MyMedR

The Asian consensus statements on endoscopic management of walled-off necrosis Part1: Epidemiology, diagnosis and treatment

Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.

J Gastroenterol Hepatol, 2016 Apr 4.

PMID: 27044023 DOI: 10.1111/jgh.13394

Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 25 experts from 8 Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 1 of this statement focused on the epidemiology, diagnosis and timing of intervention.

Matched MeSH terms: Abscess

Intracranial suppuration caused by Micrococcus luteus

Selladurai BM, Sivakumaran S, Aiyar S, Mohamad AR

Br J Neurosurg, 1993;7(2):205-7.

PMID: 8098607

Micrococcus spp. are commensal organisms colonizing the body surfaces of humans. In a few instances these organisms have been reported to colonize ventricular shunts. We report a patient, with no overt evidence of immunosuppression, in whom Micrococcus luteus was responsible for intracranial suppuration at multiple sites.

Matched MeSH terms: Brain Abscess/diagnosis; Brain Abscess/microbiology*; Brain Abscess/surgery

The bacteriology of brain abscess: a local experience in Malaysia

Puthucheary SD, Parasakthi N

Trans R Soc Trop Med Hyg, 1990 7 1;84(4):589-92.

PMID: 2091359

31 cases of intracranial abscess seen over a period of 10 years showed a peak incidence in the second and third decades of life with a male preponderance. Tetralogy of Fallot and other congenital cyanotic heart diseases were the predominant associated factors (32%). The commonest site of infection was the frontal lobe. Gram-stained smears of pus proved to be extremely useful. The majority of the organisms (82%) were either microaerophilic or anaerobic bacteria with Streptococcus milleri being the most frequent isolate. With the exception of Corynebacterium species, all isolates were susceptible to penicillin or chloramphenicol, most being susceptible to both.

Matched MeSH terms: Brain Abscess/ethnology; Brain Abscess/etiology; Brain Abscess/microbiology*

Successful surgical management of a case of pulmonary and pericardial melioidosis

Majid AA

Aust N Z J Surg, 1990 Feb;60(2):139-41.

PMID: 2327916

A 35 year old diabetic presented with features of septicaemia and developed cardiac tamponade. He was found to have pulmonary, acute septicaemic and pericardial melioidosis. Some initial improvement was achieved with medical therapy but only with surgical intervention was a successful outcome achieved.

Matched MeSH terms: Abscess/etiology; Abscess/radiography; Abscess/surgery*

Fulltext Sarcopenia is a useful risk stratification tool to prognosticate splenic abscess patients in the emergency department

Hung SK, Kou HW, Hsu KH, Wu CT, Lee CW, Leonard Goh ZN, et al.

J Formos Med Assoc, 2021 Mar;120(3):997-1004.

PMID: 32917483 DOI: 10.1016/j.jfma.2020.08.039

BACKGROUND/PURPOSE: Splenic abscess is a life-threatening surgical emergency which requires early diagnosis and intervention to maximize patient outcomes. This can be achieved through accurate risk stratification in the emergency department (ED). Sarcopenia refers to an age-related loss of skeletal muscle mass and strength that is accompanied by major physiologic and clinical ramifications, and often signifies decreased physiologic reserves. It is associated with poor clinical outcomes in sepsis, acute respiratory failure, oncological surgery, and liver transplantation. This study evaluates the utility of sarcopenia as a radiological stratification tool to predict in-hospital mortality of splenic abscess patients in the ED. This will assist emergency physicians, internists and surgeons in rapid risk stratification, assessing treatment options, and communicating with family members.

METHODS: 99 adult patients at four training and research hospitals who had undergone an abdominal contrast computed tomography scan in the ED with the final diagnosis of splenic abscess from January 2004 to November 2017 were recruited. Evaluation for sarcopenia was performed via calculating the psoas cross-sectional area at the level of the third lumbar vertebra and normalising for height, before checking it against pre-defined values. Univariate analyses were used to evaluate the differences between survivors and non-survivors. Sensitivity, specificity, and predictive values of the presence of sarcopenia in predicting in-hospital mortality were calculated. Kaplan-Meier methods, log-rank test, and Cox proportional hazards model were also performed to examine survival between groups with sarcopenia versus non-sarcopenia.

RESULTS: Splenic abscess patients with sarcopenia were 7.56 times more at risk of in-hospital mortality than those without sarcopenia (multivariate-adjusted HR: 7.56; 95% CI: 1.55-36.93). Presence of sarcopenia was found to have 84.62% sensitivity and 96.49% negative predictive value in predicting mortality.

CONCLUSION: Sarcopenia is associated with poor prognoses of in-hospital mortality in patients with splenic abscess presenting to the ED. We recommend its use in the ED to rapidly risk stratify and predict outcome to guide treatment strategies.

Matched MeSH terms: Abscess

Liver abscess

Monro JK

Journal of the Malaya Branch of the British Medical Association, 1941;5:108-9.

Matched MeSH terms: Liver Abscess, Amebic

Fulltext Ischial Tuberosity Tuberculosis : An Unusual Location andPresented as Chronic Gluteal Abscess

Krishnan, H., Yoon, T.R., Park, K.S.

Malays Orthop J, 2010;4(1):42-45.

MyJurnal

This case report describes an unusual case of extrapulmonary tuberculosis of the ischial tuberosity presenting with chronic gluteal pain of 4 years duration. The patient presented when the pain became intolerable; at that time, the ischial tuberosity was debrided and curetted while incision and drainage were used to treat the gluteal abscess. Antituberculosis chemotherapy was administered (for a period of one year) following histopathological confirmation of tuberculosis. At four yearspostoperatively, the patient has no pain and is symptom free. Furthermore, radiographs shows that the right ischial tuberosity osteomyelitis has healed. Prompt diagnosis and treatment resulted in a good clinical outcome in this patient.

Matched MeSH terms: Abscess

Fulltext Melioidosis: A Retrospective Review of Orthopaedic manifestations

Ahmad, S., Azura, L., Duski, S., MAziz, M.Y.

Malays Orthop J, 2009;3(1):53-55.

MyJurnal

Melioidosis is an infectious disease which is associated with high rate of mortality. We reviewed 33 patients treated in our hospital over a period of 14 months. About half (55%) of these patient presented with one focus of infection while the rest had multifocal infections. 81% require drainage of abscess or arthrotomy. Four patients (12%) died as a result of septicaemia and the rate is lower than those reported in literature. We conclude that mortality of melioidosis can reduce with early diagnosis followed by appropriate and prolonged antibiotic therapy.

Matched MeSH terms: Abscess

Fulltext Computed tomography of focal splenic lesions in patients presenting with fever

Joazlina ZY, Wastie ML, Ariffin N

Singapore Med J, 2006 Jan;47(1):37-41.

PMID: 16397719

INTRODUCTION: There is an awareness of the increased incidence of splenic abscess in Southeast Asia giving rise to unexplained fever. This study looks at the role of computed tomography (CT) in evaluating focal splenic lesions in patients presenting with fever.
METHODS: 37 patients presenting with fever of unknown origin underwent CT and this study retrospectively analyses the findings in these patients. 13 patients also had associated abdominal pain. Patients with conditions at high risk for splenic infection include: diabetes mellitus in ten patients, leukaemia in seven patients, human immunodeficiency virus infection in five patients, intravenous drug abuse in six patients, and steroid therapy in two patients. No risk factors could be identified in seven patients.
RESULTS: Splenic abscess was diagnosed in 28 patients. A range of infecting organisms was isolated but the most frequent were Staphylococcus aureus (eight), tuberculosis (four), Streptococcus (four), fungal (four) and melioidosis (four). No infecting organism could be identified in ten cases though in patients with leukaemia with multiple low attenuation areas, the cause was presumed to be fungal. Six patients were diagnosed to have splenic infarcts though differentiation from splenic abscess could be difficult; these patients were treated for an abscess and all had endocarditis. Three patients were subsequently diagnosed with lymphoma. Percutaneous abscess drainage was performed in five patients and splenectomy was carried out in six patients.
CONCLUSION: CT proved to be very useful as it not only revealed the size and extent of any splenic abnormality but it assisted with guidance for percutaneous drainage, determined the site for biopsy, and provided follow-up after treatment.

Matched MeSH terms: Abscess/complications; Abscess/pathology; Abscess/radiography*

Fulltext Empyema thoracis and lung abscess

Yaacob I, Ariffin Z

Singapore Med J, 1991 Feb;32(1):63-6.

PMID: 2017709

The case histories of 22 patients with lung abscess and empyema presenting to Hospital University Sains Malaysia (HUSM) between 1984 and 1989 are reviewed. The presenting features of both lung abscess and empyema were similar. The commonest predisposing factor was pneumonia, and the commonest organism isolated was Staphylococcus aureus but in the majority of cases, no causal organisms were identified. All the patients were treated with antibiotics and in addition, closed chest tube drainage was performed initially in all patients with empyema. Three patients with empyema required additional surgical drainage procedures. Death occurred in one patient with empyema and in one patient with lung abscess. The features, aetiology, treatment and outcome of thoracic empyema and lung abscess are discussed.

Matched MeSH terms: Lung Abscess/diagnosis*; Lung Abscess/drug therapy; Lung Abscess/surgery

Fulltext Antioxidant and Cytotoxic Effect of Barringtonia racemosa and Hibiscus sabdariffa Fruit Extracts in MCF-7 Human Breast Cancer Cell Line

Amran N, Rani AN, Mahmud R, Yin KB

Pharmacognosy Res, 2016 Jan-Mar;8(1):66-70.

PMID: 26941539 DOI: 10.4103/0974-8490.171104

The fruits of Barringtonia racemosa and Hibiscus sabdariffa have been used in the treatment of abscess, ulcer, cough, asthma, and diarrhea as traditional remedy.

Matched MeSH terms: Abscess

Human oesophagostomiasis: a histomorphometric study of 13 new cases in northern Ghana

Bogers JJ, Storey PA, Faile G, Hewitt E, Yelifari L, Polderman A, et al.

Virchows Arch, 2001 Jul;439(1):21-6.

PMID: 11499836

Oesophagostomiasis is an infrequently described and recognised parasitic infection in humans, caused by Oesophagostomum bifurcum. Although the disease is most often found in the northern part of Togo and the neighbouring part of Ghana, sporadic cases have been described in other parts of Africa and in Asia and South America: Uganda, Ivory Coast, Sudan, Kenya, Ethiopia, Indonesia, Malaysia and Brazil. Infection probably occurs by way of the ingestion of L3 larvae. These larvae penetrate the intestinal wall, especially that of the colon. Some of these larvae develop into young adult worms and return to the bowel lumen. Other larvae, however, develop into immature worms, which fail to settle in the lumen, forming abscesses in the bowel wall and causing pathology. In the literature 105 human cases have been described, many originating in the northern regions of Ghana and Togo. The present study was performed to evaluate 13 new cases originating in the northern part of Ghana (7 female and 6 male patients, aged between 2 and 60 years). Histopathologically, the patients could be divided into two groups: the first group showed multinodular disease, while patients in the second group presented with a single, nodular mass. In the first group, abscesses were seen throughout the colonic wall. The mean size of the cavities was 4.3+/-0.7 mm. There was no relation between the size and the localisation in the colonic wall. Abscesses were significantly larger in male patients than in female patients. There was no correlation with age. In the second group, histopathological examination showed a cyst of variable wall thickness with very limited inflammation. These cysts represented older lesions, often encapsulated in the mesentery. In conclusion, in this study we present 13 new cases of human oesophagostomiasis. The abscess formation was found to be organ specific, independent of age, and gender-related, producing a more intense tissue reaction in male patients.

Matched MeSH terms: Abscess/parasitology; Abscess/pathology; Abscess/surgery

Intramedullary spinal cord abscess: The result of a missed congenital dermal sinus

Kanaheswari Y, Lai C, Raja Lope RJ, Azizi AB, Zulfiqar MA

J Paediatr Child Health, 2015 Feb;51(2):223-5.

PMID: 25099316 DOI: 10.1111/jpc.12707

Congenital dermal sinus (CDS) and occult spinal dysraphism are suspected when a cutaneous marker overlies the spine of a newborn. CDS can have the appearance of a simple dimple and occur within the gluteal cleft without any skin markers. CDS are the commonest cause of intramedullary spinal cord abscess.

Matched MeSH terms: Abscess/etiology*; Abscess/pathology

Fulltext Parotid abscess: an unusual cause of facial nerve palsy

Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2009 Jun;64(2):172-3.

PMID: 20058583 MyJurnal

Facial nerve palsy with a parotid mass is usually associated with malignant neoplasm of parotid gland. Its occurrence as a complication of parotid abscess is extremely rare. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess were reported. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction. Underlying neoplasia was excluded.

Matched MeSH terms: Abscess/complications*; Abscess/radiography

Fulltext Salmonella: the pelvic masquerader

Valayatham V

Int J Infect Dis, 2009 Mar;13(2):e53-5.

PMID: 18829361 DOI: 10.1016/j.ijid.2008.06.015

Salmonella sp is a significant cause of morbidity and mortality. Although commonly infecting the gastrointestinal system, other presentations are not unheard of. Salmonella is an unlikely and an unusual cause of genital tract infection. We describe a woman with suspected pelvic inflammatory disease eventually confirmed as Salmonella O C2 infection.

Matched MeSH terms: Abscess/microbiology*; Abscess/surgery

Aspiration of breast abscess under ultrasound guidance: outcome obtained and factors affecting success

Elagili F, Abdullah N, Fong L, Pei T

Asian J Surg, 2007 Jan;30(1):40-4.

PMID: 17337370

To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage.

Matched MeSH terms: Abscess/therapy*; Abscess/ultrasonography

Fulltext Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

Chek Siang KC, Ahmad Fauzi A, Hasnan N

J Spinal Cord Med, 2017 01;40(1):113-117.

PMID: 26871508 DOI: 10.1080/10790268.2015.1133016

CONTEXT: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.

FINDINGS: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.

CLINICAL RELEVANCE: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.

Matched MeSH terms: Abscess/complications; Abscess/diagnosis*

Median mental sinus in twins

Ong ST, Ngeow WC

Dent Update, 1999 May;26(4):163-5.

PMID: 10765768

Sinus on the chin can be the result of a chronic apical abscess due to pulp necrosis of a mandibular anterior tooth. The tooth is usually asymptomatic, and a dental cause is therefore not apparent to the patient or the unsuspecting clinician. Not infrequently, the patient may seek treatment from a dermatologist or general surgeon instead of a dentist. Excision and repair of the fistula may be carried out with subsequent breakdown because the dental pathology is not removed. This paper reports the presence of median mental sinus of dental origin in twins. One case healed following root canal therapy while the other required both root canal therapy and surgery to eliminate the infection.

Matched MeSH terms: Periodontal Abscess/complications*; Periodontal Abscess/therapy

Clinical presentation and outcome of brain abscess over the last 6 years in community based neurological service

Abdullah J

J Clin Neurosci, 2001 Jan;8(1):18-22.

PMID: 11322120

Sixty patients with brain abscess were treated at the Neurosurgical Unit of the Department of Surgery, Hospital Universiti Sains Malaysia between January 1990 and December 1996. A retrospective study was done and data were collected from the computerise d registry of the Record Unit of Hospital Universiti Sains Malaysia. Good results were achieved in patients who were both treated surgically and medically. There were only twelve deaths in this group. The main factor that influences morbidity and mortality of brain abscess is the clinical presentation on admission. The mortality was high in patients treated solely by medical means. Death was common in patients who presented with acute onset of symptoms of less than one week duration and those with poor mental status. Brain abscess is common in the East Coast population of peninsular Malaysia, probably due in part to lower socioeconomic status. Efforts should be directed towards prevention of infection and early recognition and management.

Matched MeSH terms: Brain Abscess/physiopathology*; Brain Abscess/therapy*

Sevoflurane induction in acute airway obstruction

Chiu CL, Delilkan AE

Hosp Med, 1998 Oct;59(10):828.

PMID: 9850310

Matched MeSH terms: Abscess/complications; Abscess/surgery

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