Neonatal proteus mirabilis adrenal gland abscess]

The authors describe a case of unilateral adrenal abscess in a neonate, which was diagnosed at 13 days of age by abdominal ultrasonography. The newborn presented with persistent high white blood cells after Proteus mirabilis omphalitis. Magnetic resonance imaging and needle aspiration confirmed the diagnosis. This is the second case of Proteus mirabilis neonatal adrenal abscess reported in the literature. Percutaneous drainage allowed complete recovery.     

Needle aspiration of neck abscesses in children.

Needle aspiration of neck abscesses with CT-scan guidance was studied in 17 children with 18 abscesses from 1986 to 1991. Clinical and radiologic findings were analyzed according to treatment outcome. A majority of abscesses (55.6%) resolved after treatment with one to two attempts at needle aspiration and parenteral antibiotics. Unilocular abscesses were more likely than multilocular abscesses to resolve with needle aspiration. In general, abscesses in younger children who presented with smaller neck masses on physical examination and smaller abscess cavities on CT scan resolved with needle aspiration. The data support the use of needle aspiration as an effective initial treatment for pediatric neck abscesses. CT scan was found beneficial in documenting the abscesses and in guiding treatment. A treatment protocol is suggested for the use of needle aspiration in the management of neck abscesses in children.     

Isolated H-type recto-vaginal fistula associated with a vulval abscess

Recto-vaginal fistula is well known to occur in association with imperforate anus. We describe the case of an isolated “H-type” recto-vaginal fistula with no other anorectal abnormalities. The patient presented at 2 months of age with a vulval abscess and passing faeces per vaginum. Unilateral renal agenesis was also seen in this patient. We are unaware of any previous reports in the English-language literature of this isolated abnormality. Received: 11 January 1996 Accepted: 10 February 1996     

The value of a CT-guided fine needle aspirate in infants with lung abscess

OBJECTIVE: To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess. METHODS: The two index cases were managed in 2002. An institution-based review was conducted of all infants up to one year of age diagnosed with a lung abscess between 1989 and 2002. Data sources were hospital's disease index and Neonatal Intensive Care Unit Audit database using ICD9 and ICD10 diagnostic codes for 'lung abscess'. RESULTS: Five infants, under the age of one year, were treated for a lung abscess. In the one case where the abscess was left-sided it was associated with a congenital cystic adenomatoid malformation of the lung. Pathogens were isolated following direct culture of the abscess in four cases. In three cases a single pathogen was isolated: pseudomonas aeruginosa, staphylococcus aureus and haemophilus influenzae. In one case a mixture of escherichia coli, streptococcus milleri and an anaerobe, propionibacteria, were cultured. Antibiotic therapy was directed at the identified pathogen(s) in all four cases. There was no mortality or recurrence. CONCLUSION: Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT-guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.     

Perianal abscess and fistula‐in‐ano in children: Aetiology,management and outcome

Aim: We aimed to assess our experience in treatment and outcome of perianal abscess and/or fistula‐in‐ano in children. Method: The patients who were treated for perianal abscess and/or fistula‐in‐ano from January 2000 to December 2005 were included. Age, sex, duration of symptoms, number and site of the perianal abscess and/or fistula‐in‐ano, treatment modality and recurrences were recorded. Results: The study consisted of 39 patients (36 boys) with a mean age of 29 ± 49.1 months. At first examination the diagnosis was perianal abscess in 20 patients, perianal abscess with fistula in five patients and fistula‐in‐ano in 14 patients. No patients had an underlying illness. The primary local treatment of perianal abscess with or without fistula was incision and drainage (with or without antibiotic therapy) in 21 patients, and local care with antibiotic therapy was given to four patients. Of 20 patients with perianal abscess, 17 developed fistula‐in‐ano and three healed. One patient in the perianal abscess group who developed fistula‐in‐ano and two patients in the fistula group were lost to follow‐up. Thirty‐three patients with fistula‐in‐ano underwent surgical treatment either through a fistulotomy or through a fistulectomy. Five (15.1%) patients who experienced recurrent fistula‐in‐ano underwent fistulotomy were completely cured after the second operation. Conclusion: Treatment of a perianal abscess either through incision and drainage with antibiotics or through antibiotics alone resulted in a high rate (85%) of fistula formation. Fistula‐in‐ano can be treated either by fistulotomy or by fistulectomy, both of which are associated with a reasonable chance of recurrence of fistula‐in‐ano formation. We obtained good results in our patients through surgical approach (fistulotomy or fistulectomy), for fistula‐in‐ano formed following treatment of perianal abscess.     

Bilateral neonatal adrenal abscesses

Neonatal adrenal abscess is an exceedingly rare condition. A case of bilateral adrenal abscesses due to Escherichia coli is described. Needle aspiration under ultrasonographic (US) guidance helped to confirm the diagnosis and the abscesses resolved with conservative measures. This case illustrates the need for a careful evaluation of the perinatal history and laboratory, radiographic, and US findings in arriving at a diagnosis. Correspondence to: L. Chin-Theam     

Pyomyositis: diagnostic value of color Doppler sonography

The color Doppler sonographic appearance of pyomyositis and the usefulness of this technique in guiding needle aspiration of an intramuscular abscess in a 15-year-old diabetic girl are described.

     

Ilio-psoas abscess in the paediatric population: treatment by US-guided percutaneous drainage

Background. Image-guided percutaneous drainage has been shown to be a safe and effective alternative to surgery in the management of psoas abscess in adults and adolescents. There is little information on its use in children. Objective. To evaluate the safety and efficacy of US-guided percutaneous needle aspiration and catheter drainage of ilio-psoas abscesses. Materials and methods. A retrospective review of 14 children with 16 ilio-psoas abscesses (10 pyogenic and 4 tuberculous) who were treated by US-guided percutaneous needle aspiration (n = 5) or catheter drainage (n = 9) along with appropriate antimicrobial therapy. Results. Percutaneous treatment was successful in 10 of the 14 patients; all showed clinical improvement within 24–48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavities. Surgery was avoided in all of these ten patients except one, who underwent open surgical drainage of ipsilateral hip joint pus. Of the other four patients, two had to undergo surgical drainage of the ilio-psoas abscesses after failure of percutaneous treatment, one improved with antibiotics after needle aspiration failed to yield any pus, and one died of continuing staphylococcal septicaemia within 24 h of the procedure. There were no procedural complications. Conclusions. Percutaneous drainage represents an effective alternative to surgical drainage as a supplement to medical therapy in the management of children with ilio-psoas abscesses. Received: 12 June 1997 Accepted: 9 January 1998     

Percutaneous aspiration and catheter drainage of abscesses

Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.     

Diagnostic et traitement des abcès primitifs du psoas chez l'enfant

PurposeTo evaluate the value of ultrasound and computed tomography in the diagnosis and treatment of primitive psoas abscess in children.Patients and methodsWe retrospectively studied 20 cases of primitive psoas abscess seen between 1987 and 2005. All children were investigated by abdominal ultrasound and computed tomography. Percutaneous drainage of the abscess was performed in 15 cases.ResultsThe mean age of the children was 7.8 years (range: 11 months-12 years). Fever and pain were the presenting symptoms. Ultrasonography established the diagnosis in all patients. CT confirmed the diagnosis and allowed a percutaneous needle aspiration in all cases. Staphylococcus auerus was isolated in 19 patients and streptococcus in 1 patient. The catheter drainage was successful in 14 cases. A surgical drainage was necessary for four children. The two other patients were treated with only antibiotic.ConclusionUS and CT are useful for accurate diagnosis of primitive psoas abscess in children. CT-guided percutaneous drainage is a safe and effective alternative to surgery in the management of primitive psoas abscess.     

Adrenal abscess

A neonate presented with jaundice and abdominal mass. Intravenous pyelography (IVP) and ultrasonography revealed a suprarenal cystic mass. At operation an adrenal abscess was found and completely excised. Although current diagnostic techniques such as IVP, ultrasonography, and CAT scans have considerably facilitated the diagnosis of adrenal masses, the differentiation of adrenal abscess from adrenal hemorrhage and neonatal neuroblastoma may be difficult. Excision of the adrenal abscess, avoiding damage to adjacent vital structures, is the treatment of choice. Offprint requests to: O. Zamir     

Congenital rectovestibular fistula. An unusual diagnosis that should not be ignored]

Rectovestibular fistula without anorectal malformation is a rare anomaly. OBSERVATION: A six-week-old baby was hospitalized for a greater labium abscess. Stools leakage was secondary noted in the vagina and in abscess area. Clinical examination under anesthesia concluded to a congenital rectovestibular fistula with secondary drainage in the greater labium. Surgical treatment without colostomy led to recovery. COMMENTS: Congenital recto-vestibular fistula is a difficult diagnosis. It should be evoked when vaginal fecal leakage occurs in the absence of anorectal malformation or perineal injury. Fistula location is often confirmed by clinical examination under anesthesia. Treatment is surgical and allowed recovery without any functional damage.     

Needle aspiration for suppurative cervical lymphadenitis

In a 10-year prospective study, we used needle aspiration as the treatment of suppurative cervical lymphadenitis that required drainage procedure in 35 consecutive children aged 4 months to 13 years (mean 2.2 years). Twenty-seven patients underwent 1 puncture, 7 patients had 2 punctures, and 1 had 3 punctures. There were no major complications. Patients were followed up for 2-6 months. None required an open drainage of the cervical abscess. There was complete regression of the nodes in all patients within 21 days, with no relapse or scar formation. Needle aspiration seems to be an effective and safe treatment of suppurative cervical lymphadenitis that may avoid open drainage.     

Ilio-psoas abscess caused by methicillin-resistant Staphylococcus aureus (MRSA): a rare but potentially dangerous condition in neonates

We report a case of methicillin-resistant Staphylococcus aureus ilio-psoas abscess (IPA) in a neonate. This case has clinical importance because this neonate had toxic shock syndrome-like exanthematous disease, known as NTED, before developing IPA. A high index of suspicion is required for IPA if a neonate presents with limb disuse and fever of unknown origin. Our case required surgical drainage, since ultrasound-guided percutaneous needle aspiration failed.     

静脉留置针穿刺抽吸术后行持续负压引流治疗儿童帽状腱膜下血肿

目的 探讨静脉留置针穿刺抽吸术后行持续负压引流方法治疗儿童帽状腱膜下血肿的临床效果.方法 将45例儿童帽状腱膜下血肿的患儿分为两组.A组(治疗组):采用静脉留置针穿刺抽吸术后行持续负压引流治疗24例.B组(对照组):采用注射器穿刺抽吸联合加压包扎治疗21例.比较两组的穿刺次数、治愈时间、并发症例数的差异.结论 穿刺次...     

Acute retropharyngeal abscess in children

Due to the wide availability of effective antibiotics, acute retropharyngeal abscesses have become increasingly rare. This is a retrospective report of ten children with this condition, managed over a 10-year period. Nearly all were aged 12 months or less and presented only when respiratory obstruction had developed. Owing to administration of antibiotics at home, cultures of pus specimens were sterile in most cases. The retropharyngeal space was widened on lateral, plan cervical radiography in five children. Four had drainage by external cervical incision, and in four drainage was by mouth, all under general anaesthesia. Tracheostomy was necessary in one child who developed respiratory obstruction and the abscess was drained by needle aspiration. One child died before drainage of the abscess. Parenteral antibiotics were administered also for 5 days. There was no recurrence in any case. Laryngeal spasm occurred post-operatively in two children, leading to death in one. Overall, two children died. The features and management of the disease are reviewed briefly to re-awaken awareness of the condition, especially in developing countries where it is most likely to be seen at the present time.     

Klebsiella brain abscess in a neonate

Klebsiella pneumoniae is rarely associated with neonatal cerebral abscess. A case of Klebsiella brain abscess in a neonate is described. Diagnosis of abscess was confirmed by magnetic resonance imaging and ultrasound-guided aspiration.     

PERIANAL ABSCESS AND FISTULA IN ANO IN INFANCY AND CHILDHOOD: A Clinicopathological Study

This is a retrospective study of 78 children with perianal abscess and/or fistula in ano presenting during a 6 1/2-year period. Sixty-five were males and 13 females. Their ages at presentation ranged from 22 days to 18 years (median 1.7 year), and the majority of males were below 2 years of age. The 13 females all presented with perianal abscess, the majority of which grew Staphylococcus aureus (69.2%). On follow-up, none of them developed fistula in ano. Twenty-two of the 65 males (33.8%) presented initially with fistula in ano. The remaining 43 presented with perianal abscess. Four of them were found to have fistula in ano at the time of incision and drainage and on follow-up, and 14 others developed fistula in ano. Of the 40 cases of fistula in ano, all were males; 25 were on the right side and 9 on the left side, 5 had bilateral fistula in ano, and 1 had two fistulas on the left side at 3 and 5 o'clock positions. Gut-derived organisms were isolated from 88.4% of the males with perianal abscess. There appears to be a causal relationship between perianal abscess and fistula in ano.     

Lung abscess versus necrotizing pneumonia: implications for interventional therapy

Objective. To assess and contrast the role of interventional therapy for two types of cavitating pneumonias: lung abscess and necrotizing pneumonia. Materials and methods. We retrospectively reviewed the imaging, interventional therapy, and outcome of 14 children seen between February 1987 and January 1996 with lung abscess and 9 with necrotizing pneumonia. All children were treated with antibiotics prior to intervention. Pulmonary parenchymal fluid was percutaneously aspirated from ten lung abscesses and three necrotizing pneumonias. Percutaneous catheters drained five lung abscesses. Pleural drainage was performed for three lung abscesses and eight necrotizing pneumonias. Results. All 14 children with lung abscesses had positive Gram stains of the pulmonary fluid; 13 cultures were positive. All 14 defervesced within 48 h of intervention. None developed a bronchopleural fistula. All nine necrotizing pneumonias were presumed to be sequelae of prior pneumonia. Streptococcus pneumoniae was the only organism as documented by pleural fluid latex fixation in three patients, gram stain in two, and culture in only one. Seven of these children developed pneumatoceles, five developed bronchopleural fistulae, and three required long-term chest tubes for persistent pneumothoraces. Conclusion. Aggressive interventional therapy can be diagnostic and therapeutic in the infected lung abscess. Interventional therapy can be harmful in postinfectious necrotizing pneumonia. Received: 19 February 1997 Accepted: 24 August 1998     

A case of an iliopsoas abscess in a neonate

The present study describes a male neonate with an iliopsoas abscess. He was born by Caesarean section at 35 weeks and 3 days gestation. At 24-days-old he had a fever and localized swelling of the groin to the femur. By ultrasonography (US) and computed tomography (CT), the swelling was diagnosed as iliopsoas abscess. We treated him through percutaneous needle drainage and antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the culture of the fluid from the abscess and the urine. US and CT were useful for the diagnosis and provided guidance for the needle puncture and follow-up of the iliopsoas abscess.