ABSTRACT
Resumen Actinomyces spp es una familia de bacilos grampositivos saprofíticos que rara vez producen infecciones en el ser humano. Actinomyces odontolyticus forma parte de la microbiota oral y existen escasos reportes de casos de infecciones asociadas a este microorganismo, principalmente de localización oral, torácica, pélvica y bacteremias. Estas infecciones se caracterizan por ser recidivantes y causar abscesos y trayectos fistulosos. Su aislamiento microbiológico es difícil ya que la mayoría de los equipos automatizados no identifican la especie de Actinomyces, por lo que técnicas como MALDI-TOF MS resulta de gran ayuda en el diagnóstico definitivo. Finalmente, el tratamiento antibacteriano debe ser prolongado, acompañado del drenaje quirúrgico de las colecciones. Presentamos dos casos de infección abdominal recurrente por A. odontolyticus, en pacientes inmunocompetentes, con tratamiento exitoso.
Abstract Actinomyces spp is a family of saprophytic gram-positive rods that rarely cause infections in humans. Actinomyces odontolyticus is part of the oral microbiota and there are few case reports of infections associated, mainly oral, thoracic, pelvic involvement and bacteremia. These infections are characterized by being recurrent and causing abscesses and fistulous tracts. Microbiological isolation of the microorganism is difficult because most of the automated identification equipment does not detect the Actinomyces species. The use of identification techniques such as MALDI-TOF MS is a great help in the definitive diagnosis. Finally, antibacterial treatment should be prolonged, and accompanied by surgical drainage of the collections. We report two cases of recurrent abdominal infection by A. odontolyticus, in immunocompetent patients, with successful treatment.
Subject(s)
Humans , Male , Female , Adult , Aged , Actinomycosis/microbiology , Actinomycosis/diagnostic imaging , Abdominal Wall/microbiology , Recurrence , Actinomyces/isolation & purification , Actinomycosis/therapy , Drainage , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Anti-Bacterial Agents/therapeutic useABSTRACT
La infección por Actinomices (actinomicosis), es una entidad poco frecuente y que puede crear dificultades diagnósticas y terapéuticas; principalmente cuando por su presentación se asemeja a neoplasias malignas. El objetivo de este estudio fue reportar un caso de actinomicosis de pared abdominal con infiltración hepática y revisar la evidencia existente. Se trata de una paciente sexo femenino, de 33 años de edad, sin antecedentes quirúrgicos ni de utilización de dispositivos intra-uterinos. Consultó por dolor abdominal y masa palpable a nivel epigástrico. Se estudió con imágenes, las que permitieron verificar una masa de pared abdominal con trayecto fistuloso al hígado. Se realizó una exéresis amplia de la lesión antes descrita. Una vez extirpado el espécimen, se fue a estudio histopatológico, que reveló gránulos de azufre consistentes con actinomices. La paciente evolució de forma satisfactoria, sin inconvenientes. Presentamos un caso poco común de actinomicosis de pared abdominal con infiltración hepática. Cuando se encuentra una gran masa intraperitoneal, la actinomicosis debe incluirse en el proceso de diagnóstico diferencial.
Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses.
Subject(s)
Humans , Female , Middle Aged , Actinomycosis/diagnosis , Actinomycosis/surgery , Actinomycosis/pathology , Abdominal Wall/microbiology , Diagnosis, Differential , Liver Abscess/etiology , Abdominal Neoplasms/diagnosisABSTRACT
Researches for the ideal material for abdominal wall reconstructive procedures in Veterinary Medicine remains constant. Synthetic and biological materials are routinely studied, regarding the ability of abdominal support and reactivity of the host, both of them present advantages and disadvantages. This review analyzes the main characteristics of synthetic and biological materials currently in use, in order to compare the two of them. It was observed that biological materials have less reactivity by the host, but the strength of the synthetic materials is higher, even though, more expensive. The effort and research for the ideal material should remain active because the ideal one has not been found yet.
A busca pelo material ideal para os procedimentos de reconstrução da parede abdominal em Medicina Veterinária permanece constante. Materiais sintéticos e biológicos são rotineiramente estudados, mostrando prós e contras referentes às suas respectivas capacidades de sustentação abdominal e reatividade do hospedeiro. Esta revisão aborda as principais características dos materiais sintéticos e biológicos atualmente utilizados, e levanta comparações entre os dois tipos de materiais. Os materiais biológicos apresentam menor reatividade pelo hospedeiro, porém, a força de sustentação dos materiais sintéticos é maior, embora o seu custo seja mais elevado. Os trabalhos e a busca pelo material ideal para este tipo de procedimento devem permanecer ativos, pois o material ideal ainda não foi encontrado.
Subject(s)
Animals , Biocompatible Materials/analysis , Abdominal Wall/surgery , Abdominal Wall/microbiologyABSTRACT
Researches for the ideal material for abdominal wall reconstructive procedures in Veterinary Medicine remains constant. Synthetic and biological materials are routinely studied, regarding the ability of abdominal support and reactivity of the host, both of them present advantages and disadvantages. This review analyzes the main characteristics of synthetic and biological materials currently in use, in order to compare the two of them. It was observed that biological materials have less reactivity by the host, but the strength of the synthetic materials is higher, even though, more expensive. The effort and research for the ideal material should remain active because the ideal one has not been found yet.(AU)
A busca pelo material ideal para os procedimentos de reconstrução da parede abdominal em Medicina Veterinária permanece constante. Materiais sintéticos e biológicos são rotineiramente estudados, mostrando prós e contras referentes às suas respectivas capacidades de sustentação abdominal e reatividade do hospedeiro. Esta revisão aborda as principais características dos materiais sintéticos e biológicos atualmente utilizados, e levanta comparações entre os dois tipos de materiais. Os materiais biológicos apresentam menor reatividade pelo hospedeiro, porém, a força de sustentação dos materiais sintéticos é maior, embora o seu custo seja mais elevado. Os trabalhos e a busca pelo material ideal para este tipo de procedimento devem permanecer ativos, pois o material ideal ainda não foi encontrado.(AU)
Subject(s)
Animals , Biocompatible Materials/analysis , Abdominal Wall/microbiology , Abdominal Wall/surgeryABSTRACT
PURPOSE: Midline incisional hernia reconstruction by defect closure and reinforcement with either prosthetic or biologic materials has shown to significantly decrease recurrence rates even for complex cases. The purpose of this study is to evaluate outcomes regarding large incisional hernia reconstruction with components separation technique using rectus muscle plication as a reinforcement method. METHODS: Thirteen patients having large midline incisional hernias and either history of abdominal wall contamination or recurrence in the presence of mesh were treated between January 2007 and December 2011 with closure using components separation technique reinforced by rectus muscle plication. RESULTS: Average hernia square was 222 cm(2), and mean follow-up was 24 months. Complications occurred in 6 patients with a mean time to resolution of 59 days. One recurrence was present. CONCLUSIONS: When use of mesh or biologic materials is not desired, rectus muscle plication is a feasible tool as a reinforcement method after large hernia closure with components separation.
Subject(s)
Abdominoplasty/methods , Hernia, Ventral/surgery , Herniorrhaphy/methods , Rectus Abdominis/surgery , Surgical Wound Infection/etiology , Abdominal Wall/microbiology , Abdominal Wound Closure Techniques/adverse effects , Abdominoplasty/adverse effects , Adolescent , Adult , Aged , Female , Follow-Up Studies , Hernia, Ventral/microbiology , Hernia, Ventral/pathology , Herniorrhaphy/adverse effects , Humans , Male , Middle Aged , Recurrence , Seroma/etiology , Surgical Mesh , Surgical Wound Dehiscence/etiology , Young AdultABSTRACT
Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite of treatment.
Subject(s)
Abdominal Wall/microbiology , Cholecystectomy, Laparoscopic/adverse effects , Clostridium Infections/diagnosis , Gas Gangrene/microbiology , Atherosclerosis/complications , Fatal Outcome , Female , Humans , Hypertension/complications , Middle AgedABSTRACT
Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper, we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite oftreatment.
La gangrena gaseosa clostridial de la pared abdominal es rara, y normalmente se halla asociada con la perforación de órganos, inmunosupresión o malignidades gastrointestinales. En este trabajo, se presenta un caso de gangrena gaseosa endógena fulminante en una mujer diabética de 58 años con hipertensión arterial y ateroesclerosis, tras una colecistectomía laparoscópica sin incidentes. Doce horas después de la colecistectomía, la mujer desarrolló una gangrena gaseosa de la pared abdominal, y murió 24 horas después del comienzo de los primeros síntomas, a pesar del tratamiento.