Concomitant and secondary bacterial infection of the pus in hepatic amoebiasis

In a series of 48 consecutive patients with clinically diagnosed uncomplicated amoebic liver abscess (ALA), the pus obtained by closed drainage of the abscess was bacteriologically sterile. Secondary bacterial infection of the ALA as a direct result of the aspiration procedure occurred in only 1 patient, the causative organism being Escherichia coli. Entamoeba histolytica was identified in a total of 39 cases (81%) by means of direct microscopy of the pus as well as culture methods.     

Subdural Empyema Due to Lactococcus lactis cremoris: Case Report

Lactococcus lactis cremoris (L. lactis cremoris) infections are very rare in humans. Only three case reports of brain abscess have been reported and the infectious routes and pathological features are still unknown. We experienced a subdural empyema due to L. lactis cremoris in an immunocompetent adult. A 33-year-old man was admitted with fever, right facial pain, left hemiparesis, and left hemianopsia. Computed tomography demonstrated low density fluid collection in the right falcotentorial subdural space. Magnetic resonance (MR) images revealed a high signal lesion on a diffusion-weighted image (DWI) and fluid attenuated inversion recovery (FLAIR) images in the right paratentorial and parafalcine subdural space, right maxillary sinus, and bilateral ethmoidal sinus. He underwent two sequential open surgeries for removal and drainage of empyema and was treated with antibiotics including meropenem and ampicillin. To our knowledge, this is the first report of subdural empyema caused by L. lactis cremoris infection. We report the case and discuss the pathological features with the previous literature.     

Supra- and infratentorial subdural empyema secondary to septicemia in a patient with liver abscess--case report

An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.     

Intrathoracic Presentation of Amebic Liver Abscess

Amebic infection is endemic in tropical and subtropical countries and still remains a common cause of chronic morbidity in these areas. This is a report of 10 patients with different intrathoracic presentations of amebic liver abscess who were treated surgically after conservative measures had failed. Five of these patients had empyema when first seen, 3 had lung abscess, and 1 had intrathoracic shadow that proved on exploration to be an amebic liver abscess. All these 9 patients had abscesses on the right side secondary to amebic liver abscess of the right lobe of the liver. The tenth patient had amebic pericarditis secondary to amebic abscess of the left lobe of the liver. Failure of conservative treatment in these patients is attributed to the thick nature of the amebic pus and the severe reaction of the pleura and pericardium to the amebic infection. To avoid the serious complication of pleuropulmonary amebiasis, early operation is advised for large liver abscesses that are unlikely to be controlled by conservative treatment. Transpleural drainage of such abscesses gives direct approach to their sites, which are commonly located in the superior part of the right lobe of the liver. Such drainage has proved to be safe provided that the patient is receiving antiamebic drug treatment.     

Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy

IntroductionGas-forming pyogenic liver abscess (GPLA) caused by C. perfringens is rare but fatal. Patients with past gastrectomy may be prone to such infection post-ablation.Presentation of caseAn 84-year-old male patient with past gastrectomy had MW ablation of his liver tumors complicated by GPLA. Computerised tomography scan showed gas-containing abscess in the liver and he was managed successfully with antibiotic and percutaneous drainage of the abscess.DiscussionC. perfringens GPLA secondary to MW ablation in a patient with previous gastrectomy has not been reported in the literature. Gastrectomy may predispose to such infection. Even in high-risk patients, empirical antibiotic before ablation is not a standard of practice. Therefore following the procedure, close observation of patients’ conditions is necessary to allow early diagnosis and intervention that will prevent progression of infection.ConclusionPotential complication of liver abscess following MW ablation can never be overlooked. The risk may be enhanced in patients with previous gastrectomy. Early diagnosis and management may minimise mortality and morbidity.     

肝肿瘤射频消融术后感染性并发症的处理

目的分析肝恶性肿瘤经皮射频消融术(RFA)后感染性并发症的临床特点及处理方法。方法回顾性分析于我科接受RFA治疗的356例肝脏恶性肿瘤患者,其中原发性肝癌296例,肝转移癌60例。对于术后有严重感染表现的患者进行即刻腹部超声和(或)CT增强扫描。明确肝内局部脓肿形成后,采取置管引流、使用抗生素等干预措施,并随访1年。全部脓肿引流液均行细菌学检查并根据药敏结果调整抗生素用药。结果 356例RFA术后共5例患者发生局部严重感染,其中3例为肝脓肿,1例胆汁瘤合并感染,1例为腹壁脓肿。1例肝脓肿患者肝内局部病灶与结肠肝曲形成窦道且经久不愈,经外科手术局部修补+肝内脓肿置管引流后局部及全身症状有所缓解,但于RFA术后8个月死于全身衰竭。1例腹壁脓肿患者经抗感染、置管引流、局部换药处理后局部及全身症状有所缓解,但于RFA术后6个月死于肿瘤进展。1例肝脓肿和1例胆汁瘤合并感染患者经单纯病变部位置管引流+抗生素治疗后临床症状明显缓解,随诊1年达到临床治愈。1例肝脓肿患者经病变部位置管引流+抗生素治疗后,感染灶痊愈,但随访至9个月时死于肝内肿瘤转移导致的多脏器功能衰竭。结论 RFA术后严重感染性并发症并不少见,感染途径可来自肠道菌群逆行感染,Whipple术等导致Oddi括约肌无功能的RFA术后继发严重感染的明确诱因。除根据药敏实验应用敏感抗生素外,及时行脓腔穿刺引流、外科干预等综合治疗是针对RFA术后局部感染性并发症的有效方法。     

Simultaneous bilateral decortications via video-assisted thoracic surgery for bilateral empyema

IntroductionBilateral empyema is a rare and life-threatening condition that is difficult to treat. We herein report a case of bilateral empyema that was treated with simultaneous bilateral decortications via video-assisted thoracic surgery (VATS).Presentation of caseA 38-year-old female complained of chest pain, dyspnea, and high grade fever lasting two weeks. Computed tomography revealed bilateral notching pleural effusion and pneumonia with atelectasis. Bilateral thoracic drainage was performed. From the right chest, white pus was drained, and Streptococcus anginosus was identified. The left drainage fluid was serous, and no bacteria were identified. We diagnosed the patient with right empyema and left para-pneumonic effusion consequent to pneumonia. Because conservative therapies could not resolve the inflammatory findings, simultaneous bilateral VATS decortications were performed. Both thoracic cavities had loculated pleural effusion. In contrast to the preoperative findings, white pus was found in not only the right, but also the left thoracic cavity. She had an uncomplicated postoperative course and recovered.DiscussionBilateral empyema that has developed to the fibrinopleural phase is difficult to treat with drains alone. Bilateral VATS decortications helped to make a definitive diagnosis and treat both sides simultaneously.ConclusionSimultaneous bilateral VATS decortications should be considered as a feasible and effective procedure for bilateral empyema that is refractory to medical treatment.     

A case of amebic brain abscess

Amebic brain abscess is a rare and usually fatal complication of Entamoeba histolytica infections. We successfully treated a patient with this infection accompanied by brain, liver and pulmonary abscesses. Treatment consisted of administration of metronidazole through a nasogastric tube, and drainage of the brain abscess. A 51-year-old male patient presented with a two-week history of fever, severe back pain, and chest pain. Liver and pulmonary abscesses were drained upon admission. Biopsy of the colon showed infection by Entamoeba histolytica. After oral administration of metronicazole, the patient became somnolent, and neurological examination showed left side weakness. CT scan and MRI of the brain disclosed an abnormal lesion in the right basal ganglia. He was then transferred to our department, where stereotactic aspiration with drainage of the brain abscess was performed. The abscess was filled with reddish purulent material. Treatment with metronidazole (1,200 mg daily) for 18 days resulted in almost complete resolution of the intracerebral lesion and survival of the patient without any neurological deficits. His general condition improved dramatically, and he was discharged from our hospital 2 months later. Only 14 cases with amebic brain abscess associated with Entamoeba histolytica infection who recovered after treatment have been reported. We suggest amebic brain abscess should be taken into consideration for patients with brain abscess with a history of dysenteric illness especially since early diagnosis and aggressive management is likely to result in a cure.     

Staphylococcus aureus prostatic abscess and subdural empyema: a case report

Introduction and objectivesTo report one case of prostatic abscess and subdural empyema by Staphylococcus aureusMethodsWe describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methodsResultsThe clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversionConclusionsProstatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy     

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??Surgical treatment of liver abscess caused by cholelithiasis??A report of 62 patients CAO Ting-jia??LI Han-jun??HU Yi-lin??et al. Department of General Surgery??Wuhan General Hospital of Guangzhou Military Command of PLA??Wuhan 430070??China
Corresponding author??LU Qi-ping, E-mail: 13871160000@163.com
Abstract Objective To investigate the therapeutic method of liver abscess caused by cholelithiasis. Methods The clinical data of 62 patients with liver abscess caused by cholelithiasis undergoing hepatectomy and/or percutaneous transhepatic cholangiography and drainage (PTCD) in Department of General Surgery??Wuhan General Hospital of Guangzhou Military Command of PLA from January 2010 to December 2015 were analyzed retrospectively. Stones and foci of 12 patients (19.4%) distributed in the bilateral intrahepatic bile duct??10 patients (16.1%) in the left lateral lobe of liver??23 patients (37.1%) in left lobe of liver??1 patient (1.6%) in right anterior lobe of liver??8 patients (12.9%) in right posterior lobe of liver and 8 patients (12.9%) in right lobe of liver. When the abscess diameter > 3cm??percutaneous abscess pus aspiration or puncture PTCD drainage implant were perfomred and guided by ultrasound. Patients with stable disease??general condition improved underwent definitive surgery??including hepatectomy and abscess drainage. Results Postoperative complication rate??wound infection in 9 patients (17.3%)??intestinal obstruction in 4 patients (6.5%)??bile leakage in 2 patients (3.2%)??biliary tract bleeding in 1 patient (1.6%)??liver section / subphrenic infection in 1 patient (1.6%)??severe abdominal infection in 1 patient (1.6%)??with no liver failure. One patient (1.6%) died in perioperative peroid because of multiple organ failure caused by severe abdominal infection. Fifty patients (80.7%) were followed up for 6 months to 5 years. The efficacy was good in 55 patients (88.7%) and poor in 5 patients (8.1%)??and the 5 patients need further surgical treatment for the infection because of the stone recurrence??recurrent biliary infection. Conclusion Following the principle of individualized treatment??sufficient drainage of the liver abscess??simultaneously or elective hepatectomy are the best treatment of liver abscess caused by cholelithiasis.     

Empyema and lung abscess as complication of a perforated appendicitis in a pregnant woman

INTRODUCTIONThe development of empyema as a result of an intra-abdominal pathology is a rare condition.PRESENTATION OF CASEWe present a 31-year-old woman at 28 weeks’ gestation who was referred to our hospital with diagnosis of pneumonia with pleural effusion. She presented with signs of septicemia and fetal distress. A thoracic-abdominal-pelvic CT-scan showed a right pleural effusion with a retroperitoneal collection in contact with the pleural space. Due to her critical condition, immediate surgical exploration and pregnancy interruption was decided. The fetus was delivered by cesarean with satisfactory vitality. After abdominal exploration, a retrocecal appendicular abscess was evidenced and appendectomy was performed. Subsequently, the right chest was accessed through a posterolateral thoracotomy. An empyema with lung abscess and purulent fluid accessing from the retroperitoneum at the posterior pleural space was found. Due to parenchymal compromise, a right inferior lobectomy was performed. The patient had an uneventful recovery and was discharged at postoperative day 10.DISCUSSIONA septic condition in a pregnant patient with significant thoraco-abdominal infection requires an aggressive approach, with interruption of pregnancy and urgent exploration of the chest and abdomen.CONCLUSIONWhen an empyema is developed in absence of lung disease or other intrathoracic cause, intra-abdominal origin should be considered.     

肝胆管结石合并肝内感染灶的外科治疗（附62例报告）

目的 探讨肝胆管结石合并肝内感染灶的治疗方法。方法 回顾性分析2010年1月至2015 年12 月间,广州军区武汉总医院采用经皮经肝胆管引流（PTCD）、肝叶切除术治疗肝内胆管结石及肝内感染灶的62例病人的临床资料。结石及感染灶分布于双侧肝内胆管者12例（19.4%）,局限分布于左外叶10例（16.1%）,左半肝23例（37.1%）,右前叶1例（1.6%）,右后叶8例（12.9%）及右半肝8例（12.9%）。对脓肿直径>3 cm,在超声引导下经皮肝脓肿穿刺抽脓或穿刺置PTCD管引流。病情稳定,全身情况改善后行确定性手术,包括肝胆管结石病灶及脓肿切除或引流。结果 术后并发症发生率：切口感染9例（17.3%）、粘连性肠梗阻4例（6.5%）、胆漏2例（3.2%）、胆道出血1例（1.6%）、肝断面及膈下感染1例（1.6%）、严重腹腔感染1例（1.6%）,无肝功能衰竭。术后因为严重腹腔感染致全身多器官功能衰竭死亡1例（1.6%）。随访6个月至5年,随访率80.7%（50/62）。5年内疗效优良者占88.7%（55/62）,8.1%（5/62）病例因未行规则性肝切除,遗留病变的胆管,结石再发、胆道反复感染而需进一步手术处理。结论 遵循个体化原则,充分引流感染灶,同时或择期进行肝胆管结石并感染病灶切除是治疗肝胆管结石合并感染的最佳方案。     

Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant

IntroductionThe management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery.Presentation of caseA 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage.DiscussionPrompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique.ConclusionAggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.     

Pyogenic liver abscess of a male patient with diabetes mellitus due to <Emphasis Type="Italic">Escherichia coli</Emphasis> with fever and chills as the only symptoms

Pyogenic liver abscesses (PLAs) are the most frequent visceral abscesses with predominance in men. They are extremely rare and their mechanism of formation is extended to infection of an anatomically contiguous organ or hematogenous seeding. Diabetes mellitus is a major predisposing factor and if so, the mortality rate is high. The most common clinical presentation forms are fever with chills, abdominal pain and hepatomegaly. In the present report we present the case of a 65-year-old Greek male patient with history significant for diabetes mellitus, who attended the emergency department complaining of fever and chills for five days. The final diagnosis was pyogenic liver abscess of the right lobe. Blood cultures were positive for Escherichia coli. The patient was treated with broad spectrum antibiotics and percutaneous drainage of the abscess. To our knowledge, this is the first pyogenic liver abscess in a diabetic patient due to E. coli reported in Western Greece.     

Unusual pneumoperitoneum secondary to ruptured liver abscess-A case report

IntroductionPyogenic liver abscess is important cause of hospitalization and life threatening disease in low-middle income countries. Clinical spectrum of ruptured GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis.Case presentationWe reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 27-year-old man with a history of uncontrolled type II diabetes mellitus. He had an abdominal pain, distension of abdomen associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a ruptured liver abscess in the right lobe of the liver.. The patient was in septic shock and hence shifted to ICU with inotropic support. Antibiotic therapy was started according to pus culture sensitivity. Even with the above treatment patient was not improved and on 4th postoperative day the patient collapsed and declared dead.DiscussionPneumoperitoneum secondary to ruptured gas containing pyogenic liver abscess is rare and could represent as life threatening infection. It should be distinguished from perforation of hollow organ by clinical symptoms and image examinations, particularly like CT. Accurate diagnosis with adequate drainage and antibiotic therapy would bring good outcome.ConclusionWe are aware that not every case of pneumoperitoneum is attributable to a perforated hollow viscus. A rapid and prompt surgical intervention with appropriate antibiotics are essential to save a life.     

Right hemiparesis caused by massive otogenic brain abscess in children: Unusual case report and review of the literature

IntroductionHemiparesis caused by otogenic brain abscess in children is an unusual complication of Chronic Suppurative Otitis Media. Complications can occur when the disease is not treated properly so that the infection in the middle ear spreads intracranially.Case presentationWe report a case of Chronic Suppurative Otitis Media with cholesteatoma in a 14-year-old boy with complications of right hemiparesis caused by an otogenic brain abscess. His management included open craniotomy, drainage of the abscess, radical mastoidectomy and intravenous antibiotics according to the result of the culture and sensitivity.Clinical discussionCommonly, the location of the abscess is closely related to the source of infection. Affected brain lobes usually depend on predisposing factors that cause the development of brain abscesses. In this case, clinical manifestations appear in the form of contralateral hemiparesis even though the source of infection comes from the ear. This can occur due to massive abscesses and the presence of extensive perifocal edema which results in pressure in the subcortex area. The patient underwent radical mastoidectomy in conjunction with an abscess excision craniotomy.ConclusionHemiparesis caused by an otogenic brain abscess is unusual. Rapid and precise diagnosis and treatment can minimize patient mortality and morbidity.     

Liver abscess in Western Australia (1974-1983)

Over the 10 year period 1974-1983, 91 cases of liver abscess presented to the major teaching hospitals in Perth, Western Australia. Amoebic liver abscess (ALA) accounted for 37 (or 41%) of these cases, an incidence inflated by Perth's proximity to south-east Asia where amoebiasis is endemic. This frequent recent history of contact, the availability of sensitive and specific diagnostic serology and a clinical presentation usually suggesting pathology in the right upper quadrant, accounted for the consistently short delay in diagnosis of ALA. There were no deaths from ALA and a low incidence of complications such as secondary infection or rupture into the thorax. On the other hand, pyogenic liver abscess (PLA) commonly presented in a more non-specific manner and in an older age group, contributing to a long delay in diagnosis. Despite improvements in liver imaging techniques and advances in antibiotic and general supportive therapy, mortality for PLA remains high, 20% in this series. Fatal PLA was associated with multiple abscesses not amenable to drainage, increasing age, delay in diagnosis and the presence of septicaemia.     

Acute septic arthritis caused by Klebsiella pneumoniae

Septic arthritis caused by Gram-negative bacteria is uncommon. However, Klebsiella pneumoniae is one of the most common pathogens in Taiwan in several clinical entities, including severe community-acquired pneumonia, community-acquired lung abscess, empyema, necrotizing fasciitis, and liver abscess. However, the research focusing on septic arthritis caused by K. pneumoniae is only limited. Herein, we described three cases of K. pneumoniae-associated septic arthritis. Two of them had underlying diabetes mellitus, and one of them was caused by extended beta-lactamase–producing K. pneumoniae. All outcomes were favorable under appropriate management, which included antibiotic treatment or drainage.     

B超引导下穿刺置管引流术治疗肝脓肿 92例临床分析

目的探讨肝脓肿在超声引导下穿刺置管引流术对肝脓肿治疗的疗效.方法回顾性分析1998年3月～2004年3月,92例肝脓肿病人的临床资料.结果本组92例病人共进行102次穿刺置管引流术,总治愈率为96.63%,平均疗程19天(8～30天).术后无腹腔内出血、气胸、脓胸及严重腹腔感染等并发症.治疗效果满意.结论B超引导下肝脓肿穿刺置管引流术具有简便、安全、住院时间短、费用少,并发症低的优点,可用于治疗大多数肝脓肿.     

经皮穿刺插管治疗肺脓肿和局限性脓胸：附16例报告

应用经皮穿刺脓腔、置入细尼龙管引流和给药的方法治疗肺脓肿及局限性脓胸１６例，插管时间７～１５天，疗效满意，无并发症。该方法操作简便、安全，引流充分，创伤小，不限制病人活动。对内科治疗无效的肺脓肿，早期应用可能避免肺叶切除；对局限性脓胸是一种适应证广、可获得满意疗效的针对性治疗方法。