
- Department of Gastro-enterology, Jan Palfijn Merksem, Merksem, Belgium
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Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2022; 23:417-429. [PMID: 35612434 DOI: 10.1089/sur.2022.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
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Affiliation(s)
- Barite Gutama
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jillian K Wothe
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mengli Xiao
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dawn Hackman
- University of Minnesota Health Sciences Library, Minneapolis, Minnesota, USA
| | - Haitao Chu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Yousef Khan F, Elmudathir A, Abu Bakir M, Alsawaf B. Splenic Abscess in Qatar: A Single-Center Experience. Qatar Med J 2022; 2022:16. [PMID: 35321120 PMCID: PMC8928606 DOI: 10.5339/qmj.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND & OBJECTIVES Splenic abscess (SA) is a rare clinical entity. There is a lack of information on SA in most Arab and Gulf countries, including Qatar. This study describes the demographics, clinical features, microbiologic etiologies, treatments, and outcomes of patients with SA at the largest tertiary medical center in Qatar over the previous six years. METHODS This retrospective observational study was conducted at Hamad general hospital. It involved all patients of 18 years old or above who were admitted with the diagnosis of SA for the period between January 1, 2015, and December 31, 2020. RESULTS We recruited 25 patients, of which 14 (56%) were males, and 11 (44%) were females. The mean age ( ± SD) of them was 48.64 ± 19.08 years. The mean illness duration was 22.88 ± 11.88 days. Fever was the most common presenting symptom and was found in 21 (84%) cases, whereas bacteremia was the most predisposing factor found in 15 (60%) patients. The etiology of SA was bacterial in 16 cases (64%), mixed (fungal and bacterial) in one (4%), and tuberculous in one (4%), whereas the etiological agent was unidentified in seven (28%) cases. Intravenous antimicrobial therapy was administered empirically in all patients. However, seven patients (28%) received intravenous antibiotics as the only treatment modality for SA, 15 patients (60%) underwent percutaneous drainage with a pigtail catheter, and two patients underwent splenectomy. The inhospital mortality was three (12%). CONCLUSIONS This study showed that SA could be caused by various organisms that should be isolated to guide the choice of antimicrobial agents. An abdominal computed tomography is a good diagnostic modality, whereas computed tomography- and ultrasonography-guided percutaneous drainage were efficient therapeutic options that reduce the need for surgery.
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Affiliation(s)
| | - Ahmed Elmudathir
- Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail:
| | | | - Bisher Alsawaf
- Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail:
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Kennedy SA, Kennedy MK, Lindsay TF, Byrne J, Jaberi A, Gold WL, Tan K, Mafeld S. Percutaneous Drainage for Aortic Graft Infection Post-aneurysm Repair: A Viable Option? Vasc Endovascular Surg 2022; 56:369-375. [PMID: 35180037 PMCID: PMC9003758 DOI: 10.1177/15385744221075136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose Non-operative management of aortic graft infection is usually only considered in a palliative context. We describe the safety, efficacy, and clinical outcomes of percutaneous drainage of aortic graft infections (AGI) following either open or endovascular repair of aneurysmal disease. Methods Twelve consecutive patients (11 males, 1 female, mean age 72.7 ± 10.3 years, age range 52-88 years) between January 2010-July 2020 who underwent percutaneous drain insertion in either an infected aortic sac or periaortic abscess cavity following endovascular or open surgical graft repair were identified. Patient and procedural characteristics as well as clinical outcomes were determined. Results Of the 12 patients who underwent percutaneous drain insertion, five (41.7%) had undergone open abdominal aneurysm repair, one (8.3%) open thoracoabdominal aneurysmal repair, and six (50%) endovascular abdominal aneurysm repairs. Drain size ranged from 10-20 French. All were inserted under ultrasound (US), computed tomography (CT), and/or fluoroscopic guidance. Median duration of drain placement was 55.2 days (range 3-174). Five patients (41.7%) had the drain in place as a stabilizing bridge until or after definitive surgical explantation and aortic reconstruction. Seven patients (58.3%) were managed with drain placement and antibiotic therapy without surgical intervention. Six (50%) were alive at the most recent time of follow-up (median, 732 days, range 166-1650 days). Three patients (25%) died during follow-up with causes including erosion of aortic reconstruction into sigmoid colon, unrelated chronic obstructive pulmonary disease exacerbation, and severe clostridium difficile colitis and pseudomonal pneumonia (median 1244 days, range 992-1597 days). Three (25%) patients were lost to follow-up. No drain-related complications were noted. Conclusion Percutaneous drainage of AGI following endovascular or open aneurysm repair is a safe and viable management option either as a temporizing measure as a bridge to surgical graft explantation or as a non-surgical therapy for long term management.
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Affiliation(s)
- Sean A Kennedy
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 7938University of Toronto, Toronto, ON, Canada
| | - M Katharine Kennedy
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 7938University of Toronto, Toronto, ON, Canada
| | - Thomas F Lindsay
- Division of Vascular Surgery, Department of Surgery, 7989University of Toronto, Toronto, ON, Canada
| | - John Byrne
- Division of Vascular Surgery, Department of Surgery, 7989University of Toronto, Toronto, ON, Canada
| | - Arash Jaberi
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 7938University of Toronto, Toronto, ON, Canada
| | - Wayne L Gold
- Division of Infectious Diseases, Department of Medicine, 33540University of Toronto, Toronto, ON, Canada
| | - KongTeng Tan
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 7938University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 7938University of Toronto, Toronto, ON, Canada
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Shyam VS, Rana S, Vinay Kumar BR, Choudhury A, Mukund A. Suppurative Pylephlebitis With Portal Vein Abscess Mimicking Portal Vein Thrombosis: A Report of Two Cases. J Clin Exp Hepatol 2022; 12:208-11. [PMID: 35068801 DOI: 10.1016/j.jceh.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 01/03/2023] Open
Abstract
Suppurative pylephlebitis, that is, infected thrombosis of the portal vein and its branches is a rare condition with a high incidence of mortality and is often difficult to diagnose. We report two cases of suppurative pylephlebitis secondary to acute pancreatitis wherein the whole of the portal vein and its branches were transformed into an abscess cavity. The diagnosis was made after pus was seen coming out while the patient was taken up for portal vein thrombolysis. The pus was drained and the cavity was completely evacuated leading to recovery from this infection. These two cases highlight the fact that suppurative pylephlebitis is rare and extremely difficult to diagnose as it mimics portal vein thrombosis, but a high degree of suspicion in critically ill patients with thrombus-like appearance in portal vein having a uniform and homogeneous portal venous content on magnetic resonance imaging not responding to antibiotic therapy may be considered for aspiration for differentiating from thrombus and management.
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Das S, Shankar G, Mohapatra V. Safety and efficacy of USG-guided catheter drainage in liver abscesses. Ann Afr Med 2022; 21:21-25. [PMID: 35313400 PMCID: PMC9020638 DOI: 10.4103/aam.aam_68_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: This study aimed to evaluate the safety and efficacy of USG-guided percutaneous drainage in liver abscesses of >5 cm. A lot of literature is available on the minimally invasive treatment of liver abscesses since its introduction in the early 1980s. This study focuses on the eastern Indian population and the outcome of treatment of liver abscess of >5 cm by means of catheter drainage and the use of antibiotics. Patients and Methods: This is a retrospective study conducted on a total of fifty patients over a period of 1 year, 1 month (from June 2017 to June 2018). Only patients with liver abscess with size >5 cm were included in the study. The demographic characteristics; comorbidities; and clinical, radiological, and bacteriological characteristics of liver abscesses in the eastern Indian population and the safety and efficacy of catheter drainage were evaluated. Results: It was found that because of preprocedural empirical antibiotic intake, 70% of the patients had no growth in the pus, whereas 12% had Entamoeba histolytica, 8% had Escherichia coli, and 6% had Klebsiella pneumoniae as the causative agent. The total duration of hospital stay ranged from 3 to 22 days, and the duration of intravenous antibiotics ranged from 1 to 9 days with a clinical success rate of 96% without any drainage-related complications. Conclusion: In contradiction to the earlier belief, percutaneous drainage is a safe and effective means of treatment in liver abscesses of >5 cm with high clinical success rate and reduced duration of intravenous antibiotic requirement as well as hospital stay.
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Affiliation(s)
- Swati Das
- Department of Radiodiagnosis, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girendra Shankar
- Department of Radiodiagnosis, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Vedavyas Mohapatra
- Department of Surgical Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Xiao NJ, Cui TT, Liu F, Li W. Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis. World J Gastrointest Surg 2021; 13:633-644. [PMID: 34354797 PMCID: PMC8316846 DOI: 10.4240/wjgs.v13.i7.633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/16/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic and peripancreatic collections are the main local complications of acute pancreatitis with a high incidence. In the early phase, most acute pancreatic and peripancreatic collections can resolve spontaneously with supportive treatment. However, in some cases, they will develop into pancreatic pseudocyst (PPC) or walled-off necrosis (WON). When causing symptoms or coinfection, both PPC and WON may require invasive intervention. Compared to PPC, which can be effectively treated by endoscopic ultrasound-guided transmural drainage with plastic stents, the treatment of WON is more complicated and challenging, particularly in the presence of infected necrosis. In the past few decades, with the development of minimally invasive interventional technology especially the progression of endoscopic techniques, the standard treatments of those severe complications have undergone tremendous changes. Currently, based on the robust evidence from randomized controlled trials, the step-up minimally invasive approaches have become the standard treatments for WON. However, the pancreatic fistulae during the surgical step-up treatment and the stent-related complications during the endoscopic step-up treatment should not be neglected. In this review article, we will mainly discuss the indications of PPC and WON, the timing for intervention, and minimally invasive treatment, especially endoscopic treatment. We also introduced our preliminary experience in endoscopic gastric fenestration, which may be a promising innovative method for the treatment of WON.
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Affiliation(s)
- Nian-Jun Xiao
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
- Department of Gastroenterology and Hepatology, Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Ting-Ting Cui
- Department of Gastroenterology and Hepatology, Medical School of Chinese People's Liberation Army, Beijing 100853, China
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fang Liu
- Department of Gastroenterology and Hepatology, Medical School of Chinese People's Liberation Army, Beijing 100853, China
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Serban D, Popa Cherecheanu A, Dascalu AM, Socea B, Vancea G, Stana D, Smarandache GC, Sabau AD, Costea DO. Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis-A Global Emerging Disease. Life (Basel) 2021; 11:life11070676. [PMID: 34357049 PMCID: PMC8304989 DOI: 10.3390/life11070676] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
The review aims to document the new emerging hypervirulent Klebsiella pneumoniae (Kp) endogenous endophthalmitis (EKE) in terms of incidence, microbiological characterization of the pathogenic agent, associated risk factors, management, and outcomes. Hypervirulent (hv) strains of KP (hvKp) induce invasive liver abscesses (LA) with specific clinical features. Up to 80–90% of cases have hepatic liver abscess as a primary focus of infection, followed by renal or lung hvKp infections. However, the incidence of EKE in patients with KPLA varied between 3.4% (19) and 12.6% (13), with a total of 95 cases of endophthalmitis in 1455 cases of KPLA (6.5%). Severe visual loss was encountered in 75% of cases, with 25% bilateral involvement. Intravitreal antibiotics are the mainstay therapeutic approach. Pars plana vitrectomy is a subject of controversy. HvKp strains present mostly natural “wild-type” antibiotic resistance profile suggestive for community-acquired infections, being highly susceptive to the third and fourth generation of cephalosporins and carbapenems. Antimicrobial resistance in hypervirulent strains was recently documented via plasmid transfer and may result in extremely difficult to treat cases. Global dissemination of these strains is a major epidemiologic shift that should be considered in the diagnostic and therapeutic management of patients with endogenous endophthalmitis. Ophthalmologic screening in patients with KPLA and other hvKp infections and a multidisciplinary therapeutic approach is extremely important for early diagnosis and preservation of the visual function.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- 4th Department of General Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Alina Popa Cherecheanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- Department of Ophthalmology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Ana Maria Dascalu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- Department of Ophthalmology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Correspondence: (A.M.D.); (B.S.)
| | - Bogdan Socea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- Department of Surgery, “Sf Pantelimon” Emergency Hospital Bucharest, 021659 Bucharest, Romania
- Correspondence: (A.M.D.); (B.S.)
| | - Geta Vancea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- “Victor Babes” Infectious and Tropical Disease Hospital Bucharest, 030303 Bucharest, Romania
| | - Daniela Stana
- Department of Ophthalmology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Gabriel Catalin Smarandache
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020011 Bucharest, Romania; (D.S.); (A.P.C.); (G.V.); (G.C.S.)
- 4th Department of General Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Alexandru Dan Sabau
- 3rd Clinical Department, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550024 Sibiu, Romania; (A.D.S.); (D.O.C.)
| | - Daniel Ovidiu Costea
- 3rd Clinical Department, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550024 Sibiu, Romania; (A.D.S.); (D.O.C.)
- Faculty of Medicine, Ovidius University Constanta, 900527 Constanta, Romania
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Karpova RV, Russkova KS, Komarov RN, Petrova AA. Ultrasound-Guided Percutaneous Drainage of Abdominal Abscess in a Patient With Crohn's Disease: A Case Report. Front Surg 2021; 8:616586. [PMID: 34150835 PMCID: PMC8211758 DOI: 10.3389/fsurg.2021.616586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: The autoimmune process in Crohn's disease exacerbates destructive changes in the intestinal wall and leads to complications such as bleeding (21. 9%), strictures (21.6%), and abscesses (19.7%). Case Presentation: The case of a 32-year-old male patient with an 8-year history of Crohn's disease is presented. He was admitted for emergency indications with severe pain in the right lower quadrant, chills, and a fever reaching 39.0°C. The patient had anemia, hypocoagulation and immunodeficiency. Ultrasound and CT scans of the abdominal organs revealed an abscess in the right iliac region. It was immediately drained under ultrasound control and X-ray. A fistulogram showed the fistula between the abscess and the ileum. Routine antibiotic therapy selected in accordance with the sensitivity of the microflora and sanitization of the abscess cavity were not effective. The immunomodulatory therapy, intravenous administration of cryoprecipitate, and the introduction of fibrin glue into the abscess cavity were added to the treatment. After the treatment, the patient's immune status corresponded to normal, the abscess healed, and the fistula was closed. Conclusion: In patients suffering from Crohn's disease with the formation of an abscess and a long-term non-healing intestinal fistula, it is essential that the diagnostic algorithm includes the examination of the immune status. Treatment should include immunomodulators, intravenous administration of cryoprecipitate. To close the fistula in these patients, it is advisable to use fibrin glue that has a local immunomodulatory effect.
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Affiliation(s)
- Radmila V Karpova
- Department of Faculty Surgery No. 1, University Clinical Hospital No. 1, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ksenia S Russkova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Roman N Komarov
- Department of Faculty Surgery No. 1, University Clinical Hospital No. 1, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Arina A Petrova
- International School "Medicine of the Future", I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Mulita F, Liolis E, Tchabashvili L, Seretis F, Iliopoulos F, Drakos N, Maroulis I, Vailas M. Giant splenic abscess caused by Salmonella enterica. Clin Case Rep 2021; 9:2498-2499. [PMID: 33936730 PMCID: PMC8077386 DOI: 10.1002/ccr3.4003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
Splenectomy is the gold standard for treating a splenic abscess, when percutaneous drainage fails or is less likely to be successful.
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Affiliation(s)
- Francesk Mulita
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Elias Liolis
- Department of Internal MedicineGeneral University Hospital of PatrasAchaiaGreece
| | - Levan Tchabashvili
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Fotios Seretis
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Fotios Iliopoulos
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Nikolas Drakos
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Ioannis Maroulis
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
| | - Michail Vailas
- Department of General SurgeryGeneral University Hospital of PatrasAchaiaGreece
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Ke L, Dong X, Chen T, Doig GS, Li G, Ye B, Zhou J, Xiao X, Tong Z, Li W. Early on-demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: A pilot randomized controlled trial. J Hepatobiliary Pancreat Sci 2021; 28:387-396. [PMID: 33595879 DOI: 10.1002/jhbp.915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE The current standard care for acute pancreatitis with acute necrotic collections (ANC) is to postpone invasive intervention for 4 weeks when indicated. However, in patients with persistent organ failure (POF), this delayed approach may prolong organ failure. In this study, we aimed to assess the feasibility and safety of earlier drainage for acute pancreatitis patients with ANC and POF. METHODS A single-center, randomized controlled trial was conducted. Eligible patients were randomly assigned to either the early on-demand (EOD) group or the standard management (SM) group. Within 21 days of randomization, early drainage was triggered by unremitted or worsening organ failure in the EOD group. The primary endpoint was a composite of major complications/death during 90-days follow-up. RESULTS Thirty patients were randomized. Within 21 days of randomization, eight of the 15 patients (53%) in the EOD group underwent percutaneous drainage compared to four of the 15 patients (27%) in the SM group (P = 0.26). The primary outcome occurred in three of the 15 (20%) patients in the EOD group and seven of the 15(46.7%) in the controls (P = 0.25, relative risk 0.43, 95%CI 0.14 to 1.35). CONCLUSIONS Although the EOD approach did not result in significant differences between groups, the primary outcome assessed in this trial demonstrated the potential for clinical benefits favoring early drainage.
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Affiliation(s)
- Lu Ke
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
| | - Xiaowu Dong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Chen
- Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gordon S Doig
- Northern Clinical School Intensive Care Research Unit, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gang Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xiaojia Xiao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), The First School of Clinical Medicine, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
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Coulon A, Ould-Nana I, Wilputte JY. Infected hepatic cyst complicating urinary sepsis. Acta Gastroenterol Belg 2021; 84:131-4. [PMID: 33639705 DOI: 10.51821/84.1.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Congenital hepatic cysts are a common disorder. Usually they are asymptomatic and do not have to be treated. However, some serious complications can occur. We report here the case of an 86-year old patient who has been treated by a percutaneous drainage for an infected solitary hepatic cyst due to urinary sepsis. She was admitted to the Department of Internal Medicine for epigastric pain with fever and chills. The patient was treated for a urinary tract infection 3 weeks ago by her General Practitioner. On admission, blood tests showed 21 620 neutrophils per microliter with a C-reactive protein level at 443.7 mg/L, procalcitonin > 200 ng/mL, total bilirubin at 1.43 mg/dL, lactate dehydrogenase at 666 U/L and alanine aminotransferase at 227 U/L. Urinalysis and hemocultures highlighted the presence of Escherichia coli and Streptococcus constellatus. The abdominal tomodensitometry indicated the presence of a left hepatic biliary cyst with banal appearance. She was first treated with intravenous amoxicillin clavulanic acid. After a few days, another abdominal tomodensitometry with contrast pinpointed a large abscess of 11 centimeters in diameter extending to liver segments II and IV with a similar small lesion in segments IV and V. clindamycin per os was added to the treatment because of its good diffusion in tissues. Percutaneous drain was inserted under tomodensitometric control and stayed in place until the follow-up at three weeks. Bacteriologic culture on the fluid sample demonstrated the presence of Escherichia coli and Streptococcus constellatus. The abscess completely regressed after 6 weeks of treatment and the biologic abnormalities resolved at the same time.
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Khuroo MS. Percutaneous Drainage in Hepatic Hydatidosis-The PAIR Technique: Concept, Technique, and Results. J Clin Exp Hepatol 2021; 11:592-602. [PMID: 34511821 PMCID: PMC8414317 DOI: 10.1016/j.jceh.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
Over decades, surgery has been the only accepted mode of treatment for liver hydatid cysts. It had been a surgical dogma for a long that hydatid disease is an absolute contraindication for needle puncture/aspiration as it can cause anaphylaxis, death, and dissemination. We envisaged prospectively perform percutaneous drainage as a primary form of treatment for hepatic hydatidosis. Through extensive and very careful experimentation, we proved that aspiration of hydatid cysts can be performed safely and is the ideal way to manage a subset of patients with hydatid cysts in the liver. The patient and cyst characteristics good and not good for percutaneous drainage were carefully selected. The procedure of percutaneous drainage of hepatic hydatid cysts involves four sequential steps as defined in the alphabets of the title PAIR, denoting puncture (P), Aspiration (A), Instillation (I), and Reaspiration (R). During and postprocedure, we enforced strict monitoring given the anticipated anaphylaxis. The first PAIR procedure was performed in June 1988. The results of percutaneous drainage of 21 cysts in 12 patients were reported in 1991. Next, a prospective study was done to show that concomitant Albendazole therapy is recommended as an adjuvant to percutaneous drainage for hepatic hydatidosis. In a seminal prospective study comparing percutaneous drainage and surgery, we showed that percutaneous drainage is as good as surgery in the management of uncomplicated hydatid cysts with fewer complications and shorter hospital stays. Lastly, long-term follow-up results of percutaneous drainage on a large cohort of patients with hepatic hydatid cysts were reported, with excellent results and no evidence of local, peritoneal or systemic dissemination. Based on these data percutaneous drainage, the so-called PAIR technique has established itself as a novel therapeutic advance in hepatic hydatid disease.
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Affiliation(s)
- Mohammad S. Khuroo
- Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia,Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Srinagar, Kashmir, India,Address for correspondence. Prof. Mohammad Sultan Khuroo, Director Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Sector-1, SK Colony, Qamarwari, Srinagar, J&K (UT), 190010, India. http://www.drkhuroo.inwww.facebook.com/mohammad.khurooTwitter iconMohammad Khuroo@mskhuroo
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Singh AK, Karmani S, Samanta J, Gupta P, Gupta V, Yadav TD, Kumari S, Dutta U, Sinha SK, Kochhar R. Splenic abscess in a tertiary care centre in India: clinical characteristics and prognostic factors. ANZ J Surg 2020; 91:1819-1825. [PMID: 33369845 DOI: 10.1111/ans.16517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Splenic abscess has been an uncommon entity which is now being encountered more frequently due to increased prevalence of immunodeficiency disorders and chronic illnesses. This study was aimed to audit our experience with splenic abscesses at a tertiary care centre in India highlighting usefulness of an algorithmic approach. METHODS Retrospective analysis of data of patients (January 2014 to December 2019) with splenic abscess was done. Data were retrieved for clinical characteristics, radiological findings, organism spectra, abscess characteristics, therapeutic measures and clinical outcome. RESULTS The mean age of the study population (n = 36) was 41.3 ± 19.0 years with 50% males. Comorbidities were identified in 17 (47.2%) patients, with diabetes mellitus being the commonest. Fever and abdominal pain were the most common presenting features. Multiple splenic abscesses were present in 21 (58.3%) patients. Extra-splenic abscesses in liver were seen in five (13.9%) patients while nine (25%) patients had ruptured splenic abscess. Microorganisms were identified in 24 (66.7%) patients, with Salmonella typhi being the commonest (n = 9, 25%) followed by Escherichia coli (n = 7, 19.4%) and Staphylococcus aureus (n = 4, 11.1%). Six patients received only antimicrobials, 24 were managed with percutaneous aspiration or catheter drainage and six required surgery. Five (13.9%) patients died, with highest mortality being seen in those who received only antimicrobial (50%), compared to percutaneous aspiration or catheter drainage (8.3%) and surgery (0%), P = 0.017. CONCLUSION Using percutaneous aspiration or drainage in conjunction with antibiotics, followed by surgery in non-responder, patients with splenic abscesses can be managed successfully with acceptable mortality.
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Affiliation(s)
- Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Karmani
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Gastrointestinal Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur D Yadav
- Department of Gastrointestinal Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Kumari
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chawla L, Rajaram S, Arora S, Chauhan U, Mishra J. Minimally invasive management of pyoperitoneum in a COVID-19 patient: A therapeutic dilemma. Int J Gynaecol Obstet 2020; 153:179-180. [PMID: 33332602 PMCID: PMC9087618 DOI: 10.1002/ijgo.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022]
Abstract
A case report of successful minimally invasive management of puerperal sepsis with pyoperitoneum and acute peritonitis in a COVID‐19‐positive patient.
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Affiliation(s)
- Latika Chawla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Shivani Arora
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Udit Chauhan
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Juhi Mishra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
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Inaba Y, Izawa N, Ishikawa M, Yamamiya A, Hoshi K, Arisaka T, Majima Y, Tominaga K, Iijima M, Goda K, Irisawa A. Huge Amoebic Liver Abscess in the Left Lobe Treated by Oral Administration of Metronidazole. Intern Med 2020; 59:3023-3026. [PMID: 32727992 PMCID: PMC7759695 DOI: 10.2169/internalmedicine.5301-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.
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Affiliation(s)
- Yasunori Inaba
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Mutsumi Ishikawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Yuichi Majima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
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