Anaerobic liver abscesses as initial presentation of silent colonic cancer.

BACKGROUND: Rarely, multiple liver abscesses caused by anaerobic organisms are the presenting form of unsuspected colonic cancer in the absence of liver metastases. CASE OUTLINE: A 68-year-old man was admitted with abdominal pain, fever and chills. Imaging scans and repeated cytology yielded a diagnosis of multiple liver abscesses. Pus cultures grew Peptostreptococcus anaerobius, Bacteroides melaninogenicus and Peptostreptococcus spp. A search for the underlying cause led to the discovery of an adenocarcinoma of the sigmoid colon. After a 12-month postoperative follow-up, the patient is free of hepatic metastases. DISCUSSION: Anaerobic liver abscesses should always alert the clinician to possible silent colonic carcinoma.

Incarcerated groin hernias in adults: presentation and outcome.

Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There were 77 men and 70 women. Femoral hernias were seen in 77 patients and inguinal hernias in 70. Coexisting diseases were found in 82 cases (55.8%). Bowel resection was required in 19 patients (12.9%). The overall and major morbidity rates were 41.5% and 9.6%, respectively. The mortality rate was 3.4%. Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes. Because of high morbidity and mortality associated with incarceration, elective repair of groin hernias should be done whenever possible.

Abscesos hepáticos piógenos. Importancia de la existencia de gas / Pyogenic liver abscesses. The importance of the presence of gas

Introducción. Nuestro objetivo fue analizar el comportamiento clínico de los pacientes con abscesos hepáticos piógenos formadores de gas y, además, determinar si existía alguna diferencia en relación con los enfermos con abscesos sin producción de gas. Pacientes y métodos. Mediante un estudio multicéntrico se han revisado, retrospectivamente, las historias clínicas de 126 pacientes diagnosticados de abscesos hepáticos piógenos, durante un período de 13 años. Los enfermos fueron divididos en dos grupos: 25 con visualización radiológica de gas en el absceso (grupo 1) y 101 sin formación de gas (grupo 2). Los aspectos estudiados y comparados entre ambos grupos fueron: características clínicas, biológicas y bacteriológicas, morfología y topografía lesional, tratamiento y evolución clínica. Resultados. La presentación clínica de los pacientes del grupo 1 se caracterizó por la mayor frecuencia de pérdida de peso (60 frente al 37,6 por ciento; p = 0,03), shock (16 frente al 4 por ciento; p = 0,04) y derrame pleural (48 frente al 26 por ciento; p = 0,03). También en dicho grupo hubo mayor tasa de complicaciones relacionadas con el absceso (36 frente al 18 por ciento; p = 0,04). En el resto de datos clínicos, microbiológicos y terapéuticos no hubo diferencias significativas entre los dos grupos. Conclusiones. La aparición de gas en los abscesos genera escasas peculiaridades en la presentación clínica, pero su presencia implica peor evolución clínica, sobre todo en lo concerniente a la morbilidad relacionada con el absceso (AU)

Single and multiple pyogenic liver abscesses: etiology, clinical course, and outcome.

BACKGROUND: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. METHODS: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. RESULTS: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. CONCLUSIONS: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess.

BACKGROUND: Pyogenic liver abscess is a threatening condition. The purpose of this study was to audit the clinical behavior and to analyze the risk factors. METHODS: One hundred and thirty-three patients treated in five hospitals during the years 1985 to 1997 were studied. By univariate and multivariate analysis we tried to identify any risk factor associated with complicated clinical course and complicated-related clinical course, and with hospital mortality. RESULTS: Sixty-three patients (47%) were subjected to a percutaneous drainage, 45 (34%) were treated by open surgical drainage, and the remaining 25 cases (19%) received antibiotic therapy alone. Prognostic variables for a complicated clinical course were the presence of shock, low hemoglobin level, elevated prothrombin time, and polymicrobial infection. Shock, distress, low hemoglobin level, increased creatinine, and positive blood culture were significant predictors of a complicated-related clinical course. Concerning mortality, a biliary origin, shock, multiple abscesses, low hemoglobin level, and high concentration of blood urea nitrogen were independent predictors. CONCLUSIONS: Treatment of pyogenic liver abscesses should be tailored to each patient, however, the majority of them can be successfully treated with antibiotics and percutaneous methods. Those with signs of organ failure or septicemia should preferably be managed in the intensive care unit.

Pyogenic liver abscesses: a comparison of older and younger patients.

BACKGROUND: Pyogenic liver abscess is a life-threatening disease. Few studies have specifically explored the way in which the clinical features and management of elderly patients with pyogenic liver abscess differ from those of younger individuals. METHODS: A retrospective study was undertaken to evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or whether their management and outcome differ from that of younger patients. A total of 133 patients with liver abscess treated in five hospitals during 13 years comprised two groups: 78 patients aged 60 years or above (older group) and 55 patients below age 60 years (younger group). Clinical features, laboratory data, imaging and microbiological findings, management and outcome were determined in each group. RESULTS: The older group contained more patients with associated diseases (p=0.03), nausea and vomiting at presentation (p=0.02), higher APACHE II (Acute Physiological and Chronic Health Evaluation II scale) score (p<0.001) and blood urea nitrogen (p<0.001) and serum creatinine levels (p=0.002). Multiple abscess (p=0.05) and bilobar (p=0.03) abscess were also commoner in this group. By contrast, in the younger group men predominated (p=0.01), and there was a higher overall complication rate (p=0.05).Time to diagnosis, hospital mortality rate and other variables analysed were similar in both groups. DISCUSSION: Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with a lower morbidity rate than in younger patients and no difference in the mortality rate.