A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous draninage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.
Abdominal Abscess/*etiology/surgery ; Child, Preschool ; Humans ; Infection/*complications ; Ligaments/*pathology/surgery ; Male ; Umbilicus/*pathology

OBJECTIVE: To systematically evaluate the safety and efficacy of laparoscopic surgery versus conservative treatment for appendiceal abscess. METHODS: The databases of CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with conservative treatment for appendiceal abscess published before June 2018. The search terms were Chinese or English. Chinese search terms included appendix, abscess, and laparoscopy; English search terms included appendix, abscess, and laparoscope. References of the resulted papers, related reviews or meta-analysis references were also induded. Literature inclusion criteria: (1)RCT or CCT, whether or not to assign concealment or blinding; (2) appendiceal abscess was diagnosed at admission; (3) laparoscopic group: laparoscopic appendectomy or laparoscopy surgical methods, such as irrigation and drainage, for appendiceal abscess; conservative treatment group: conservative methods, such as antibiotics or percutaneous abscess drainage were used to treat appendiceal abscess. EXCLUSION CRITERIA: (1) review, case report, single cohort study and other non-controlled studies literature; (2) single study sample size ≤ 20; (3) subjects with simple appendicitis or perforation of appendix to form diffuse peritonitis; (4) no valid data available for extraction; (5) repeated publication of the literature. Data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis. RESULTS: Three RCTs and four CCTs with a total of 591 patients were included in this study. There were 312 patients in the laparoscopic group and 279 patients in the conservative group. Compared with the conservative group, the laparoscopic group had higher uneventful recovery rate (OR=11.91, 95%CI: 4.59 to 30.88, P<0.05), shorter hospital stay (WMD=-2.98, 95%CI: -5.96 to -0.01, P=0.05), lower incidence of recurrent or residual abscess (OR=0.07, 95%CI:0.03 to 0.20, P<0.05), and shorter time to recover to normal condition for body temperature and white blood cell respectively (SMD=-2.12, 95%CI:-2.49 to -1.75, P<0.05; SMD=-2.07, 95%CI: -3.84 to -0.29, P<0.05). However, no significant difference was found in hospital charge(P>0.05). CONCLUSIONS Laparoscopic surgery for appendiceal abscess is safe and feasible. It can improve the recovery with shorter postoperative hospital stay and less recurrent or residual abscess.
Abdominal Abscess ; surgery ; therapy ; Appendix ; surgery ; Cohort Studies ; Conservative Treatment ; Humans ; Laparoscopy ; Length of Stay ; Treatment Outcome

Use of laparoscopic appendectomy (LA) for perforated appendicitis (PA) in children remains controversial because of the development of postoperative intra-abdominal abscess formation. We developed the irrigation method for the prevention of abscess formation after LA performed for PA in children with severe panperitonitis. We called it 'the shaking irrigation'. The object of this study was to analyze the efficacy of this irrigation method. All cases of PA with severe panperitonitis in children that underwent LA with massive shaking irrigation and drainage between June 2003 and December 2007 were studied retrospectively. We included only PA with panperitonitis and large amounts of purulent ascites throughout the abdomen as well as an inflamed small bowel with ileus. Thirty-four children were involved in this study. The mean patient age was eight years. The mean amount of irrigation fluid was 8.2L (range: 4-15L). The mean operative time was 89.5 min. The mean length of the hospital stay was 5.1 days. There were no postoperative intra-abdominal abscesses. There was no conversion to open surgery. In conclusion, Use of LA in PA with severe panperitonitis in children is safe and effective. Massive shaking irrigation and abdominal drainage appears to prevent intra-abdominal abscesses after LA for PA with panperitonitis.
Abdomen ; Abdominal Abscess ; Abscess ; Appendectomy ; Appendicitis ; Ascites ; Child ; Conversion to Open Surgery ; Drainage ; Humans ; Ileus ; Length of Stay ; Operative Time ; Retrospective Studies

OBJECTIVETo compare the safety of anastomosis and ostomy following 2-stage definitive colonic resection when severe colonic injuries treated in the setting of damage control surgery(DCS).

METHODSClinical data of 67 patients with severely traumatic colonic injuries undergoing DCS at the Third Affiliated Hospital of Sun Yat-sen University between 2005 and 2013 were analyzed retrospectively. Patients were divided into the anastomosis group undergoing colonic resection and anastomosis (n=40), and the ostomy group undergoing anastomosis with a protecting proximal ostomy (n=27). Postoperative complications were compared between these two groups. The risk factors of colonic anastomosis leakage were analyzed.

RESULTSDemographics, injury severity, physiological imbalance on admission, transfusion during the first operative procedure were similar in the two groups (all P>0.05). Rates of anastomotic leakage, intra-abdominal abscess, enterocutaneous fistula, and would infection after definitive resection were not statistically different between the two groups (all P>0.05). Colonic anasomotic leakage rates were 15.0% (6/40) in anastomosis group and 11.1% (3/27) in ostomy group without significant difference (P>0.05). Left-sided colon injuries occurred in 7 out of 9 patients with anatomotic leakage, whose proportion was significantly higher than that in those without anastomotic leakage (7/9 vs. 24/58, 77.8% vs. 41.4%, P<0.05). A prolonged peritoneal closure was also observed in patients with anastomotic leakage (median, 10 days vs. 2 days, P<0.05).

CONCLUSIONSA strategy of diverting ostomy is not the first choice for patients suffering from severe colonic injuries in the setting of DCS. Peritoneal closure at early stage may decrease the risk of colonic anastomotic leakage.

Abdominal Abscess ; Abdominal Injuries ; Anastomosis, Surgical ; Anastomotic Leak ; Colonic Diseases ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Risk Factors

Systemic septic embolism is one of the most important complications of infective endocarditis, but subacute infective endocarditis has a milder clinical course and rare metastatic lesions. Extracardiac complications and poor response to adequate medical therapy is a good indication of cardiac surgery. We report a case of subacute infective endocarditis combined with multiple brain and splenic abscesses. A 55 year old woman was admitted to this hospital because of intermittent spiking fever for 2 months. She had hypertension and valvular heart disease 4 years ago. Small vegetations of the mitral valve, spiking fever exceeding 38degrees C and septic embolic event including brain and splenic abscesses were present. On the 9th hospital day, fever subsided with vancomycin therapy. 4 weeks after admission, mitral valve replacement was performed.
Abdominal Abscess ; Abscess* ; Brain Abscess ; Brain* ; Embolism ; Endocarditis* ; Female ; Fever ; Heart Valve Diseases ; Humans ; Hypertension ; Middle Aged ; Mitral Valve ; Thoracic Surgery ; Vancomycin

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.
Abdominal Abscess/surgery ; Drainage/*methods ; Endosonography/*methods ; Humans ; Necrosis/surgery ; Pancreas/*pathology/surgery ; Pancreatic Diseases/*surgery ; Pancreatic Pseudocyst/surgery ; *Stents ; Surgery, Computer-Assisted/*methods ; Ultrasonography, Interventional/methods

No abstract availble.
Abdominal Abscess/diagnosis/*surgery ; Crohn Disease/etiology/surgery/*therapy ; Humans ; Length of Stay ; Predictive Value of Tests ; Recurrence ; Severity of Illness Index

Desmoid tumor is a rare benign tumor derived from fibrous sheath or musculoaponeurotic structure. The tumor is benign histologically but considered as malignant clinically because it has high propensity on infiltrative growth with local invasion and tendency to recurrence after local excision. Especially, when this tumor happens to be in the intra-abdomen, the prognosis is worse because it can cause intestinal obstruction, ureter obstruction and, fistula formation. It also can invade major vessels in abdomen. This tumor occurs more frequently in patients with familial adenomatous polyposis (FAP), in post-partume women, and at old surgical incision site. However, in this case, the patient had neither previous surgery nor a FAP history. We report a rare case of the young male patient who presented with an acute abdomen and underwent laparotomy and was found to have an intra-abdominal desmoid tumor with abscess formation.
Abdominal Abscess/diagnosis ; Adult ; Diagnosis, Differential ; Fibromatosis, Abdominal/*diagnosis/pathology/surgery ; Humans ; Male ; Peritoneal Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Pediatric onset Crohn's disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, intestinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medically untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient's clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic modifications according to the conditions.
Abdominal Abscess ; Adult ; Aged ; Child ; Colorectal Surgery ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Hemorrhage ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Intestinal Fistula

OBJECTIVETo study the effects of placement of double cannula using trocar puncture for intra-abdominal abscess drainage.

METHODSA retrospective study was performed to investigate the clinical data of 32 patients undergoing intra-abdominal abscess drainage with double cannula placed using trocar puncture between June 2010 and December 2010.

TECHNIQUESthe location and size of the abscess was evaluated by ultrasound and CT. Placement of double cannula using trocar puncture was performed under CT or ultrasound guidance.

RESULTSTrocar puncture was successful in all the patients. One patient died of liver metastasis and multiple organ failure after surgery for pancreatic cancer. One patient required laparotomy and drainage because non-localization of sepsis from intestinal fistula. The remaining 30 patients experienced alleviation of septic symptoms after drainage and eventually cured. The mean healing time was(7±3) days. Two patients developed subcutaneous bleeding and were management by local compression.

CONCLUSIONSPlacement of double cannula using trocar puncture for intra- abdominal abscess drainage results in satisfactory outcomes. This technique is especially suitable for abscesses with viscous drainage, those with the presence of phlegmon or necrotic debris, and those with multiple large cavities.

Abdominal Abscess ; surgery ; Adult ; Aged ; Catheters, Indwelling ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult