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Abscess
Kinds of Abscess Terms modified by Abscess Selected AbstractsTHERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATIONDIGESTIVE ENDOSCOPY, Issue 4 2005Yoshihisa Saida Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra-abdominal complication. A case of a 69-year-old male with an abdominal abscess after he underwent right hemi-colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re-operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40-cm-long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra-abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool. [source] Extremely Rapid Formation of Mitral Valve Ring Abscess in Infective EndocarditisECHOCARDIOGRAPHY, Issue 6 2004Balaram Shrestha M.D., Ph.D. A patient with infective endocarditis (IE) due to methicillin-resistant staphylococcus aureus (MRSA) was found to have conversion of the hypoechoic region of the posterior mitral valve ring apparatus into a clearly delineated echolucent space by repeating transthoracic echocardiography at an interval of 1 week. Color Doppler showed features of blood entry into this space. Abscess formation in IE due to MRSA may be quick and repeated echocardiography may help detect the complications of IE. Semiurgent mitral valve plasty was performed for the associated prolapse of the posterior mitral leaflet using a hand-made, rolled, twisted autologous pericardial ring. [source] Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and preventionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007Philip R. Cohen MD Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection. [source] Extensive Scalp Necrosis and Subepicranial Abscess in a Patient with Giant Cell ArteritisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Simon Smitz MD No abstract is available for this article. [source] Management of Coronary Artery Compression Caused by Recurrent Aortic Root AbscessJOURNAL OF CARDIAC SURGERY, Issue 3 2008Scott W. Cowan M.D. We report the case of a 61-year-old male who developed a recurrent aortic root abscess causing extrinsic coronary artery compression. This complication occurred one year after undergoing aortic valve replacement and pericardial patch exclusion of an aortic root abscess. Surgical correction required debridement of the abscess and replacement of the aortic root with a homograft resulting in resolution of coronary compression. [source] Total Autologous Ross Procedure in a Child With Aortic Root AbscessJOURNAL OF CARDIAC SURGERY, Issue 5 2006Yusuf Kenan Yalcinbas M.D. Methods: An 8-year-old girl was presented with dyspnea, high fever, and fatigue. She had stenotic bicuspid aortic valve with endocarditis and aortic root abscess. Ross procedure was performed with fresh autologous pericardial tube and pericardial monocusp valve. Right internal mammary artery to right coronary artery bypass was also done due to destructed right coronary artery ostium. Results: Four years after the operation she is in excellent clinical condition without medications. Echocardiography reveals mild autograft regurgitation and mildly stenotic right ventricular outflow tract. Conclusions: If homografts are not available, total reconstruction of RVOT with autologous fresh pericardium may offer reasonable early and mid-term results especially when active endocarditis and aortic root abscess is involved. [source] Aseptic Subcutaneous Abscess Associated With Ulcerative ColitisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2003Fukunori Kinjo No abstract is available for this article. [source] Ultrasound-guided Ulnar Nerve Block in the Management of Digital Abscess and Hand CellulitisACADEMIC EMERGENCY MEDICINE, Issue 1 2010Michael B. Stone MD No abstract is available for this article. [source] The Incidence of Spontaneous Epidural Abscess in Olmsted County from 1990 Through 2000: A Rare Cause of Spinal PainPAIN MEDICINE, Issue 4 2007Anne E. Ptaszynski MD ABSTRACT Objective., The primary objective of this study is to determine the population-based incidence of spontaneous epidural abscess. The secondary objective is to characterize the clinical course of patients with this rare infectious disease. Design., The records-linkage system of the Rochester Epidemiology Project was used to identify incident cases of spontaneous epidural abscess in residents of Olmsted County, Minnesota, USA, from 1990 through 2000. Setting., Tertiary referral medical center. Patients., All patients were residents of Olmsted County and had spontaneous epidural abscesses that were radiographically or surgically confirmed. Results., Eight patients, including six women, were identified and the mean age was 56 years (range, 40,80). The incidence of epidural abscess was 0.88 cases per 100,000 person-years (95% confidence interval, 0.27,1.48). The median time from symptom onset to diagnosis was 18 days (interquartile range, 4,30 days). Six patients presented with spinal pain and one presented with focal neurological deficits. Risk factors were identified in all patients, including concomitant infections, diabetes mellitus, immunosuppression, and intravenous substance abuse. Staphylococcus aureus was cultured in six patients and streptococcal species were cultured in two patients. Three patients were treated surgically and five received medical treatment. One patient treated surgically and one patient treated medically had residual neurological deficits. One patient, who was immunosuppressed and received medical treatment died of pneumonia. Conclusions., This is the first published report of the population-based incidence of spontaneous epidural abscess. These findings could serve as a reference point for further epidemiological research related to this uncommon infection. [source] Spinal Epidural Abscess as a Result of Dissemination from Gluteal Abscess Secondary to Intramuscular Analgesic InjectionPAIN PRACTICE, Issue 5 2009Mehdi Sasani MD Abstract Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intramuscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the suspected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess. [source] Papillon,Lefèvre Syndrome with Pyogenic Hepatic Abscess: A Rare AssociationPEDIATRIC DERMATOLOGY, Issue 1 2001D.N.B., Sujay Khandpur M.D. The patient showed a dramatic response to acitretin therapy. [source] Have the Organisms that Cause Breast Abscess Changed With Time?,,Implications for Appropriate Antibiotic Usage in Primary and Secondary CareTHE BREAST JOURNAL, Issue 4 2010Natalie Dabbas MBBS Abstract:, Many patients with breast abscess are managed in primary care. Knowledge of current trends in the bacteriology is valuable in informing antibiotic choices. This study reviews bacterial cultures of a large series of breast abscesses to determine whether there has been a change in the causative organisms during the era of increasing methicillin-resistant Staphylococcus aureus (MRSA). Analysis was undertaken of all breast abscesses treated in a single unit over 2003 , 2006, including abscess type, bacterial culture, antibiotic sensitivity and resistance patterns. One hundred and ninety cultures were obtained (32.8% lactational abscess, 67.2% nonlactational). 83% yielded organisms. Staphylococcus aureus was the commonest organism isolated (51.3%). Of these, 8.6% were MRSA. Other common organisms included mixed anaerobes (13.7%), and anaerobic cocci (6.3%). Lactational abscesses were significantly more likely to be caused by S. aureus (p < 0.05). Methicillin-resistant Staphylococcus aureus rates were not statistically different between lactational and nonlactational abscess groups. Appropriate antibiotic choices are of great importance in the community management of breast abscess. Ideally, microbial cultures should be obtained to institute targeted therapy but we recommend the continued use of flucloxacillin with or without metronidazole (or amoxicillin-clavulanate as a single preparation) as initial empirical therapy. [source] Rare Species of Actinomyces as Causative Pathogens in Breast AbscessTHE BREAST JOURNAL, Issue 5 2007Kaka Hama Attar MRCS Abstract:, Actinomyces species are commensal flora usually found in the oropharynx, gastrointestinal tract, and female genital tract. Primary actinomycosis of the breast is an unusual condition, where the most commonly isolated pathogen has been Actinomyces israelii. In recent years, other Actinomyces strains have been found associated with breast disease. We present the first reported cases of breast infection caused by the rare species, Actinomyces turicensis and Actinomyces radingae. Both infections displayed chronicity and abscess formation. In the first case, the infection was refractory to recurrent aspirations and initial antibiotic therapy. In the second case, aspiration and prolonged antibiotic therapy was required to overcome the chronic infection. [source] Conservative Therapy of Esophageal Perforation With Neck Abscess in a Child,THE LARYNGOSCOPE, Issue 11 2007Matthew C. Miller MD Abstract Conservative management of complicated esophageal perforations has gained favor in recent years. However, there are limited data concerning the applicability of this approach in the pediatric population. We describe the care and outcome of a 14-year-old girl who sustained an esophageal perforation after accidental ingestion of a shard of glass. The patient was treated using ultrasound-guided drainage catheter placement with simultaneous esophagoscopy and postoperative antibiotics. She was discharged within 1 week of presentation and enjoyed an uncomplicated recovery. We believe that selected cases of pediatric esophageal perforation may be safely and effectively treated using a conservative approach. [source] Incision and Drainage of a Retropharyngeal Abscess Located Adjacent to C1 with InstaTrak Image Guidance,THE LARYNGOSCOPE, Issue 3 2006Amar C. Suryadevara MD No abstract is available for this article. [source] Laryngeal Abscess after Injection Laryngoplasty with Micronized AlloDerm,THE LARYNGOSCOPE, Issue 9 2004Philip E. Zapanta MD Objective: Patients with unilateral vocal cord paralysis usually present with dysphonia and occasionally with swallowing problems. Operative management includes thyroplasty type I, injection laryngoplasty, arytenoid adduction, and reinnervation. Recent publications have documented the safety of micronized AlloDerm (Cymetra, LifeCell Corporation, Branchburg, NJ) for injection laryngoplasty, but we report the first documented case of a laryngeal abscess after injection laryngoplasty with Cymetra. Study Design: Single case report of a laryngeal abscess after injection laryngoplasty with Cymetra. Methods: The patient's clinical course is presented and discussed, and the pertinent literature is reviewed. Results: Prompt hospital admission with intravenous antibiotics and steroids resolved this airway emergency. Follow-up visits showed a significantly improved postoperative voice with an intact airway. Conclusion: A review of the literature reveals that this case of a laryngeal abscess after injection laryngoplasty with Cymetra is the first of its kind. Studies have shown that the use of AlloDerm in the head and neck region is safe, but otolaryngologists need to be cognizant of potential complications when working with this material. [source] Brain Abscess in an Adult With Atrial Septal DefectCLINICAL CARDIOLOGY, Issue 4 2010Chong Won Sung MD Brain abscess is a serious complication of congenital heart disease in children and adolescents. This association is rarely observed in adults. This article describes the case of a 41-year-old man who presented with altered mental status. Brain MRI showed a brain abscess at the left frontal lobe. The patient was successfully treated with surgical removal and appropriate antibiotics. Echocardiographic examination showed atrial septal defect (ASD) with bidirectional shunt. Transcatheter closure of ASD was carried out 6 months after neurosurgical treatment. We discuss the association of brain abscess and ASD. Copyright © 2010 Wiley Periodicals, Inc. [source] Late-Appearing Abscesses after Injections of Nonabsorbable Hydrogel Polymer for HIV-Associated Facial LipoatrophyDERMATOLOGIC SURGERY, Issue 2007DEREK H. JONES MD First page of article [source] Intracranial Vasculitis and Multiple Abscesses in a Pregnant WomanJOURNAL OF NEUROIMAGING, Issue 3 2001Mutlu Cihangiroglu ABSTRACT Cerebral vasculitis is an unusual disorder with many causes. Infectious causes of cerebral vasculitis are predominantly bacterial or viral in nature. Purulent bacterial vasculitis is most often a complication of severe bacterial meningitis. The patient is a 25-year-old African American female, 25 weeks pregnant, who presented to the neurology service after a consult and referral from an outside hospital. She had a 1-month history of right sixth nerve palsy. Initial workup included a negative lumber puncture and a noninfused magnetic resonance imaging (MRI). Three days later, the patient developed right-sided migraine headaches and right third nerve palsy. The angiogram revealed diffuse irregularity and narrowing of the petrous, cavernous, and supraclinoid portions of the internal carotid and right middle cerebral arteries. Shortly thereafter, an MRI examination revealed diffuse leptomeningeal enhancement and abscess and a right parietal subdural empyema. Infectious vasculitis secondary to purulent meningitis has a rapidly progressive course and presents with cranial nerve palsy with involvement of the cavernous sinus. Although the association of this disease with pregnancy has not been established, it should be recognized that the early imaging studies may be negative or discordant and follow-up imaging might be necessary. [source] Psoriasiform Lesions and Abscesses as Initial Manifestations of Severe Hypothyroidism in a Previously Healthy 15-Year-Old GirlPEDIATRIC DERMATOLOGY, Issue 3 2007JENNIFER KWINTER B.A. We describe a previously healthy 15-year-old girl with psoriasiform lesions, abscesses, and extremely severe hypothyroidism, all presenting simultaneously. The pathophysiology of the connection is unclear, but several hypotheses are discussed. The temporal relationship of these conditions and the significant improvement of the skin lesions upon normalization of T4 levels following initiation of thyroid supplementation illustrate a direct association. It is probable that the extreme severity of hypothyroidism in our patient is implicated in the etiology of these skin lesions. This unique case illustrates that novel cutaneous manifestations may sometimes act as an early presenting sign of hypothyroidism and may be associated with more severe forms of the disorder. [source] Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably UnnecessaryACADEMIC EMERGENCY MEDICINE, Issue 5 2009Gerald F. O'Malley DO Abstract Objectives:, The objective was to determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone. Methods:, In a prospective, randomized, single-blinded trial, subjects with simple cutaneous abscesses (less than 5 cm largest diameter) underwent incision, drainage, irrigation, and standard abscess preparation in the usual manner. Subjects were then randomized to either packing or no-packing. Visual analog scales (VAS; 100 mm) of pain were recorded in the emergency department (ED). All patients received trimethoprim-sulfamethoxazole (TMP-SMX), ibuprofen, and narcotic prescriptions, recorded twice daily VAS pain scores, and returned in 48 hours at which time dressings and packing, if present, were removed and a physician blinded to the randomization and not part of the initial visit repeated measurements and determined the need for further intervention. Results:, Forty-eight subjects were included in the final analysis. There were no significant differences in age, sex, abscess location, or initial pain scores between the two groups. There was no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) groups (p = 0.72; relative risk = 1.3, 95% confidence interval [CI] = 0.4 to 4.2). Patients in the group that received packing reported higher pain scores immediately postprocedure (mean difference = 23.8 mm; p = 0.014, 95% CI = 5 to 42 mm) and at 48 hours postprocedure (mean difference = 16.4 mm; p = 0.03, 95% CI = 1.6 to 31.2 mm), as well as greater use of ibuprofen (mean difference = 0.32; p = 0.12, 95% CI = ,1.4 to 2.0) and oxycodone/acetaminophen (mean difference = 2.19; p = 0.03, 95% CI = 0.2 to 4.1). Conclusion:, In this pilot study, not packing simple cutaneous abscesses did not result in any increased morbidity, and patients reported less pain and used fewer pain medications than packed patients. [source] Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 yearsDENTAL TRAUMATOLOGY, Issue 4 2005Nuket Sandalli Abstract,,, The aim of this study was to evaluate etiology, types of traumatic dental injuries, treatment and to determine the incidence of complications according to dental injuries in patients who referred to Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. The study was based on the clinical data of the 161 traumatized teeth in 92 patients. WHO classification slightly modified by Andreasen & Andreasen for dental trauma was used. The causes and localization of trauma, traumatized teeth classification, treatment and complications were evaluated both primary and permanent teeth. The distribution of complications according to diagnosis and treatment of the injured teeth were evaluated. Of 35 (38%) girls and 56 (72%) boys with a mean age 7.6 ± 3.5 (ranging 1,14.2) participated to study and the mean followed up was 1.72 ± 1.28 years (ranging 0.10,3.8 years). From the 161 affected teeth, 69 (42.9%) were in primary teeth and 92 (57.1%) in permanent teeth. The highest frequency of trauma occurred in the 6,12 year age group. Overall boys significantly outnumbered girls by approximately 1:1.6. The most common type of injury in the primary and permanent teeth was seen as luxation (38%) and enamel fracture (20%) of the maxillary central incisors, respectively. Falls were the major sources of trauma both the primary (90%) and the permanent teeth (84%). In the primary dentition, the most common type of soft tissue injury is contusion (62.5%) and in the permanent dentition, it is laceration (49%). The most of the treatment choice was determined as examination only and extraction in primary teeth (58 and 24.6%, respectively) while it was applied as restoration and pulpectomy in permanent teeth (31.5 and 18.5%, respectively). Complications were recorded on 37 teeth (23%) with a most common type of necrosis (10.5%) and dental abscess (7.4%). Necrosis was more frequent in luxation whereas dental abscess were in crown fracture with pulpal involvement in both dentitions. The study showed that boys were more prone to dental traumas than girls. Falls were more frequent trauma type with a high complication risk. It reveals that the time of the immediate treatment showed the important predisposing factors that increase the success of treatment and decrease the risk of complication. The correct diagnosis of dental injuries is more important for eliminating the occurrence of complications. [source] Neurological complications in two children with Lemierre syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010BASHEER PEER MOHAMED Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ,clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ,forgotten disease'. [source] Mycobacterium avium complex infection in a neck abscess: A diagnostic pitfall in fine-needle aspiration biopsy of head and neck lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2009Valerie A. Fitzhugh M.D. Abstract Fine-needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of mycobacterial disease, especially Mycobacterium tuberculosis. However, nontuberculous mycobacterial infection diagnosed with FNAB material is much rarer, with Mycobacterium avium complex being the most common. In this report, we present the case of a 21-year-old HIV positive man, who presented with a unilateral, tender, enlarging cervical neck mass. FNAB had revealed acute inflammation. Mycobacterium avium complex grew in culture from the material that was aspirated and was confirmed by DNA probe. Because of the paucity of articles on this subject in the cytology literature, it is important to reiterate the value of the material aspirated at the bedside and the clinic in the diagnosis of infectious disease. When faced with antibiotic-resistant cellulitis and abscesses, the FNAB material must be sent for acid fast bacteria smears and culture. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] High-grade neuroendocrine carcinoma presenting as an abscess: Diagnosis by fine needle aspiration and review of the literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2008Jonathon B. Herbst M.D. Abstract Neuroendocrine carcinomas (NEC) comprise about 2% of all carcinomas. Review of the literature indicates only a few cases of NEC presenting as an abscess, all having been diagnosed by tissue biopsy. Here, we report the FNA diagnosis of a high-grade neuroendocrine carcinoma presenting as an abscess of the axilla/chest wall in a 68-year-old man and review the pertinent literature. Diagn. Cytopathol. 2008;36:670,673. © 2008 Wiley-Liss, Inc. [source] THERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATIONDIGESTIVE ENDOSCOPY, Issue 4 2005Yoshihisa Saida Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra-abdominal complication. A case of a 69-year-old male with an abdominal abscess after he underwent right hemi-colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re-operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40-cm-long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra-abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool. [source] Conservative management of duodenal perforation following endoscopic sphincterotomyDIGESTIVE ENDOSCOPY, Issue 2 2005Chee Fook Choong Overall endoscopic retrograde cholangiopancreatography (ERCP) complication rates of 4,10% and mortality rates of 1.5% have been reported. For those patients who fail conservative therapy, a mortality rate of almost 50% has been reported. This has led some authors to recommended early operation in all duodenal perforations. We report two cases of duodenal perforations following endoscopic sphincterotomy. Perforation was suspected immediately post-ERCP in one case and, in the second case, perforation was evident during ERCP and a biliary stent was inserted. Both of the patients were managed conservatively with bowel rest, nasogastric suction, analgesia and intravenous antibiotics. Although abdominal XR and CT showed extensive intraperitoneal and retroperitoneal gas, both of the patients made an uneventful recovery without surgical management. Based on our experience and literature review, routine surgery is not required in patients with duodenal perforations following endoscopic sphincterotomy. Surgery should be considered in any patients with clinical signs of sepsis, abscess or fluid collection in the retroperitoneum or peritoneum, documented ERCP perforation with cholelithiasis, choledocholithiasis or retained hardware. There are currently no strong data to support the benefits of early routine surgery and management should be tailored individually according to the patient's clinical condition and response to therapy. [source] Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopyDISEASES OF THE ESOPHAGUS, Issue 3 2002S. Sato SUMMARY. Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully. [source] ORIGINAL INVESTIGATIONS: Potential Faces of Patent Foramen Ovale (PFO PFO)ECHOCARDIOGRAPHY, Issue 8 2010F.R.C.P., Tasneem Z Naqvi M.D. Background: Patent foramen ovale (PFO) is diagnosed on echocardiography by saline contrast study with or without color Doppler evidence of shunting. PFO is benign except when it causes embolic events. Methods and Results: In this report, we describe unique additional manifestations related to the diagnosis and presentation of PFO. These include demonstration of PFO during the release phase of "sigh" on the ventilator in the operating room, use of a separate venipuncture to allow preparation of blood-saline-air mixture after multiple failed saline bubble injections, resting and stress hypoxemia related to left to right shunting across a PFO in the absence of pulmonary hypertension, presentation of quadriperesis secondary to an embolic event from a PFO and development of a thrombus on the left atrial aspect of PFO in a patient with atrial fibrillation, and on the right atrial aspect of PFO in a patient who had undergone repair of a flail mitral valve. Finally, in one patient with end-stage renal disease, aortic valve endocarditis and periaortic abscess, PFO acted as a vent valve relieving right atrial pressure following development of aortoatrial fistula. Conclusion: PFO diagnosis can be elusive if appropriate techniques are not used during saline contrast administration. PFO can present as hypoxemia in the absence of pulmonary hypertension, can be a rare cause of quadriperesis, and can be associated with thrombus formation on either side of interatrial septum. Finally, PFO presence can be lifesaving in those with sudden increase in right atrial pressure such as with aortoatrial fistula. (Echocardiography 2010;27:897-907) [source] The Rupture of Periaortic Infective Aneurysm into the Left Atrium and the Left Ventricular Outflow Tract: Preoperative Diagnosis by Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 3 2002Ewa Lastowiecka M.D. We present a rare complication of infective endocarditis, perforated periaortic abscess with fistulous communication between the aortic root, the left atrium, and the left ventricular outflow tract. Preoperative transthoracic echocardiographic diagnosis was confirmed intraoperatively. The patient was treated successfully by aortic homograft implantation. [source] | |||||||||||||||||||||||||||||||||||||||||||