RESUMEN
Management of diverticular abscess (DA) is still controversial. Antibiotic therapy is indicated in abscesses ≤ 4 cm, while percutaneous drainage/surgery in abscesses > 4 cm. The study aims to assess the role of antibiotics and surgical treatments in patients affected by DA. We retrospectively analyzed 100 consecutive patients with DA between 2013 and 2020, with a minimum follow-up of 12 months. They were divided into two groups depending on abscess size ≤ or > 4 cm (group 1 and group 2, respectively). All patients were initially treated with intravenous antibiotics. Surgery was considered in patients with generalized peritonitis at admission or after the failure of antibiotic therapy. The primary endpoint was to compare recurrence rates for antibiotics and surgery. The secondary endpoint was to assess the failure rate of each antibiotic regimen resulting in surgery. In group 1, 31 (72.1%) patients were conservatively treated and 12 (27.9%) underwent surgery. In group 2, percentages were respectively 50.9% (29 patients) and 49.1% (28 patients). We observed 4 recurrences in group 1 and 6 in group 2. Recurrence required surgery in 3 patients/group. We administered amoxicillin-clavulanic acid to 74 patients, piperacillin-tazobactam to 14 patients and ciprofloxacin + metronidazole to 12 patients. All patients referred to surgery had been previously treated with amoxicillin-Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation clavulanic acid. No percutaneous drainage was performed in a hundred consecutive patients. Surgical treatment was associated with a lower risk of recurrence in patients with abscess > 4 cm, compared to antibiotics. Amoxicillin-clavulanic acid was associated with a higher therapeutic failure rate than piperacillin-tazobactam/ciprofloxacin + metronidazole.
Asunto(s)
Absceso Abdominal , Diverticulitis del Colon , Diverticulosis del Colon , Humanos , Absceso/complicaciones , Absceso/cirugía , Diverticulitis del Colon/complicaciones , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Estudios Retrospectivos , Metronidazol , Combinación Amoxicilina-Clavulanato de Potasio , Colectomía/métodos , Diverticulosis del Colon/cirugía , Antibacterianos/uso terapéutico , Drenaje/métodos , Ciprofloxacina/uso terapéutico , Combinación Piperacilina y TazobactamRESUMEN
OBJECTIVES: To report the clinical signs, diagnostic findings, surgical treatment, postoperative complications, and long-term outcome in 2 adult alpacas with large intra-abdominal abscesses treated by marsupialization of the abscess to the ventral body wall. STUDY DESIGN: Clinical report. ANIMALS: Alpacas (n = 2). METHODS: Two alpacas each presented with decreased appetite, lethargy, poor body condition, and marked abdominal distension. A complete physical examination, abdominal radiography, and ultrasonography confirmed the presence of large intra-abdominal abscesses. Streptococcus equi ssp. zooepidemicus was cultured from the abscess fluid of alpaca 1, and a Gram-negative bacillus from alpaca 2. RESULTS: Both alpacas had exploratory celiotomy with marsupialization of the abdominal abscess to the ventral body wall. Postoperatively, alpacas were administered systemic antibiotics and non-steroidal anti-inflammatory drugs, and the abscesses were lavaged for several days. Alpaca 2 required a second surgical procedure. The abscesses ultimately resolved in both alpacas, with body wall hernia formation as the only major complication. Both alpacas had good long-term outcomes. CONCLUSION: Marsupialization to the ventral abdominal wall with concurrent antibiotic treatment should be considered as a treatment option for alpacas with large intra-abdominal abscesses in which complete surgical resection of the abscess is not possible. An abdominal wall hernia can result from this procedure, and clients should be informed of this potential complication before surgery.
Asunto(s)
Absceso Abdominal/veterinaria , Camélidos del Nuevo Mundo , Absceso Abdominal/diagnóstico , Absceso Abdominal/microbiología , Absceso Abdominal/cirugía , Animales , Diagnóstico Diferencial , Drenaje/métodos , Drenaje/veterinaria , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/cirugía , Infecciones por Bacterias Gramnegativas/veterinaria , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/cirugía , Infecciones Estreptocócicas/veterinaria , Streptococcus/aislamiento & purificaciónRESUMEN
BACKGROUND: Initial antibiotics with planned interval appendectomy (interval AP) have been used to treat patients with complicated perforated appendicitis; however, little experience exists with this approach in children with suspected acute perforated appendicitis (SAPA). We sought to determine the outcome of initial antibiotics and interval AP in children with SAPA. METHODS: Over an 18-month period, 751 consecutive patients underwent appendectomy including 105 patients with SAPA who were treated with initial intravenous antibiotics and planned interval AP ≥ 8 weeks after presentation. All SAPA patients had symptoms for ≤ 96 hours. Primary outcome variables were rates of readmission, abscess formation, and need for interval AP prior to the planned ≥ 8 weeks. RESULTS: Intraabdominal abscess rate was 27%. Appendectomy prior to planned interval AP was 11% and readmission occurred in 34%. All patients underwent eventual appendectomy with pathologic confirmation confirming the previous appendiceal inflammation. White blood cell (WBC) count >15,000, WBC >15,000 plus fecalith on imaging, and WBC >15,000 plus duration of symptoms >48 hours were all significantly associated with higher rates of readmission (p=0.01, p=0.04, p=0.02) and need for interval AP prior to the planned ≥ 8 weeks (p=0.003, p=0.05, p=0.03). CONCLUSIONS: Treatment of SAPA with antibiotics and planned interval AP is successful in the majority of patients; however, complications such as abscess formation and/or readmission prior to planned interval AP occur in up to one-third of patients. Certain clinical variables are associated with increased treatment complications.
Asunto(s)
Antibacterianos/uso terapéutico , Apendicectomía/métodos , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Peritonitis/tratamiento farmacológico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Dolor Abdominal/etiología , Apendicitis/complicaciones , Niño , Vías Clínicas , Esquema de Medicación , Combinación de Medicamentos , Fiebre/etiología , Humanos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Readmisión del Paciente , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/uso terapéutico , Peritonitis/etiología , Piperacilina/uso terapéutico , Combinación Piperacilina y Tazobactam , Estudios Prospectivos , Succión , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: The primary therapy for deep tissue abscesses is drainage accompanied by systemic antimicrobial treatment. However, the long antibiotic course required increases the probability of acquired resistance, and the high incidence of polymicrobial infections in abscesses complicates treatment choices. Photodynamic therapy (PDT) is effective against multiple classes of organisms, including those displaying drug resistance, and may serve as a useful adjunct to the standard of care by reduction of abscess microbial burden following drainage. STUDY DESIGN/MATERIALS AND METHODS: Aspirates were obtained from 32 patients who underwent image-guided percutaneous drainage of the abscess cavity. The majority of the specimens (24/32) were abdominal, with the remainder from liver and lung. Conventional microbiological techniques and nucleotide sequence analysis of rRNA gene fragments were used to characterize microbial populations from abscess aspirates. We evaluated the sensitivity of microorganisms to methylene blue-sensitized PDT in vitro both within the context of an abscess aspirate and as individual isolates. RESULTS: Most isolates were bacterial, with the fungus Candida tropicalis also isolated from two specimens. We examined the sensitivity of these microorganisms to methylene blue-PDT. Complete elimination of culturable microorganisms was achieved in three different aspirates, and significant killing (P < 0.0001) was observed in all individual microbial isolates tested compared to controls. CONCLUSIONS: These results and the technical feasibility of advancing optical fibers through catheters at the time of drainage motivate further work on including PDT as a therapeutic option during abscess treatment.
Asunto(s)
Absceso/tratamiento farmacológico , Candidiasis/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Azul de Metileno/uso terapéutico , Fotoquimioterapia , Fármacos Fotosensibilizantes/uso terapéutico , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/microbiología , Absceso Abdominal/cirugía , Absceso/microbiología , Absceso/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Candida tropicalis/aislamiento & purificación , Candidiasis/microbiología , Candidiasis/cirugía , Terapia Combinada , Drenaje/métodos , Estudios de Factibilidad , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/cirugía , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Absceso Pulmonar/tratamiento farmacológico , Absceso Pulmonar/microbiología , Absceso Pulmonar/cirugía , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Succión , Adulto JovenRESUMEN
AIM: To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess. METHODS: Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)]. In the SDPC group, the internal opening was excised and incisions at external openings were made for drainage. Silk sutures were put through every two incisions and knotted in loose state. The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge. In the FSLT group, the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed. The time of healing, postoperative pain score (visual analogue scale), recurrence rate, patient satisfaction, incontinence evaluation and anorectal manometry before and after the treatment were examined. RESULTS: There were no significant differences between the two groups regarding age, gender and fistulae type. The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT, P < 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT, P < 0.05). The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT. None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively. The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and trans-sphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT. The maximal squeeze pressure and resting pressure declined after treatment in both groups. The maximal anal squeeze pressures after treatment were reduced (23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures (12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT), but there were neither significant differences between the two groups and nor significant differences before or after treatment. CONCLUSION: Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe, effective and less invasive.
Asunto(s)
Absceso Abdominal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Medicina Tradicional China/métodos , Fístula Rectal/cirugía , Adulto , Distribución de Chi-Cuadrado , China , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Incontinencia Fecal , Femenino , Humanos , Masculino , Manometría , Medicina Tradicional China/efectos adversos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Presión , Recurrencia , Encuestas y Cuestionarios , Técnicas de Sutura , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de HeridasAsunto(s)
Absceso Abdominal/tratamiento farmacológico , Apendicitis/tratamiento farmacológico , Absceso Abdominal/diagnóstico , Absceso Abdominal/cirugía , Enfermedad Aguda , Administración Oral , Adolescente , Adulto , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antiinfecciosos/administración & dosificación , Apendicitis/diagnóstico , Apendicitis/cirugía , Cefuroxima/administración & dosificación , Niño , Preescolar , Ciprofloxacina/administración & dosificación , Drenaje , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Sistema de Registros , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adolescente , Neoplasias del Bazo/complicaciones , Neoplasias del Bazo/cirugía , Inmunocompetencia , Inmunocompetencia/fisiología , Absceso Hepático/complicaciones , Absceso Abdominal/complicaciones , Absceso Abdominal/cirugía , Ceftriaxona/uso terapéutico , Ciprofloxacina/uso terapéutico , Esplenectomía/métodos , Calcinosis/complicaciones , Calcinosis/diagnóstico , Infecciones por Salmonella/complicaciones , Infecciones por Salmonella/cirugía , Salmonella/patogenicidadRESUMEN
AIM OF THE STUDY: Oncological patients are particularly prone to the onset of septic complications such as abdominal abscesses. The aim of our study was to analyze clinical and microbiological data in a population of oncological patients, submitted to percutaneous ultrasound-guided drainage (PUD) for postoperative abdominal abscesses. PATIENTS AND METHODS: Data from 24 patients operated on for neoplastic pathologies and treated with PUD for abdominal abscesses during the postoperative period were reviewed. In all cases cultural examination with antibiogram was performed. RESULTS: In 5 out of 24 patients (20.8%), the abdominal abscesses appeared after the discharge, with a mean hospital stay of 34.2 +/- 24.9 days. In six out of 24 patients (25%) there were multiple abscesses localizations. The cultural examination was positive in 23 patients and negative only in one patient. Abscesses localized only in the upper abdominal regions had a significant prevalence of monomicrobial cultural examinations (57.1%) with respect to the results for abscesses placed in the lower abdominal regions, that were polymicrobial in 88.8% of cases (p = 0.027). An antibiogram demonstrated a stronger activity of beta-lactamines, chinolones, and glycopeptides with respect to aminogycosides, cephalosporins, and metronidazole. CONCLUSIONS: In oncological patients, the planning of the empiric antibiotic therapy should be based on the anatomotopographic localization of the abdominal abscess and on the typology of the operation performed giving preference to beta-lactamines, chinolones and glycopeptides.
Asunto(s)
Absceso Abdominal/microbiología , Neoplasias del Sistema Digestivo/complicaciones , Drenaje/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Complicaciones Posoperatorias/microbiología , Ultrasonografía Intervencional/métodos , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/cirugía , Adenocarcinoma/complicaciones , Adenocarcinoma/cirugía , Anciano , Antibacterianos/uso terapéutico , Neoplasias del Sistema Digestivo/cirugía , Farmacorresistencia Bacteriana , Femenino , Glicopéptidos/uso terapéutico , Humanos , Tiempo de Internación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Quinolonas/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , beta-Lactamas/uso terapéuticoRESUMEN
The incidence of anastomotic leakage in colorectal surgery is 1% to 12%. Every deviation from the normal postoperative course must raise suspicion of a leak. Diagnosis is made radiologically by rectal enema or CT. Limited leakages without clinical signs can be treated conservatively by wait-and-see. Larger anastomotic failure with intra-abdominal abscesses or peritonitis requires reanastomosis in combination with a diverting loop ileostomy or colostomy. A Hartmann procedure with open abdominal management may be indicated in severely ill patients with feculent peritonitis. In the pelvis, even large leaks may heal spontaneously when stool passage is diminished by a proximal diverting enterostomy. There is no benefit of primary loop enterostomies concerning the incidence of anastomotic leaks; however, they reduce the number of operative revisions due to anastomotic failure. Therefore they are proposed in risk patients and intraoperatively difficult anastomoses.
Asunto(s)
Anastomosis Quirúrgica/efectos adversos , Cirugía Colorrectal/efectos adversos , Complicaciones Posoperatorias , Abdomen/diagnóstico por imagen , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Algoritmos , Colostomía , Endosonografía , Enema , Humanos , Análisis Multivariante , Peritonitis/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: A non-invasive diagnostic modality for differential diagnosis and detection of complications in inflammatory bowel disease (IBD) is desirable as alternative to invasive and troublesome endoscopy and conventional radiological methods. METHODS: 51 patients suspicious of inflammatory bowel disease (bloody diarrhoea, symptoms of stenosis, abdominal pain) were investigated consecutively according to a standardised protocol by magnetic resonance tomography (MRI). Also, endoscopy was performed dependent on clinical presentation. MRI findings were compared to clinical follow-up, percutaneous ultrasonography (US), endoscopy, and surgical findings. RESULTS: MRI confirmed diagnosis of Crohn's disease (CD) in more than 90 % of cases. In case of distinct lesions, all of these were detected by MRI in the small bowel and colon. Discreet inflammatory lesions were not seen regularly. Numerous findings in endoscopically inaccessible bowel segments were described by MRI, extraintestinal lesions (conglomerate, abscess, fistulae) were detected accurately. Altogether, MRI was superior to abdominal ultrasonography. CONCLUSION: In patients with distinct inflammatory bowel disease, and in detection of complications (abscess, fistulae), MRI appears as versatile, non-invasive and accurate diagnostic instrument with therapeutical consequence. Endoscopy remains method of first choice for detection of discreet lesions and for histopathological diagnosis.
Asunto(s)
Medios de Contraste/administración & dosificación , Enfermedad de Crohn/diagnóstico , Imagen por Resonancia Magnética/métodos , Absceso Abdominal/diagnóstico , Absceso Abdominal/patología , Absceso Abdominal/cirugía , Adolescente , Adulto , Anciano , Colon/patología , Colon/cirugía , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/patología , Enfermedades del Colon/cirugía , Colonoscopía , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Diagnóstico Diferencial , Enema , Femenino , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/patología , Fístula Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/patología , Obstrucción Intestinal/cirugía , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
The efficacy of piperacillin/tazobactam at 100/12.5 mg/kg every 8 h (35 patients) was compared to cefotaxime plus metronidazole at 50/7.5 mg/kg every 8 h (35 patients) in 70 children with intra-abdominal infections requiring surgery. Diagnoses were gangrenous or perforated appendicitis (n =56), peritonitis (n =12), and abscess (n =2). Clinical cure was observed in 35 of 35 evaluable patients treated with piperacilin/tazobactam and in 34 of 34 evaluable patients treated with cefotaxime plus metronidazole. Presumed bacteriological eradication was noted in 29 of 30 evaluable patients in the piperacillin/tazobactam group and in 31 of 31 evaluable patients in the cefotaxime plus metronidazole group. In this study, piperacillin/tazobactam was as effective as cefotaxime plus metronidazole for treating children with intra-abdominal infections requiring surgery.
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Absceso Abdominal/tratamiento farmacológico , Apendicitis/tratamiento farmacológico , Infecciones Bacterianas/tratamiento farmacológico , Quimioterapia Combinada/administración & dosificación , Perforación Intestinal/tratamiento farmacológico , Ácido Penicilánico/análogos & derivados , Peritonitis/tratamiento farmacológico , Absceso Abdominal/microbiología , Absceso Abdominal/cirugía , Adolescente , Apendicitis/microbiología , Apendicitis/cirugía , Infecciones Bacterianas/microbiología , Cefotaxima/administración & dosificación , Niño , Preescolar , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Perforación Intestinal/microbiología , Perforación Intestinal/cirugía , Masculino , Metronidazol/administración & dosificación , Pruebas de Sensibilidad Microbiana , Ácido Penicilánico/administración & dosificación , Peritonitis/microbiología , Peritonitis/cirugía , Piperacilina/administración & dosificación , Estudios Prospectivos , Tazobactam , Resultado del TratamientoRESUMEN
An 81-year-old man who had been aware of a right anterior abdominal mass for 1 week was admitted to our hospital on July 3, 1999, after the mass had perforated and was secreting mucinous purulent material. Computed tomography clearly showed an anterior abdominal wall abscess and a large intraabdominal tumor that contained a fistula-like structure. Barium enema revealed an apple-core sign at the transverse colon, with a fistula that connected the colon to the abscess cavity. Transverse colonic cancer complicated by an anterior abdominal wall abscess was diagnosed, and an extended right hemicolectomy was performed. We did not perform en bloc excision of the full thickness of the anterior abdominal wall, including the abscess, because the defect was determined to be too large to repair. Thus, when curative resection is not feasible, as in our patient, resection of the primary tumor with en bloc partial resection of the adherent parietal wall should be performed if possible, as this procedure has the potential to improve the postoperative quality of life of the patient.
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Absceso Abdominal/etiología , Adenocarcinoma Mucinoso/complicaciones , Colectomía/métodos , Neoplasias del Colon/complicaciones , Absceso Abdominal/patología , Absceso Abdominal/cirugía , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Humanos , Masculino , Cuidados Paliativos , Calidad de Vida , Resultado del TratamientoRESUMEN
STUDY AIM: The aim of this multicentric retrospective study was to report the results on the percutaneous drainage of perisigmoid abscesses during acute sigmoid diverticulitis in 12 patients. PATIENTS AND METHOD: Between January 1993 and March 2000. 12 patients with a perisigmoid diverticular abscess were treated by antibiotic therapy and percutaneous drainage of the abscess. The patient population consisted of eight males and four females (mean age: 50.2 years). The diagnosis was established in two out of seven cases by enema, in four cases out of seven by abdominal ultrasonography, and in eight cases out of 11 by CT scan. Percutaneous drainage was carried out in all cases, and was guided by ultrasonography (n = 3) and CT scan (n = 9). The mean duration of drainage was 6.5 days. RESULTS: No drainage-associated complications were observed. Drainage combined with antibiotic treatment provided satisfactory results in ten out of 12 cases. Two cases of failure of the method occurred, and the patients involved were operated on day 4 and week 5 by colectomy with protective lateral ileostomy. There was an early recurrence of the abscess in three patients, who were treated by the Hartmann procedure in one case, and by one-stage colectomy in two cases. Five patients underwent a secondary one-stage colectomy. Two patients in whom no residual abscess was detected were not operated on at the time of the study. CONCLUSION: Percutaneous drainage of perisigmoid diverticular abscesses combined with antibiotic therapy provided efficient treatment in ten out of 12 cases. Secondary one-stage colectomy was performed in seven out of the eight patients requiring further surgery.
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Absceso Abdominal/cirugía , Diverticulitis del Colon/complicaciones , Drenaje/métodos , Enfermedades del Sigmoide/complicaciones , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/etiología , Adulto , Anciano , Colectomía , Colitis/complicaciones , Colitis/cirugía , Diverticulitis del Colon/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía Abdominal , Recurrencia , Estudios Retrospectivos , Enfermedades del Sigmoide/cirugía , Factores de TiempoRESUMEN
We report the unusual case of a patient with chronic carriage of Salmonella typhi who presented with partially calcified splenic abscess linked to colic fistula and ascitis. The colic fistula could be secondary to ischemic necrosis by left colon compression due to spleen large abscess. Fistula was evidenced by abdominal computed tomography scan and confirmed by barium enema. The possible etiologies of ascitis are either tuberculosis or ascitic peritonitis secondary to the fistulisation; nevertheless, the role of segmentary portal located hypertension cannot be completely excluded. The splenic abscess was probably due to Salmonella typhi which was only isolated from stool specimens. The calcified splenic abscess was the evidence that the infection had occurred first. In addition, the isolation of Salmonella typhi in stool cultures six months after the subject had returned from the Comores proved the chronic carriage. Treatment by splenectomy and left colectomy was successful in this patient.
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Absceso Abdominal/microbiología , Ascitis/microbiología , Calcinosis/microbiología , Portador Sano , Enfermedades del Colon/microbiología , Fístula Intestinal/microbiología , Enfermedades del Bazo/microbiología , Fiebre Tifoidea/complicaciones , Absceso Abdominal/diagnóstico , Absceso Abdominal/cirugía , Ascitis/diagnóstico , Sulfato de Bario , Calcinosis/diagnóstico , Calcinosis/cirugía , Enfermedad Crónica , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/cirugía , Comoras/etnología , Emigración e Inmigración , Enema , Francia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To compare the performances of computed tomography (CT) and water soluble contrast enema in the diagnosis and evaluation of the severity of acute left colonic diverticulitis, and to propose indications for elective colectomy after a first episode of diverticulitis successfully treated medically. PATIENTS AND METHODS: Prospective non-randomized study (1986-1997) of 542 patients (290 women and 252 men with a median age of 64 years) whose final diagnosis was confirmed either histologically or radiologically. 465 patients (86%) had a CT, 439 (81%) had a water soluble contrast enema, and 420 (77%) had both examinations. Diverticulitis was considered moderate when CT showed localized thickening of colonic wall (> or = 5 mm) and inflammation of pericolic fat and water soluble contrast enema showed segmental lumen narrowing and tattered mucosa; it was considered severe when abscess and/or extraluminal air/or extraluminal contrast were described by CT or the two latter by water soluble contrast enema. RESULTS: 410 patients (76%) were treated medically and 132 were operated during their hospitalization. Sensitivity of CT for diagnosis of diverticulitis was 96%, compared to 87% for water soluble contrast enema (p < 0.0001). Severe diverticulitis was found in 139 patients (30%) by CT and in 45 patients (11%) by water soluble contrast enema (p < 0.0001). Age < or = 50 years, severe diverticulitis in the initial CT and associated pelvic abscess were found to be statistically significant parameters to predict the risk of secondary complications after a first episode of diverticulitis successfully treated medically. CONCLUSIONS: Performances of CT for diagnosis and evaluation of severity of acute diverticulitis are statistically higher than that of water soluble contrast enema. We would recommend elective colectomy in patients 50 years of age or younger with a severe diverticulitis in initial CT, and in all patients with an associated pelvic abscess.