Adenocarcinoma mimicking appendicular lump: a diagnostic dilemma-a case report.

BACKGROUND: Primary appendiceal adenocarcinoma is a rare tumor, mucinous variety being common. This case is reported to highlight the unusual presentation and diagnostic difficulty of appendiceal adenocarcinoma. CASE PRESENTATION: Patient presented with acute appendicitis with ill-defined tender lump which responded to conservative management. CONCLUSIONS: High index of suspicion should be kept in mind for elderly patients presenting with appendicular lump. Every effort should be made during elective appendectomy to remove stump in case of sloughed out appendix.

Treatment of the intraabdominal abscesses through percutaneous ultrasound-guided drainage in oncological patients: Clinical and microbiological data.

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.

[Abdominal wall abscess as the presenting sign in carcinoma of the colon: report of 4 cases]. / Abcès pariétal abdominal révélateur de néoplasie colique: présentation de 4 cas.

PURPOSE: We report four cases of unusual presentation of colonic cancer revealed by an abscess of the abdominal wall. MATERIALS AND METHODS: Our study included 3 men and 1 women ranging in age from 33 to 66 years presenting with abdominal wall abscess (in the left anterior abdominal wall in 2 patients and in the quadratus lumborum muscle in the other 2 patients). Our cases were listed from the departments of radiology and abdominal surgery of Sahloul hospital from 1995 through 2000. Ultrasonography (US) and computed tomography (CT) were performed in all cases; barium enema in three. RESULTS: US and CT revealed segmental colonic wall thickening (left colon in three patients and right colon in one patient). The diagnosis of colonic cancer was reached by colonoscopy with biopsy in all 4 cases. All of our patients underwent surgical treatment. CONCLUSION: In this era of newer diagnostic imaging modalities, US and CT must frequently be used in the evaluation of patients with abdominal wall abscess, to depict intra-abdominal infection and especially malignant lesion causing abdominal wall abscess.

Retroperitoneal abscess complicated by acupuncture: case report.

With acupuncture treatment becoming an increasingly popular analgesic, there have been increasing reports on its associated complications. Although pneumothorax is the most frequently reported injury caused by acupuncture needles, infectious complications may not be uncommon. Most infectious complications show less serious clinical manifestations than pneumothorax, but retroperitoneal or intraabdominal abscess caused by acupuncture may be much more serious conditions. We experienced a 56-yr-old male diabetic patient presenting with serious retroperitoneal abscess after acupuncture treatments. Emergency operative drainage with adequate antibiotic therapy was performed. Bacterial culture of blood and closed pus specimens recovered Klebsiella pneumoniae. In addition to application of better knowledge on anatomy, appropriate antiseptic practice by practitioners will reduce many serious complications associated with acupuncture.

Retroperitoneal Abscess Complicated by Acupuncture: Case Report

With acupuncture treatment becoming an increasingly popular analgesic, there have been increasing reports on its associated complications. Although pneumothorax is the most frequently reported injury caused by acupuncture needles, infectious complications may not be uncommon. Most infectious complications show less serious clinical manifestations than pneumothorax, but retroperitoneal or intraabdominal abscess caused by acupuncture may be much more serious conditions. We experienced a 56-yr-old male diabetic patient presenting with serious retroperitoneal abscess after acupuncture treatments. Emergency operative drainage with adequate antibiotic therapy was performed. Bacterial culture of blood and closed pus specimens recovered Klebsiella pneumoniae. In addition to application of better knowledge on anatomy, appropriate antiseptic practice by practitioners will reduce many serious complications associated with acupuncture.

Más signos radiológicos relacionados con la gastronomía / More radiological signs selected

Hay una serie de signos imagenológicos descriptos en la literatura médica que están asociados con las comidas o los utensillos que se usan en relación con ella. La mayoría son signos clásicos que permiten la rápida interpretación de la imagen. Estos signos de comidas son fáciles de reconocer y memorizar. En este artículo describimos signos asociados con comida: migas de pan (fecaloma y abscesos), esqueleto de arenque (pliegues yeyunales noemales), vértebra de pescado (osteoporosis, Paget, neoplasias), ristra de chorizos (pancreatitis crónica), queso suizo (enfermedad poliquística, pulmón en estadio final, hiperplasia de glándulas de Brunner), coliflor (pólipos adenomatosos y vellosos), cebolla de verdeo (ureterocele), racimo de uvas (várices esofágicas, hemorroides internas), frutilla (colesterolosis), coco (áreas gástricas con hiperplasia folicular), pera (derrame pericárdico), medialuna (neumoperitoneo), sandwich (linfoma mesentérico). Entre los utensillos asociados con comida describimos: sacacorchos (espasmo esofágico difuso), botella de cuero (linitis gástrica), bandeja (tumor de Ewing), servilletero (cáncer del tracto digestivo), copa (tumor ureteral). Para el consumo y uso de estos elementos debemos disponer del último signo que agregamos a esta serie: el signo de la pila de monedas (hemorragia en intestino delgado) (AU)

[Radiologic diagnosis of fistulas and abscesses in Crohn's disease: cost-effectiveness analysis of 2 different imaging strategies]. / Radiologische Diagnostik von Fisteln und Abszeessen bei Morbus Crohn: Kosten-Effektivitäts-Analyse zweier bildgebender Verfahren.

PURPOSE: To analyze cost-effectiveness of magnetic resonance imaging and conventional enteroclysis in the assessment of fistulas and abscesses in patients with Crohn's disease (CD). METHODS: A decision analytic model was used to compare enteroclysis with MRI, performing a cost-effectiveness analysis of both diagnostic strategies. Data from 84 patients undergoing a clinical trial were used. Primary outcome was defined as one correctly diagnosed patient regarding Crohn's disease, fistulas, and abscesses, including true-positive and true-negative cases. Costs of the two procedures were estimated in German Marks (DM) using fee schedules. The influence of different definitions of effects was calculated. For all variables single and multiple sensitivity analyses were performed. RESULTS: Incremental cost effectiveness of MRI vs. enteroclysis was 3,119.33 DM per one additional correctly diagnosed patient. The results of sensitivity analyses suggest that MRI use in certain patient subgroups (patients at higher prevalence of CD, fistulas, and abscesses) even becomes more cost-effective. In this case one additional effect could be gained below 1,650 DM. CONCLUSIONS: From an economic perspective, decision makers should consider the use of MRI in the work-up of patients with Crohn's disease as an efficient procedure under certain conditions. To support treatment policies for physicians or insurance coverage of certain diagnostic strategies the costs possibly saved with MRI should also be considered.

[Percutaneous drainage of perisigmoid abscesses of diverticular origin]. / Le drainage percutané des abcès périsigmoïdiens d'origine diverticulaire.

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.

[Acute left-sided colonic diverticulitis: diagnosis and surgical indications after successful conservative therapy of first time acute diverticulitis]. / Akute linksseitige Kolondivertikulitis: Diagnose und Operationsindikationen nach erfolgreicher konservativer Therapie des ersten akuten Divertikulitisschubes.

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.

Abdominal actinomycosis: barium enema and computed tomography findings.

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

Absceso de bazo / Splenic abscess

El absceso de bazo es una rara enfermedad que puede presentarse en forma aislada o ser una manifestación de múltiples enfermedades. Se presenta a continuación el caso de un hombre de 49 años que presenta un síndrome febril posterior a la realización de un colon por enema y desarrolla un absceso esplénico que requirió para su tratamiento la esplenectomía. Se discuten los aspectos fisiopatológicos y las consideraciones terapéuticas de la entidad (AU)