Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess.

BACKGROUND: Phlegmonous gastritis (PG) is a rare and potentially fatal disease characterized by bacterial infection of the gastric wall. However, its clinical features are nonspecific, which may delay its diagnosis and treatment. CASE REPORT: We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.

[A case of type 2 diabetes mellitus complicated with left iliopsoas abscess caused by a left femoral vein catheter during treatment for right pyothorax and right subphrenic abscess].

A 78-year-old man was receiving regular treatment for diabetes and dementia at our hospital. Diabetes was diagnosed about 10 years previously, at which time the patient's HbA(1)c level had been maintained at 6% by diet therapy and an oral hypoglycemic agent. In July, 2008, he was admitted with fever and hospitalized for pneumonia, which improved with antibiotic treatment and chest drainage. However, pyothorax developed, and in October, 2008 he was admitted again with fever and inflammation. A chest computed tomography (CT) scan revealed a right subphrenic abscess, which improved with antibiotic treatment. He was readmitted for fever and lumbago in November, 2008, and an abdominal CT scan showed a left iliopsoas abscess that did not improve with antibiotic treatment, and had increased in size. Due to infection from the central vein catheter in the left femoral vein inserted at the end of October, the catheter was withdrawn at the end of November. There was a rapid reduction of the left iliopsoas abscess, his inflammation and lumbago symptoms reduced, and he was discharged in January 2009. In cases of dementia in elderly with diabetes, a catheter from a femoral vein is frequently used to prevent complications. However, this method has been known to result in infection at the site of the catheter, and to cause fever. The circumstances of this case strongly support the removal of such a catheter in elderly patients at the first indication of persistent infection.

[Aspergillus peritonitis--a case report]. / Aspergillus peritonitis esete.

The incidence of fungal infections such as Aspergillosis is increasing among immunocompromised patients. Demand for diagnosis of mycotic diseases is steadily raising among clinicians and treatment of these patients represents a continually growing challenge. The authors present a case of a 53-year-old male patient with Aspergillus peritonitis. This case deserves attention because its extreme rarity in the medical literature and complex therapy of coinfections during the hospital stay which was difficult and relatively expensive. The importance of consultation and microbiological sampling is emphasized.

Retroperitoneal abscess: an uncommon localization of tubercular infection.

We describe a rare case of a 29-year-old immunocompetent Nigerian male affected by an abdominal abscess due to Mycobacterium tuberculosis infection. Diagnosis was achieved with cultures from surgical drainage. No pulmonary, renal, or gastrointestinal involvement was identified. The patient was successfully treated with standard four-drug antitubercular therapy.

Retroperitoneal abscess with retained gall-stones as a late complication of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.

Intra-abdominal abscess caused by Staphylococcus epidermidis.

An immunologically compromised patient was found to have a postoperative intra-abdominal abscess from which Staphylococcus epidermidis was the sole isolate. Studies of the isolate in a rabbit and in mice showed no evidence for unusual virulence of the organism. The S epidermidis probably was introduced into the peritoneal cavity during surgery and, because of the patient's neutropenia, produced a serious infection within a few weeks. To our knowledge, this is the first case of a intra-abdominal abscess associated with S epidermidis to be described in the literature.

Early appearance of abscess after biliary operation.

Three patients who had an air shadow and fluid levels within seven days after biliary surgery are discussed. In retrospect, this direct evidence of a postoperative abscess was overlooked because of its early appearance and other sources of fever that coexisted.

Continual postoperative antibiotic peritoneal lavage in diffuse peritonitis complicating cesarean section.

Nine women treated surgically for diffuse peritonitis complicating cesarean section underwent continual postoperative antibiotic peritoneal lavage as an adjunct to surgery. In all the patients the indication for surgery was failure to respond to standard medical therapy. Seven patients treated with hysterectomy recovered without evidence of continuing peritonitis or intraabdominal abscess formation. One of two patients in whom uterine conservation was attempted required an emergency hysterectomy three days later. In this series, continual postoperative antibiotic peritoneal lavage appeared to be an effective adjunctive treatment in the prevention of continuing peritonitis and abscess formation provided that hysterectomy was performed at the initial operation.

Subphrenic abscess following laparoscopic cholecystectomy and spilled gallstones.

The natural biology of spilled intraperitoneal gallstones is not known. We report a patient with subphrenic abscess following spilled gallstones at laparoscopic cholecystectomy.

[Clinical evaluation of cefminox in surgery].

Cefminox (CMNX, MT-141) was administered to 7 cases with postoperative infections including subphrenic abscess and wound abscess, and the clinical effect was good in 2 cases, fair in 2, poor in 2 and unknown in 1. A daily dose was 2 g in 7 cases. The maximum total dose and duration were 22 g and 11 days respectively. Side effect which was observed during the test period was 1 case of drug eruption. No abnormal laboratory findings related to this drug were noted.

[Abdomino-pelvic actinomycosis: a case report]. / Actinomycose abdomino-pelvienne: à propos d'un cas.

The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.

A rare late complication of laparoscopic cholecystectomy.

An 86-year-old woman presented three years after laparoscopic cholecystectomy with right upper quadrant pain and raised inflammatory markers. Liver function tests were normal; however, a previous ultrasound scan suggested a common bile duct stone so she was treated for cholangitis secondary to choledocholithiasis. Repeat ultrasound scan again showed a common bile duct (CBD) stone and also a subdiaphragmatic abscess. CT scan confirmed the abscess, associated with a surgical clip from her previous surgery. There was no evidence of a persistent CBD stone on the CT scan. She was treated conservatively with intravenous antibiotics and her symptoms improved. Follow-up MRI did not show any choledocholithiasis. Surgical clips causing delayed abscess formation are very unusual. We discuss the presentation, investigations and treatment of this interesting case. Existing relevant literature is reviewed, and management strategies to treat such rare complications are suggested.

Subhepatic appendicitis with subdiaphragmatic abscess in a pediatric patient without intestinal malrotation: case report.

BACKGROUND: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. When these conditions are met, accurate diagnosis and early management decisions are delayed. CLINICAL CASE: We present the case of a 10-year-old male who had diarrhea without mucus or blood for 5 days. He was treated with antibiotics. Afterwards, he presented with vomiting, abdominal pain, and fever. Physical examination of the abdomen demonstrated a soft and depressible mass and pain in the lower right abdomen. Abdominal ultrasound and tomography reported image of subdiaphragmatic abscess. Percutaneous puncture and drainage were performed without results. Exploratory laparotomy was then performed, revealing a subhepatic perforation of the appendix. The patient evolved with abdominal sepsis and septic shock, resulting in a new surgical intervention for drainage of serohematic fluid. The patient improved and was discharged on day 40. DISCUSSION: It is very important to consider the position of the anatomic appendix during appendicitis because it contributes to the various clinical symptoms, of which 30% are atypical. Diagnosis is masked, leading to complications such as perforations and/or abscesses that extend the hospital stay. CONCLUSIONS: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. Delay in treatment due to atypical symptoms caused by the abnormal position of the appendix conditioned complications that implied a prolonged hospital stay, with the risk of increasing morbidity and mortality of the patient.