Brain abscess as a complication of cranial traction

A case of cerebral abscess developing as a late complication of cervical traction by means of Crutchfield tongs is reported and compared with 18 published cases of cerebral abscess after cranial traction with tongs or halo fixation. Penetration of the inner table by the pins of the tongs or halo unit seems to be the main cause of this complication. The literature is reviewed.     

Syringomyelia presenting as a delayed complication of treatment for nocardia brain abscess

OBJECTIVE: Syringomyelia is defined as a dilatation of the central canal of the spinal cord which often leads to neurologic impairment. Syringomyelia has not previously been reported as a late complication for the treatment of brain abscess. In this report, we review a case involving this unusual association. CLINICAL PRESENTATION: A 25 year-old woman sustained a nocardia brain abscess initially presenting as a pulmonary infection. Treatment led to the development of multiloculated hydrocephalus and syringomyelia. INTERVENTION: Treatment included placement of multiple ventriculoperitoneal shunts and a syringo-pleural shunt. This resulted in stabilization of neurologic symptoms. CONCLUSION: The possibility of developing syringomyelia should be considered in any case involving post-infectious hydrocephalus.     

Splenic abscess as complication of perinephric abscess

Retroperitoneal extension of perinephric abscess with fistulization to intra-abdominal and intrathoracic structures has been well documented in the literature. Intraperitoneal rupture is much less common, and exceptionally may not present as an acute abdominal condition. We describe herein 1 such case involving the spleen. Since the extent of the disease may not be apparent radiologically, and often is only ascertained at the time of surgery, we recommend an aggressive approach to renal calculi as the most effective means of preventing complicated perinephritis.     

Staphylococcal meningitis and abscess associated with intracranial Foreign body,as a late complication of cranial trauma

Summary Report of the case of a patient who presented a meningitis associated with a brain abscess as the result of a head injury which occurred several months beforehand and which, although it seemed trivial at the time, resulted in the penetration into the brain of an unsuspected foreign body. The possibilities of prevention and treatment of such complications are discussed and the necessity for a careful exploration of any penetreting wound of the face even after a trivial head injury is stressed.     

Cranial nerve palsy as a complication of operative traction

STUDY DESIGN: Case report. OBJECTIVE: This report documents one case of diplopia from abducens (sixth cranial) nerve palsy after spinal surgery using a Jackson table and cranial traction. SUMMARY OF BACKGROUND DATA: Cranial nerve deficits have frequently been described in the orthopedic literature after trauma, halo pelvic traction, and halo skeletal fixation. The theorized mechanism of injury to the abducens nerve involves stretch or traction force, which causes localized ischemia or a change in nerve position. An extensive literature search failed to show this type of injury using Gardner-Wells tongs in conjunction with the Jackson table. METHODS: This is a case report that included a chart review, examination of the patient, and a literature search. RESULTS: The patient had complete spontaneous resolution of abducens nerve dysfunction within 6 months. CONCLUSIONS: It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.     

Splenic abscess as a complication of percutaneous nephrostomy

We report a case of splenic abscess as a complication of percutaneous nephrostomy tube placement. The patient was a sixty-three-year-old man suffering from a recurrence of transitional cell carcinoma of the bladder after cystectomy and neobladder substitution. Computed tomography of the abdomen identified the abscess, which was drained percutaneously. The patient's condition improved dramatically, and computed tomography showed complete resolution of the abscess two weeks after drainage. Splenic abscess is fatal if untreated and should be considered in a patient in whom sepsis or left lower pulmonary effusion develops after percutaneous manipulation of the kidney.     

Esophageal-aortic fistula as a complication of a traction diverticulum]

After massive hematemesis esophageal varices were found by radiography and endoscopy in a 79-year-old woman. Two episodes of bleeding could be stopped with the Sengstaken-Blakemore-tube. The patient, however, died after heavy vomitting of arterial blood, although the tube was in the proper position. Atopsy shows a fistula between a tractiondiverticulum of the esophagus and the aorta. A flaringup of an old tuberculosis, demonstrated by histology, caused the colliquating of the wall of the diverticulum and also the arrosion of the aorta.     

Breast abscess as a complication of human brucellosis

Breast abscess caused by human brucellosis is extremely rare. A 46-year-old woman received the diagnosis of brucellosis with positive serologic tests. Two weeks after the onset of symptoms, the case was complicated by vertebral (L5-S1) abscess which was treated by surgical drainage. One month after the diagnosis of brucellosis, the patient noticed a mass in her left breast. Breast palpation revealed a painless, mobile, round mass that was hypoechoic on ultrasound imaging. Purulent material was obtained by needle aspiration. Besides treatment of the breast abscess by needle aspiration, brucellosis was successfully controlled by prolonged antimicrobial treatment.     

Spinal subdural haematoma as a complication of cranial surgery

Summary ?Background. Spinal subdural haematoma is a rare condition usually associated with several precipitating factors including coagulopathy, lumbar puncture, trauma, vascular malformation and previous spinal surgery. In this paper we report spinal subdural haematoma related to cranial surgery which is a previously unknown precipitating factor. Method. The medical records of six patients in whom spinal subdural haematoma developed after cranial surgery was reviewed retrospectively for clinical presentation, radiological findings, treatment, and outcome. Findings. Six patients presented with low back pain and radiculopathy in the lower extremity after surgery for intracranial lesions. Symptom onset was between 2 and 9 days after cranial surgery. Initial cranial procedures were craniotomy and tumour removal in 1 patient, clipping of aneurysm in 1, temporal lobectomy for epilepsy in 4. None of the patients had previously known precipitating factors for spinal subdural haematoma. In all of them, the diagnosis was confirmed by magnetic resonance (MR) imaging and the spinal segment involved was the lower lumbar and sacral level except for one patient with a wide distribution of haematoma over the thoracolumbar region. All patients recovered completely without surgical intervention. Interpretation. Spinal subdural haematoma is a rare but possible complication of cranial surgery. It should be considered in patients with back pain and radiculopathy in the lower extremity developing after surgery for intracranial lesions. Unlike spontaneous spinal subdural haematoma with other precipitating factors, spinal subdural haematoma developing after cranial surgery takes a benign clinical course and resolves spontaneously over several days to 2 weeks without surgical intervention. Published online May 19, 2003     

Perineal abscess formation as a complication of intermittent self-catheterization

STUDY DESIGN: Case report. OBJECTIVES: To present a rare but severe complication of intermittent catheterization. SETTING: Paraplegic centre in Switzerland. METHOD AND RESULTS: A 52-year-old man presenting with fever and septicaemia was diagnosed with a perineal abscess due to a bulbar urethral lesion caused by acute false passage during intermittent catheterization. CONCLUSION: Especially in patients with a history of urethral strictures performing intermittent catheterization, the possibility of perineal abscess formation should be taken into account when treating such a patient with fever of unknown origin.     

Hepatic abscess as a complication of the sump syndrome

We report a case of hepatic abscess associated with the sump syndrome. The patient was a 66-year-old woman who had undergone cholecystectomy and side-to-side choledochoduodenostomy for a common bile duct (CBD) stone in 1983, and who presented with fever and right lower chest pain. A hepatic abscess was diagnosed; after it was drained, percutaneous transhepatic biliary drainage was performed. Bacteriological studies revealed the presence of Bacteroides fragilis and Streptococcus intermedius in the pus in the hepatic abscess cavity, and Klebsiella pneumoniae and Pseudomonas aeruginosa in the bile. The hepatic abscess and cholangitis rapidly resolved in response to two drainage procedures. At surgery, simple closure of the anastomosis was performed, because free drainage was observed from the distal CBD into the duodenum, despite the existence of a periampullary diverticulum. Received for publication on July 9, 1999; accepted on Oct. 18, 1999     

Late Aspergillus fumigatus endomyocarditis with brain abscess as a lethal complication after heart transplantation.

We report the case of a 65-year-old male patient who died from lethal Aspergillus fumigatus endomyocarditis and multiple cerebral septic emboli 6 months after cardiac transplantation. This complication developed 4 weeks after diagnosis of bilateral pulmonary aspergillosis, which was immediately treated by surgical removal and intravenous amphotericin B. Preceding colonization with Aspergillus spp was not identified. Primary cytomegalovirus infection (donor+/recipient-) and toxoplasmosis reactivation (donor+/recipient+) occurring at 1 and 2 months post-transplantation were successfully treated.