Liver abscesses of the right hepatic lobe after cholecystectomy

The authors discuss the results of the diagnosis and treatment of abscesses of the right hepatic lobe which were consequent upon ischemic necrosis; they were encountered after cholecystectomy in 0.15% of cases. Ultrasonography and angiography are the main diagnostic methods suggested. The optimal results of treatment were produces in combination of percutaneous drainage and puncture of the destruction cavities under control of ultrasonography and endovascular regional infusion therapy.     

Epidural abscesses

Editor—We read with interest the review by Grewal andcolleagues¹ and have followed the epidural abscess story closelyover the last few years. We wish to add our experience to thegrowing collection of case series. We experienced a cluster of three cases of epidural analgesiarelated epidural abscesses at Western Hospital over a periodof 9 months in 2001–2. An investigation was performedlooking for risk factors and potential for improved patientcare. A search back to 1992 revealed one other epidural catheter-relatedabscess, which occurred in 1996. Epidural catheters were inserted by     

Pancreatic abscesses

This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the infra-mesocolic approach for drainage is emphasized.     

Epidural abscesses

Until recently epidural abscess was considered a rare, almosttheoretical, complication of central nerve block, but anecdotalreports suggest that this is no longer the case. Thus a reviewof the risk factors, pathogenesis, clinical features and outcomeof this condition is appropriate, the primary aim being to makerecommendations on best anaesthetic practice to minimize therisk of this serious complication. A search of EMBASE©,PUBMED© and MEDLINE© databases from 1966 to September2004 was performed using several strategies, supplemented byreference list screening. Spontaneous epidural abscess is rare,accounting for 0.2–1.2 cases per 10 000 hospital admissionsper year. Estimates of the incidence after central nerve blockvary from 1:1000 to 1:100 000. Risk factors (compromised immunity,spinal column disruption, source of infection) are present inthe majority of patients, whether the condition is spontaneousor associated with central nerve block. Presentation is vague,fever and back pain usually preceding neurological deficit.Diagnosis requires a high index of suspicion and modern imagingtechniques. Treatment involves early surgical drainage to preventpermanent deficit and high dose parenteral antibiotics chosenwith bacteriological advice. Primary prevention depends on properuse of full aseptic precautions. Epidural abscess can be a catastrophicconsequence of central nerve block. Early diagnosis will minimizepermanent damage, but primary prevention should be the aim.There is a need for a large survey to indicate the true incidenceto better inform the risk–benefit ratio for central nerveblock.     

Intra-abdominal abscesses

A study of 501 patients with 540 intra-abdominal abscesses seen on the surgical services of the University of Cincinnati Medical Center during the past twelve years was undertaken to define the incidence by type and anatomic location, the sources, the effectiveness of diagnosis and treatment, the extended periods of required hospitalization, and the causes of mortality.The results have emphasized the continuing incidence, clinical importance, complexity of bacterial etiology, and the obscure nature of the various types of intra-abdominal abscesses. The high mortality of patients with unrecognized and undrained pancreatic and retroperitoneal abscesses has been striking when compared to the marked reduction in mortality possible by earlier diagnosis and adequate surgical drainage. Although significant advances have been made in the diagnosis and localization of hepatic abscesses, improved methods of earlier recognition and localization will be necessary to achieve earlier diagnosis, more effective surgical treatment, and lower mortality in patients with other types of intra-abdominal abscesses, particularly those in the retroperitoneal and recessed intraperitoneal areas.     

Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases

Several hepatobiliary complications secondary to gastrointestinal perforation after ingestion of a fish bone have been described in the literature, the most common being liver abscess, which can be potentially fatal. Treatment involves removal of the foreign body if possible (endoscopically or surgically), drainage of the abscess (radiologically or surgically), and appropriate antibiotic therapy. To our knowledge, no cases of hepatic hilar abscesses secondary to gastrointestinal perforation by a fish bone have been described in the literature. We report surgical management of two cases of abscess localized in the hepatic hilum secondary to the ingestion of fish bones.     

Epidural spinal abscesses

Fifteen cases of peridural empyemas are reported. 12 patients reported with motor dysfunction of the lower extremities and pain radiating from the spine. In one case, localized pain of the spine was discovered and in two cases there were no signs of spinal or radiating pain. Treatment in all cases was laminectomy and systemic antibiotic administration. Microbiological analysis showed staphylococcus aureus in 11 cases. 9 patients recovered with no neurological defects, two had major improvement of the paresis, and one died. Three patients with paraplegia recovered from the primary infection.     

Pan-nephric candidial abscesses

This report illustrates the destructive nature of renal candidiasis in a neonate with a cloacal anomaly.     

Multiple brain abscesses

A young woman with 12 separate brain abscesses was treated medically after aspiration of one abscess for diagnostic bacteriological examination. She made an excellent recovery with only minimal residual neurological dysfunction. Surgical aspiration for detailed bacteriological studies followed by appropriate antimicrobial therapy is an effective way of treating multiple brain abscesses in the neurologically stable patient.