Clinical characteristics of patients with septated loculations of pyogenic liver abscesses / 中华肝胆外科杂志

Objective:To compare clinical features of patients with pyogenic liver abscesses with and without septated lobulations.Methods:Patients diagnosed to have pyogenic liver abscesses who were treated in our hospital from January 2011 to March 2021 were enrolled into this retrospective study. There were 203 males and 132 females, with age of (56±14) years old. The patients were divided into two groups by findings on computed tomography and ultrasound into the septated lobulation group ( n=68) and the non-septated lobulation group ( n=267). The clinical data of these patients were compared. Results:In the septated lobulation group, the neutrophil count was 9.17(5.97, 12.33)×10 9/L and the TBil was 17.65(11.92, 27.84) μmol/L. These were significantly higher than the corresponding figures of 7.81(5.42, 10.81)×10 9/L, 12.90(9.00, 19.68) μmol/L, respectively in the non-septated lobulation group ( P<0.05). The difference in the maximum diameters of the septated lobulation group was also significantly larger than the non-septated lobulation group ( P=0.032). Additionally, pus culture showed the proportion of Klebsiella pneumoniae positive patients in the septated lobulation group was significantly higher than that in the non-septated lobulation group [41.18% (28/68) vs. 25.84% (69/267), P=0.013]. The use of fluoroquinolones in patients in the septated lobulation group was higher than that in the non-septated lobulation group [20.59% (14/68) vs. 10.11% (27/267), χ 2=5.54, P=0.019]. Conclusion:Compared to patients without septated lobulations, those with septated lobulations had a larger diameter of abscesses, a higher positive rate of Klebsiella pneumoniae on pus culture and a higher proportion of patients receiving fluoroquinolones.

Assessment of outcome and complications of ultrasonography guided pigtail catheter drainage in management of liver abscess

Background: Liver abscess (LA) is defined as an encapsulated collection of suppurative material within the liver parenchyma. Liver abscesses are most commonly due to bacterial, amoebic or mixed infections. Less commonly these may be fungal in origin. Liver abscess are associated with mortality of up to 20% and are categorized into various types based on aetiology, of which amoebic (ALA) and pyogenic (PLA) liver abscess are major types. The objective is to evaluate and assess the response of percutaneous pigtail catheter drainage in treatment of liver abscess and to document the complications of liver abscess (LA).Methods: The study was conducted on patients who were admitted from casualty and outpatient department with a diagnosis of liver abscess (LA). 100 patients of LA were included in the study. They were divided into two groups. Group 1 consists of LA patients without associated complications and Group 2 consists of LA patients with associated complications like rupture, jaundice, IVC compression, persistent or recurrent LA.Results: There were 88% males and 12% were females in the study. 30% patients had complications. Out of them, 14 (46.6%) patients of LA presented with intra-peritoneal rupture. 12 (40%) with jaundice, 2 (6.7%) with rupture into pleural cavity and 2 (6.7%) patients had IVC compression. (70%) had involvement of right lobe while minimum patients (12.9%) had bilateral lobe involvement in group 1 and (10%) had involvement of left lobe of liver in group 2.Conclusions: Pigtail insertion and percutaneous catheter drainage (PCD) of abscesses, peritoneal or pleural cavity are safe procedures. PCD is a good alternative to open surgical drainage.

Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.

Tratamiento con drenaje percutáneo ecoguiado de hematomas vesicouterinos postcesárea complicados. Experiencia en 4 casos / Treatment with ultrasound-guided percutaneous drainage of complicated post-cesarean vesicouterine hematomas. Experience in 4 cases

Resumen ANTECEDENTES: Los hematomas vesicouterinos sobreinfectados son una rara complicación de la histerotomía segmentaria transversa. La acumulación de sangre entre la pared posterior de la vejiga y el segmento uterino facilita la proliferación de microorganismos patógenos. Cuando el tratamiento antibiótico falla deben plantearse técnicas invasivas para su resolución, entre las que destaca el drenaje percutáneo ecoguiado. CASOS CLÍNICOS: Se exponen 4 casos de mujeres que, después de la cesárea, iniciaron con descenso del hematocrito, fiebre (3 casos) y cuadro pseudooclusivo (1 caso). Con base en la ecografía se estableció el diagnóstico de hematoma vesicouterino sobreinfectado. Después de la falla del tratamiento con antibióticos se propuso el drenaje percutáneo ecoguiado. Se observó mejoría clínica en todos los casos de forma significativa. El cultivo del material drenado orientó al tratamiento antibiótico específico. La evolución de las pacientes fue satisfactoria. CONCLUSIONES: El drenaje percutáneo ecoguiado permite evacuar el contenido hemático, obtener suficiente muestra para el cultivo y aportar información del microorganismo patógeno concreto. Además, es una técnica efectiva, menos invasiva que la cirugía y se asocia con escasas complicaciones.

Abstract BACKGROUND: Infected bladder-flap hematomas are a rare complication after a lower uterine segment caesarean section. This blood collection located in the space between the posterior bladder wall and the lower uterine segment allows microorganism proliferation. When the treatment with antibiotics fails, invasive techniques are considered, such as ultrasound percutaneous drainage. CLINICAL CASE: We present 4 cases of women whom, after the performance of a cesarean section, began with a decrease in hemoglobin levels, spiking fevers in 3 cases and pseudo-occlusive symptoms in the other one. With an ultrasound examination, the diagnosis of infected bladder-flap hematomas were achieved. After the failure of the antibiotics treatment, an ultrasound percutaneous drainage was performed. As a result of the evacuation of the collection, the clinical situation improved significantly. Culture of the sample obtained permitted to establish a more effective antibiotic treatment. CONCLUSIONS: Ultrasound percutaneous drainage allows not only the evacuation of the blood collection to obtain a sample for culture, but also provides information about the presence of a specific microorganism. Moreover, it is a highly efficient technique, less invasive than surgery which presents few complications.

Absceso esplénico post traumático / Splenic abscess post-traumatic

RESUMEN Los abscesos esplénicos son afecciones infrecuentes, pero con alta mortalidad atribuida a un diagnóstico tardío debido fundamentalmente a la ausencia de síntomas y signos específicos. Presentamos un paciente con antecedente de trauma 6 meses antes en región toraco abdominal, que ingresó con un síndrome febril prolongado de causa no precisada. Se constató la existencia de dolor a la palpación en región de hipocondrio izquierdo, que por ultrasonido abdominal, informa presencia de una lesión hipo ecogénica en un bazo aumentado de tamaño y en la angio tomografía no se evidencio fuga de contraste Se aplicó antibioticoterapia y drenaje percutáneo bajo tomografía con la cual se logró buena respuesta clínica, con evolución favorable y se evitó su esplenectomía.

ABSTRACT Splenic abscesses are infrequent conditions, but with high mortality attributed to a late diagnosis, mainly due to the absence of specific symptoms and signs. We present a patient with a history of trauma 6 months earlier in the abdominal thorax region, who was admitted with a prolonged febrile syndrome of unknown origin. The existence of palpation pain in the left hypochondrium region was confirmed by abdominal ultrasound, the presence of a hypo-echogenic lesion in an enlarged spleen and in the angio tomography no evidence of contrast leakage. Antibiotic therapy and percutaneous drainage were applied under tomography with good clinical response, with favorable evolution and splenectomy was avoided.

Adjuvant urokinase: percutaneous drainage of post lower segment cesarean section intra-abdominal abscess

The mortality in abdominal abscess is high, however the outcome has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, and site.  The single abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters.  Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage but the success rate is lower for abscesses that have septa and are multilocular. Several clinical and in vitro studies suggest urokinase may be useful in such cases. To the knowledge, however, there has been no case of post LSCS intra-abdominal abscess in which intracavitary urokinase was administered. Therefore, we report a case of post LSCS multiseptated intra-abdominal abscess occurring in a 21-year-female. Conventional percutaneous tube drainage failed, but the use of transcatheter intracavitary urokinase was successful.  Our results showed no significant change in hematologic studies and no bleeding complications. Intracavitary urokinase can be given safely during percutaneous drainage of an abscess, with no associated bleeding complications or changes in coagulation parameters.

Technical difficulties and countermeasures in the source control of intra-abdominal sepsis / 中国实用外科杂志

Source control of intra-abdominal infections is an important part in the treatment of intra-abdominal sepsis,which mainly includes drainage,elimination of necrotic tissue,control of sepsis as well as restoration of anatomy and function of gastrointestinal tract.Source control should be taken immediately after ascertaining intra-abdominal infections.Specific measures of source control include percutaneous drainage,surgery,open abdomen and antimicrobial therapy.The key to percutaneous drainage is accurate location and adequate drainage.When performing surgical drainage,extent of trauma should be restricted while accurate location and avoiding omissions.Accurate timing of open abdomenand definitive abdominal closure,proper selection of temporary abdominal closure method,avoiding complications of OA,and enteral nutrition are essentials of successful definitive abdominal closure and reduction of complications.Effective antimicrobial therapy relies on time,type selection and avoiding antibiotic abuse.Factors should be searched for rigorously after failure to control intra-abdominal sepsis.Comprehensive global treatment is not only the basis but also the countermeasure of source control.

Effect of continuous renal replacement therapy during percutaneous drainage in severe acute pancreatitis patients: a retrospective cohort study / 中华危重病急救医学

Objective To evaluate the clinical efficacy and safety of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP) receiving percutaneous drainage (PCD). Methods Clinical data of SAP patients receiving PCD admitted to department of hepatobiliary surgery of the First Affiliated Hospital of Xi'an Jiaotong University from November 11th 2015 to May 13th 2018 were retrospectively analyzed. The patients were divided into CRRT group and control group according to whether or not receiving CRRT. Demographic data, relevant variables before and after PCD, complication and outcome were all compared. Results A total of 75 patients were included in the study, 30 were treated with application of CRRT and 45 without CRRT. ① There was no significant difference in gender, age, body mass index (BMI), medical history (smoking, drinking), complications (cardiovascular disease, chronic lung disease, diabetes, chronic renal insufficiency), etiology (gallstone, alcohol abuse, hyperlipidemia and others), or white blood cell count (WBC), C-reactive protein (CRP), serum procalcitonin (PCT), fluid resuscitation, mechanical ventilation, vasoactive agent or intra-abdominal pressure within 48 hours after admission between the two groups. However, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within 48 hours after admission of CRRT group was significantly higher than that of control group (18.3±4.5 vs. 12.8±6.2, P < 0.05). ② There was no significant difference in WBC, PCT, APACHEⅡ score or computed tomography severity index (CTSI) before PCD between the two groups. There was no significant difference in the position or times of PCD procedure between the two groups, but the time interval of PCD in the CRRT group was significantly longer than that in the control group (days: 19.4±5.4 vs. 12.8±2.2, P < 0.05). Meanwhile, there was no significant difference in drainage of fluid properties, incidence of abdominal bleeding, infection, gastrointestinal fistula, endoscopic removal of necrotic tissue, laparotomy for removal of necrotic tissue or the time from PCD to endoscopy or laparotomy between two groups. However, the length of intensive care unit (ICU) stay and the length of hospital stay in the CRRT group were significantly longer than those in the control group (days: 23.2±8.5 vs. 15.3±12.1, 51.2±21.2 vs. 31.2±14.0, both P < 0.01). ③ Kaplan-Meier survival analysis showed that there was no significant differences in 1-year or 3-year cumulative survival rates between the two groups (χ21 = 0.097, P1 = 0.755; χ22 = 0.013, P2 = 0.908). Conclusions CRRT is safe and feasible in the treatment of SAP patients receiving PCD procedure. It does not increase the risk of bleeding and may delay the time interval of PCD intervention. However, it may prolong the length of ICU stay and the length of hospital stay. It should be worthy of much attention for clinicians.

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

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

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

Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated / 대한소화기학회지

Splenic abscess is a rare disease that generally occurs in immunocompromised patients. It is difficult to distinguish between splenic abscesses and cysts using imaging studies, especially if they are asymptomatic. A 50-year-old asymptomatic man who had received steroid therapy for underlying rheumatoid arthritis was referred to a university hospital due to presence of several splenic cysts, with the largest being 3.5 cm in diameter. Percutaneous aspiration was performed, and fluid analysis showed cysts infected by extended-spectrum, beta-lactamase-producing Escherichia coli. The patient was treated with ertapenem for four weeks, and the lesion disappeared on follow-up imaging studies. Splenic abscess should be included as a differential diagnosis of splenic cystic lesions in immunocompromised patients.

Puerperal sepsis caused by liver abscess: case report / Sepse puerperal secundária a abscesso hepático: relato de caso

Abstract Introduction: sepsis is a serious public health problem, affecting millions of people in the world each year, with a high mortality rate (one out of four patients) and an increasing incidence. Sepsis is one of the main causes of maternal mortality and an important cause of admission to obstetric intensive care units. Case description: In this study, the authors report the case of a woman having been submitted to cesarean section three days before presenting clinical signs of sepsis and septic shock caused by a liver abscess. The patient had a set of complications secondary to shock, such as thrombocytopenia, coagulopathy, toe ischemia and acute kidney failure. The patient had cholelithiasis and recurrent pain in the right hypochondrium during pregnancy. During hospitalization, the mechanism involved in the development of hepatic abscess was infection of the biliary tract. The patient was treated in an obstetric intensive care unit with antibiotics and drainage of the liver abscess. Progress was favorable and the patient was discharged in good health. Discussion: pyogenic liver abscess during pregnancy and puerperium is a serious condition which represents a diagnostic and therapeutic challenge, with few cases reported. The normally nonspecific clinical and laboratory findings can lead to a late diagnosis, which increases the risk of maternal morbidity and mortality.

Resumo Introdução: a sepse é um problema grave de saúde pública, afetando milhões de pessoas no mundo a cada ano. Apresenta uma alta mortalidade, um em quatro doentes, e vem aumentando sua incidência. É uma das principais causas de mortalidade materna, sendo uma causa importante de admissões emunidades de terapia intensiva obstétrica. Descrição do caso: puérpera, no terceiro dia pós-cesariana, apresentou quadro clinico de sepse e choque séptico secundário a um abscesso hepático piogênico.Evoluiu com complicações secundárias ao choque: plaquetopenia, coagulopatia, isquemia de pododáctilos e insuficiência renal aguda. A paciente era portadora de colelitíase e apresentou repetidas crises álgicas em hipocôndrio direitodurante a gestação.Durante o internamento, ficou definido que a causa do abscesso hepático foi a infecção das vias biliares.Realizou-se tratamento em unidade de terapia intensiva obstétrica, tendo a paciente sido submetida à drenagem do abscesso hepático e antibioticoterapia. A evolução foi satisfatória e a paciente obteve alta em boas condições. Discussão: o abscesso hepático piogênico durante a gravidez e o puerpério é uma condição extremamente grave, com poucos casos relatados, representando um desafio diagnóstico e terapêutico. Como os achados clínicos e laboratoriais são usualmente inespecíficos, um diagnóstico retardado é possível, aumentando os riscos de morbidade e mortalidade materna em casos não tratados precocemente.

Resultados del tratamiento quirúrgico de las colecciones de pus del pulmón / Results of the surgical treatment of lung abscess

Introducción: el diagnóstico y tratamiento de las colecciones de pus del pulmón ha variado a través del tiempo. Objetivo: evaluar los resultados del tratamiento quirúrgico de los enfermos en los que fracasó el tratamiento médico. Métodos: estudio descriptivo observacional de 45 enfermos con colecciones de pus del pulmón en los que se realizó algún procedimiento quirúrgico. Resultados: predominó el sexo masculino, 82,2 por ciento entre la sexta y séptima década de la vida, todos presentaban factores de riesgo. El absceso pulmonar primario fue el más frecuente, seguido por cáncer de pulmón abscedado, las bullas, bronquiectasia y el absceso por tuberculosis, 91,1 por ciento eran ASA II o III y 8,9 por ciento IV. Predominaron los gérmenes gran negativos. El pulmón derecho fue el más afectado. Las intervenciones más realizadas fueron las resecciones con predominio de la lobectomía. El drenaje percutáneo y la pleurostomía, la supuración por TB fue tratada con drenaje y drogas antituberculosas. Las complicaciones más frecuentes fueron: infección respiratoria, arritmias e infecciones del sitio quirúrgico, la morbilidad fue inferior al 25 por ciento y la mortalidad 3,8 por ciento. Conclusiones: la selección individual del procedimiento a utilizar -teniendo en cuenta la causa, el estado físico y los factores de riesgo quirúrgico- permiten obtener resultados satisfactorios(AU)

Introduction: diagnosis and treatment of lung abscess has varied throughout the time. Objective: to evaluate the results of the surgical treatment in patients whose medical treatment failed. Methods: observational and descriptive study of 45 patients with lung abscess, who had undergone some type of surgery. Results: males predominated; 82.2 percent aged 60 to 70 years and all presented with risk factors. Primary lung abscess was the most common, followed by abscessed lung cancer, bullas, bronchiectasis and tuberculosis abscess. In the group, 91.1 percent were classified as ASA II or III and 8.9 percent as ASA IV. Gram-negative germs prevailed. Right lung was the most affected one. The most performed surgeries were resections, mainly lobectomy. Percutaneous drainage and pleurostomy; tuberculosis suppuration was treated with drainage and anti-tuberculosis drugs. The commonest complications were respiratory infections, arrhythmias and surgical site infections. The morbidity rate was below 25 percent and the mortality rate was 3.8 percent. Conclusions: taking into account the cause, the physical condition and the surgical risk factors, the individual selection of the procedure to be used allows achieving satisfactory outcomes(AU)

Study of technique, advantages and effectiveness of percutaneous drainage of intra-abdominal abscesses

Background: Intra-abdominal abscess remains a significant cause of morbidity and mortality in the patient population. Despite therapeutic advances, it is a perplexing diagnostic and management challenges and remains a dreaded complication of surgery. Materials and methods: Forty eight patients underwent fifty one percutaneous drainage procedures in the Barnard Institute of Radiology at the General Hospital, Chennai. There were 44 men and 7 women. The youngest of the patients was 13 years old and the oldest 56 years old. Results: Of the 51 drainage, 35 were done under CT guidance and 16 under US guidance. Successful drainage of the collection with avoidance of operation was achieved in 43 of the 48 abscesses (89.5%). If the total number of drainages were considered, the success rate was 84.3% (43 out of 51). Conclusion: Percutaneous catheter drainage is an important treatment option for management of intra-abdominal abscesses. It is especially valuable in patients at high risk for general anesthesia. It is also an effective alternative to operative drainage in other healthier patients. Computed tomography is the imaging modality of choice for percutaneous abscess drainage.

Role of Doppler Navigation in Minimally Invasive Procedures under Ultrasound Guidance.

Aim: To highlight the possibilities of Doppler methods to optimize navigation and control of percutaneous echo-controlled minimally invasive interventions. Study Design: 25,543 diagnostic and therapeutic minimally invasive interventions were carried out on organs and tissues of different localizations. Place and Duration of Study: Department of Oncology and Radiology, M. Gorky Donetsk National Medical University, Ukraine. 25,543 diagnostic and therapeutic minimally invasive interventions (2004-2013). Methodology: Ten years of experience in carrying out percutaneous minimally invasive interventions under ultrasound guidance using Doppler modes. Fine needle aspiration and core needle biopsy, drainage, etc of different organs and tissues, effectiveness of optimization methods of visualization and analysis of results of their use in minimally invasive treatment of liver abscesses under US control, comparative analysis of main and control groups were carried out using student t-test and chi square - χ2. Ultrasound scanners used: Dornier AI 5200, Philips HDI 5000, Toshiba Aplio 500), probes - linear (7.5 MHz), convex (3.5-5.0 MHz). Paramount was the safety of minimally invasive procedure in visualizing instrument used. Results: It was established that optimal was the power Doppler mode for navigation in percutaneous interventions, prevent hemorrhagic complications, select a safe acoustic window, which improved the location of fluid motion in the hollow needle and visualization of the biopsy instrument based on initiation of twinkling artifact. The use of developed methods to improve ultrasound visualization in minimally invasive treatment of liver abscesses significantly reduced pain - 12.9%, avoided haemorrhage and leakage of pus into peritoneal cavity, reduced the number of inadequate drainages - 36.6%, reduced the duration of inpatient treatment - 2.2 times. Conclusion: It was established that use of power Doppler mode enhances the effectiveness and safety of percutaneous ultrasound-guided interventions. Thus, the studies confirmed the clinical use of optimization techniques of visualization in minimally invasive procedures under ultrasound guidance.

Manejo percutáneo de colecciones abdominales en el hospital distrital de Villa Elisa / Percutaneous treatment of abdominal collections in the district hospital of Villa Elisa

Los abscesos abdominales se definen como colecciones localizadas que presentan pus, gérmenes en el frotis o crecen en el cultivo. Estas adquieren importancia cuando se hacen sintomáticas. En el manejo actual, el drenaje percutáneo es el tratamiento de elección por múltiples ventajas, reservándose el drenaje quirúrgico para ciertos casos. Esto se debe al avance de la tecnología de los métodos auxiliares de diagnóstico por imágenes, especialmente la ecografía.Objetivo: demostrar la factibilidad del manejo percutáneo de colecciones intra-abdominales en un hospital periférico de baja complejidad y con disponibilidad de ecógrafo.Diseño: retrospectivo, longitudinal, observacional, cuantitativo, no aleatorio, con componente analítico.Pacientes y método: pacientes con diagnóstico de colección intra-abdominal de distintas etiologías, internados en el Servicio de Cirugía del Hospital Distrital de Villa Elisa, desde junio de 2014, hasta setiembre de 2015.Resultados: 5 pacientes estudiados, 60% del sexo femenino, el cuadro de presentación fue conformado por dolor abdominal, distensión, plastrón palpable y fiebre. Laboratorialmente, leucocitosis con neutrofilia. En todos se realizó el drenaje de la colección bajo pantalla ecográfica con catéteres multipropósito de 10Fr, con la técnica del trocar. Se obtuvo el éxito en el tratamiento en el 80% de los casos. Conclusión: el manejo de colecciones abdominales es factible en hospitales periféricos de baja complejidad.

Abdominal abscess are defined as localized collections of pus, germs visualizated in a frotis or grow in culture. These become important when they become symptomatic. Actually, percutaneous drainage is the gold standard, reserving the surgery approach for a few special cases. This is due to the advanced of technology, particularly the ultrasound. Objective: to demonstrate the feasibility of percutaneous management of intraabdominal collections in a peripheral low complexity hospital, with ultrasound availability. Design: retrospective, longitudinal, observational, quantitative, no randomized, with analytical component. Patients and methods: patients with diagnosis of intraabdominal collections, admitted in surgery service of the Hospital Distrital of Villa Elisa, from June of 2014 to September of 2015. Results: 5 patients studied, 60% female, with clinical of abdominal pain, distension, palpation of abdominal mass or fever. Laboratorial findings neutrophilic leukocytosis. In all cases, percutaneous drainage was made it under ultrasound view, using 10 Fr multipurpose catheter, using trocar technique. Success was possible in 80% of the cases. Conclusion: the management of abdominal collections is possible in peripheral low complexity hospitals.

A prospective study of USG guided pigtail catheter drainage in management of liver abscess.

Background: Treatment of the liver abscess of any etiology has evolved in the recent years. Percutaneous drainage of liver abscess has been an important advancement in the treatment of pyogenic liver abscesses. Aim: to evaluate and assess response, morbidity and complication rates of percutaneous pig tail catheter drainage in treatment of liver abscess. Methods: During a period of 27 months, 25 patients with liquefied liver abscess ≥5x5 cm underwent percutaneous drainage under sonographic guidance. Results: 18 had solitary abscess, while 7 had multiple abscesses. Pigtail catheters of various sizes (10 F or 12 F) were introduced in these patients using the Seldinger technique. The volume of pus drained ranged from 150 to 400 ml, while the period of catheter drainage ranged from 6 to 17 days. Complications were minor and included catheter blockage in 2 patients and tract pain in 8 patients. There was no mortality associated with this procedure. This study shows a success rate of 96% (successful treatment in 24 out of 25 patients). Conclusion: Percutaneous catheter drainage of liver abscesses is successful with a low morbidity and mortality and should be the first line of management in liquefied moderate to large sized liver abscesses.

Utilidad de la ecografia en manos del cirujano para el drenaje percutáneo de los abscesos abdominales y pélvicos / Utility of ultrasound in the hands of the surgeon in percutaneous drainage of abdominal and pelvic abscess

Antecedentes: los abscesos o colecciones abdominopélvicas sintomáticas se caracterizan por ser una entidad clínico-quirúrgica de origen multifactorial, aunque casi siempre su etología es posoperatoria. Objetivo: describir la aplicabilidad y eficacia del drenaje percutáneo de colecciones abdominales y pelvianas, bajo guía ecográfica, en un servicio de cirugía. Material y métodos: en un período de 9 años se incluyeron todos los pacientes con colecciones ab-dominopelvianas tratados en forma consecutiva con drenaje percutáneo bajo guía ecográfica, en el Hospital Italiano de Bahía Blanca. Resultados: desde junio de 2003 hasta junio de 2012 se trataron 87 pacientes con colecciones abdomi-nopelvianas sintomáticas; en 79 de ellos el tratamiento fue realizado bajo guía ecográfica; 4 pacientes no fueron incluidos en el estudio debido a que el tratamiento se realizó bajo guía tomográfica, y los restantes 4 fueron descartados porque eran pacientes pediátricos. En 51 (64,5%) de ellos, el origen fue posoperatorio. Treinta y ocho (48,1%) pertenecían al sexo femenino. El promedio de edad fue 55 años (rango 18-92). El drenaje se realizó bajo guía ecográfica y radioscópica en 78 pacientes (98,7%) y en uno el abordaje fue ecográfico y laparoscópico. En 15 pacientes (18,9%) se presentaron complicaciones inherentes al procedimiento: 7 pacientes cursaron con febre, 3 refrieron dolor luego de la intervención (abordaje intercostal), en 3 se constataron equivalentes febriles, en una, celulits, y en otra, fistula de colon. De acuerdo con la Clasificación de Dindo-Clavien: 14 puntos Grado I (93,3%) y 1 punto Grado III B (6,7%). No hubo mortalidad asociada al procedimiento; 7 pacientes (8,8%) fallecieron por causas no relacionadas con este. La técnica fue resolutiva en 70 pacientes (88,6%) y satsfactoria en 74 (94%). Conclusiones: el drenaje percutáneo de las colecciones abdominales y pélvicas bajo guía ecográfica en manos del cirujano fue factble y eficaz, lo que la convierte en una técnica segura con baja morbilidad y nula mortalidad.

Background: abscesses or symptomatic abdominal collectons have multifactorial origin, although in more than 65% of the cases, the etology is postoperative. Objective: to describe the applicability and utility of abdominal and pelvic percutaneous drainage guided by ultrasound in a surgical team. Methods: a series of consecutive patents with ultrasound guided percutaneous drainage of abdominal or pelvic collecton performed during in a 9 year period. Results: from June 2003 to June 2012, 87 procedures were performed, 79 of them guided with ultrasound.The etology was postoperative in 51 patents (64.5%). Thirty eight (48.1 %) were female. Average age was 55 (range 18-92). Drainage was performed under ultrasound and radiology guide in 78 patents (98.7%) and by laparoscopic and ultrasound guide in one patent. Fifeen patents (18.9%) presented morbidity related to the procedure: fever in 7 patents, unusual pain in 3 (all with intercostal drainage), chills and sweating in 3, cellulits in one, and a colonic leak in one. All patents were included into of Dindo-Clavien Classificaton of Surgical Complicatons and the results were: Grade I: 14 patents, Grade IIIb: one patent. There was no mortality related to the procedure; seven patents (8.8%) died because of other causes. The overall success rate was 88.6 % (70 cases), and satsfactory in 94% (74 cases). Conclusions: in surgeons hands, ultrasound guided percutaneous drainage of abdominal and pelvic collectons was a feasible, efective and safe procedure with low morbidity.

Tratamiento del absceso hepatico. Experiencia en el hospital nacional de itaugua / Treatment of hepatic abscess. The experience at the national hospital of itaugua

Introducción: La introducción de los antibióticos y el desarrollo de técnicas radiológicas (ecografía y TC) que han mejorado la eficacia diagnóstica y posibilitado el drenaje percutáneo de los abscesos. Se realiza un estudio de los aspectos clínicos, terapéuticos y evolutivos. Las técnicas percutáneas, la aspiración y el catéter drenaje han relegado a un segundo plano al drenaje quirúrgico como principal forma de tratamiento. OBJECTIVO: conocer en profundidad la situación actual de este proceso patológico, estudiando los diferentes aspectos clínicos, terapéuticos y evolutivos en el Hospital Nacional de Itaugua en 3 años. MÉTODOS: Estudio descriptivo – retrospectivo, basado en la revisión de historias clínicas de pacientes con diagnóstico de AH entre Enero 2011 a junio 2014. Resultados: De 58 historias clínicas revisadas. La edad media fue entre los 41-50 años (43,1%), y 55% fueron varones. El diagnóstico principalmente fue ecográfico (97,8%), absceso único (73%), ubicado en lóbulo derecho (77%). Treinta y nueve pacientes (67,2%) fueron operados, diesinueve pacientes (32,7%) recibieron drenaje percutáneo. CONCLUSIÓN: El absceso hepatico es una patología aguda, de mediana edad, frecuente en el sexo masculino, el tratamiento actual es el drenaje percutaneo.

Introduction: The introduction of antibiotics and the development of imaging techniques (ultrasound and CT) have improved the diagnostic efficacy and facilitated percutaneous drainage of abscesses. A study of clinical, therapeutic and evolutionary aspects is performed. Percutaneous techniques, aspiration and drainage catheter been relegated to the background surgical drainage as the main form of treatment. OBJECTIVE: To learn more about the current status of this disease process, studying the different clinical, therapeutic and evolutionary aspects in the National Hospital of Itaugua in three years. METHODS: Descriptive - retrospective, based on review of medical records of patients diagnosed with AH between January 2011 to June 2014. RESULTS: Of 58 clinical histories. The average age was between 41-50 years (43.1%), and 55% were male. The diagnosis was mainly ultrasound (97.8%), single (73%) abscess located in the right lobe (77%) .. Thirty-nine patients (67.2%) underwent surgery, diesinueve patients (32.7%) received percutaneous drainage. CONCLUSION: The liver abscess is an acute disease of middle age, frequent in males, the current treatment is percutaneous drainage.

Abscesso hepático por Klebsiella pneumoniae e suas complicações sistêmicas / Liver abscess by Klebsiella pneumoniae and its systemic complication

Abscesso hepático por Klebsiella pneumoniae é incomum em países ocidentais e tem sido associado a complicações severas, sobretudo em pacientes diabéticos. A manifestação clínico-laboratorial da doença é inespecífica. Endoftalmite é uma rara complicação de septicemia por Klebsiella pneumoniae. Atraso terapêutico pode resultar em perda visual acentuada e irreversível. Relatamos um caso de abscesso hepático por Klebsiella pneumoniae complicado com endoftalmite, embolia pulmonar séptica e endocardite em homem diabético.

Klebsiella pneumoniae liver abscess is unco mmon in western countries and has been associated with severe complications, especially in diabetic patients. The clinical and laboratory manifestations of the disease are nonspecific. Endophthalmitis is a rare complication of septicemia due to Klebsiella pneumoniae. Therapeutic delay can result in severe and irreversible visual loss. We report a case of Klebsiella pneumoniae liver abscess complicated by endophthalmitis, septic pulmonary emboli and endocarditis in diabetic man.

Neumostomía con sonda de balón en colecciones purulentas del pulmón / Neumostomy with a balloon catheter in supurative lung collections

Introducción: el desarrollo de los antimicrobianos provocó que el drenaje externo dejara de realizarse en pacientes con absceso de pulmón, en quienes la resección pulmonar es la opción ante el fracaso médico. En los últimos años, la neumostomía ha resurgido por la necesidad de asistir a enfermos con un marcado deterioro físico que impide una intervención quirúrgica resectiva. Objetivo: caracterizar a los pacientes con supuración pulmonar tratados quirúrgicamente mediante drenaje percutáneo externo y neumostomía con sonda de balón (método de Monaldi) practicados con anestesia local. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo en el período de 1995 a 2012 en el Hospital Universitario Comandante Manuel Fajardo. El universo estuvo conformado por 8 pacientes a los que se les practicó el método de Monaldi. En todos los casos se utilizaron sondas de goma de balón de 24 unidades F, de tres ramas. Resultados: cuatro pacientes padecían de absceso del pulmón y el resto de bullas enfisematosas voluminosas infectadas. Todos los casos tuvieron resolución de la colección infectada en un período inferior a las 2 semanas, y no hubo complicaciones ni mortalidad quirúrgica. Conclusiones: el drenaje percutáneo con anestesia local utilizando sondas de balón es un instrumento adecuado para el tratamiento de colecciones pulmonares en enfermos con deterioro físico por el cuadro infeccioso. Con él se logra la resolución de la lesión pulmonar, y es efectivo tanto en los abscesos pulmonares como en las bullas enfisematosas infectadas(AU)

Introduction: with the advent of the antibiotic therapy, external drainage ceased to be performed in lung abscess patients for whom the pulmonary resection is the choice. In the last few years, pneumostomy has reemerged due to the need of giving assistance to patients with remarkable physically deterioration that hinders resective surgery. Objectives: to characterize patients with pulmonary suppuration and surgically treated by means of external percutaneous drainage with balloon catheter pneumostomy (Monaldi method) using local anesthesia. Methods: retrospective, descriptive and longitudinal study of eight patients, who underwent Monaldi method-based surgery, conducted from 1995 through 2012 at Manuel Fajardo university hospital. Three branch twenty-four F unit balloon rubber catheters were used in all these cases. Results: out of the eight, four had been diagnosed with lung abscess and the other four had large septic emphysematous sacs. The infected collection was eliminated in all these patients in less than 2 weeks with no complication and no surgical death. Conclusion: The percutaneous drainage with local anesthesia using balloon catheter as an instrument was adequate and useful in the treatment of septic lung collections in patients with very poor physical condition. This method manages to eliminate the pulmonary lesion and is good for both pulmonary abscesses and infected emphysematous sacs(AU)