Splenic abscess is an uncommon lesion and may be present either as a localized area of infection in the spleen or as a part of generalized sepsis. The diagnosis is difficult because of the rather nonspecific clinical picture. Hence, splenic abscess has a high mortality rate and is after diagnosed only at autopsy. Computerized tomography (CT) offers the clinician a reliable tool for the diagnosis of intra-abdominal abscess. A successful outcome is dependent on an early diagnosis and prompt treatment by splenectomy with antibiotic cover. We experienced a care of splenic abscess which was diagnosed by CT and treated by splenectomy with antibiotics. Postoperative course was relatively uneventful.
Abdominal Abscess ; Abscess* ; Anti-Bacterial Agents ; Autopsy ; Diagnosis ; Early Diagnosis ; Mortality ; Sepsis ; Spleen ; Splenectomy

Various complications following laparoscopic cholecystectomy have been reported. We describe a case of intraabdominal abscess formation which was developed two months after the inadvertently spilling of gallstones laparoscopic cholecystectomy in a patient with acute cholelithiasis. The condition was initially found on computed tomography and the diagnosis was confirmed with ultrasound. Although this is a rare complication of laparoscopic cholecystectomy, the spilling of gallstones should be recognized as a potential source of intra-abdominal abscess formation even in a patient presenting months after laparoscopic cholecystectomy. We suggest that routine use of the specimen retrieval bag is highly recommended especially for beginners of laparoscopic cholecystectomy during their initial learning period.
Abdominal Abscess ; Abscess* ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Diagnosis ; Gallstones* ; Humans ; Learning ; Postoperative Complications ; Ultrasonography

Intraabdominal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and it has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a noninvasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intraabdominal abscesses and the results are as follows; 1. In total 48 cases, the intraabdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intraabdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the other (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8%). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo pattern of the lesions was cystic with or without internal echogenicity (69%).
Abdominal Abscess* ; Abscess ; Appendicitis ; Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Leukocytosis ; Liver Abscess ; Methods ; Postoperative Complications ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A 77-year-old man was referred for the evaluation of general weakness and leukocytosis. Computed tomography showed a 9.5×6.5-cm cavitary lesion with an air-fluid level near the stomach, which was thought to be a perigastric abscess. Upper endoscopy revealed a fistula on the greater curvature at the mid body of the stomach. The margin of the fistula opening was clearly demarcated, and yellow turbid fluid oozing from the fistula was seen. Laparoscopic wedge resection was performed at the perforated area of the stomach. Immunohistochemistry revealed CD117 expression. A diagnosis of intermediate-risk GIST was made. No recurrence was identified within 18 months after the operation. The final diagnosis was perforated gastric GIST communicating with the gastric lumen and presenting as an intra-abdominal abscess.
Abdominal Abscess ; Abscess* ; Aged ; Diagnosis ; Endoscopy ; Fistula ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Laparoscopy ; Leukocytosis ; Recurrence ; Stomach*

OBJECTIVETo investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease(CD).

METHODSData of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography.

RESULTSCT enterography showed mural thickening(>4 mm) in 34(87.2%) patients, mural gas in 7(17.9%), mural edema in 7(17.9%), mural fat in 4(10.3%), increased enhancement of bowel wall(>10 HU) in 37(94.9%), multiple segmental lesions in 33(84.6%), single segmental lesions in 6(15.4%), mesenteric lymphadenopathy(>5 mm) in 13(33.3%), vascular bundle thickening in 9(23.1%), cellulitis in 12(30.8%), peritoneal abscess in 10(25.6%), phlegmon in 8(20.5%), incomplete intestinal obstruction in 14(35.9%), seroperitoneum in 22(56.4%), and fistulization in 4(10.3%). CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases(82.1%) presented with multiple segmental lesions, 5(17.9%) with single segmental lesions, 18(64.3%) with strip ulcer, 16(57.1%) with cobblestones, 4(14.3%) with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases (72.2%) presented with intestinal fistula, 12(66.7%) with peritoneal abscess, 8(44.4%) with sinus tract.

CONCLUSIONSCT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to show the bowel wall and extraintestinal inflammatory mass and abscesses. The sinus tract enterography is easy to demonstrate the intestinal fistula and intra-abdominal abscess. Combination of these methods is more beneficial to guild the diagnosis and treatment.

Abdominal Abscess ; diagnosis ; diagnostic imaging ; pathology ; Aged ; Groin ; diagnostic imaging ; pathology ; Humans ; Male ; Radiography

Ingested foreign bodies usually pass through the digestive system uneventfully. The diagnosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon. Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon. The chicken bone was successfully removed by using balloon dilatation during colonoscopy.
Abdominal Pain ; Abscess ; Chickens* ; Colon ; Colon, Sigmoid* ; Colonoscopy ; Diagnosis ; Digestive System ; Dilatation* ; Fistula ; Foreign Bodies ; Humans

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.
Abdominal Abscess ; Aged ; Anesthesia, General ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Drainage* ; Female ; Gallbladder* ; Gallstones ; Humans ; Mortality

Renal abscess is rare in children and presents varying features which often lead to delay or error in diagnosis. Fever, lumbar pain, abdominal pain and occasional flank rnass are the usual presenting cornplaints but a high degree of suspicion is important for the early detection of renal abscess. Hematogenous seeding of the kidney or ascending infection from the urinary collecting system are two proposed mechanisms of renal abscess formation. Renal ultrasonography facilitates an earlier diagnosis and is also useful in establishing percutaneous drainage, which appears to be the treatment method of choice. We experienced a case of renal abscess which was treated by percutaneous aspiration and antibiotics without surgical intervention.
Abdominal Pain ; Abscess* ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Drainage ; Fever ; Humans ; Kidney ; Ultrasonography

Benign cystic mesothelioma is an uncommon tumor arising from the peritoneal mesothelium. It is characterized by multilocular grapelike, thin-, and translucent-walled cysts, or a unilocular cyst lined by benign mesothelial cells. It occurs predominantly in women of reproductive age, and shows a predilection for the surface of the pelvic peritoneum or visceral peritoneum. Patients usually present abdominal pain and palpable mass, but many cases have been found incidentally during laparotomy. Definite preoperative diagnosis is known to be difficult. Benign cystic mesothelioma has a tendency towards local recurrence, although the gross microscopic features are benign. Moreover, there is controversy over whether this disease is neoplastic or reactive. Initial complete surgical resection and cytoreductive surgery for recurred cases are standard treatments. In the following report, we describe a case of complicated benign cystic mesothelioma in a postpartum woman, involving the pelvic peritoneum and mesoappendix, which was initially misdiagnosed as a periappendiceal abscess.
Abdominal Pain ; Abscess* ; Appendix ; Diagnosis ; Epithelium ; Female ; Humans ; Laparotomy ; Mesothelioma, Cystic* ; Peritoneum ; Postpartum Period* ; Recurrence