PURPOSE: To clarify the clinical features of appendicitis in preschool children and to explore clinical appendicitis scoring systems in this age group. METHODS: We retrospectively collected data on 142 children, aged 10 years or younger, with confirmed diagnosis of appendicitis based on surgical and pathologic findings. Enrolled subjects were divided into two groups: Group 1 (preschool children aged ≤5 years, n=41) and Group 2 (school children aged >5 to ≤10 years, n=101). Data analyzed included clinical presentation, laboratory findings, the pediatric appendicitis score (PAS), and the modified Alvarado score (MAS). RESULTS: The most common presenting symptom was abdominal pain in both groups (92.7% vs. 97.0%). Other presenting symptoms were as follows: fever (65.9%), vomiting (68.3%), right lower quadrant (RLQ) localization (24.4%), anorexia (14.6%), and diarrhea (7.3%) in Group 1, and RLQ localization (74.3%), vomiting (71.3%), anorexia (52.5%), fever (47.5%), and diarrhea (11.9%) in Group 2. Perforation and abscess occurred more frequently in Group 1 than in Group 2 (43.9% vs. 12.9%, p < 0.001; 34.1% vs. 5.0%, p < 0.001; respectively). PAS and MAS were lower in Group 1 than in Group 2 (4.09±1.97 vs. 6.91±1.61, p=0.048; 4.65±1.79 vs. 6.51±1.39, p=0.012; respectively). CONCLUSION: In preschool children, appendicitis often presents with atypical features, more rapid progression, and higher incidence of complications. This age group is more likely to have lower PAS and MAS than those of school children.
Abdominal Pain ; Abscess ; Anorexia ; Appendicitis ; Child ; Child, Preschool ; Diagnosis ; Diarrhea ; Fever ; Humans ; Incidence ; Retrospective Studies ; Vomiting

Crohn disease (CD) is a chronic inflammatory disease involving the entire digestive tract and non-perianal fistula is the most serious surgical complication of CD. The goal of treatment is to cure intestinal fistula and intra-abdominal infection, restore the continuity of digestive tract, reduce postoperative recurrence, and improve the quality of life. Evaluation of nutritional status, especially during perioperative period, is important and nutrition support for malnutritional CD patients is necessary. Full assessment of non-perianal fistula and promotion of self-healing is the principal treatment, and surgical drainage combined with enteral nutrition may be a feasible treatment. Trocar puncture with sump drain is recommended to control intra-abdominal abscess. Surgical treatment of enterocutaneous fistula, enteroenteric fistula, enterovesical fistula or enterogynaecological fistula should be considered if medical treatment, nutrition support and surgical drainage fail. Laparoscopic surgery is recommended for patients with mild adhesion of non-perianal fistulating CD. Postoperative medical treatment and risk assessment should be carried out to reduce postoperative recurrence of CD and fistula.
Abdominal Abscess ; etiology ; therapy ; Consensus ; Crohn Disease ; complications ; diagnosis ; therapy ; Drainage ; Humans ; Quality of Life ; Rectal Fistula ; etiology ; therapy

Appendicitis is the most common diagnosis of acute abdominal pain that may require surgical treatment, and 8.6% for men and 6.9% for women are at risk for this illness over the course of their lives. During the past century, appendectomy was the standard treatment for acute appendicitis. However, laparoscopic appendectomy has been used as the first-line treatment choice for appendicitis since the introduction of laparoscopic surgery. In cases of perforation or abscess, interval appendectomy and percutaneous drainage are recommended. Treatment strategies have become more diverse. In recent years, in some European countries, non-surgical treatment has been used for simple appendicitis without complications, and nonoperative treatment of appendicitis has become increasingly common in adults and children. In this article, nonoperative treatment of appendicitis is introduced, and guidelines for the selection of antibiotics according to appendicitis classification are summarized.
Abdominal Pain ; Abscess ; Adult ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Child ; Classification ; Diagnosis ; Drainage ; Female ; Humans ; Laparoscopy ; Male

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

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*

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about 70 μm, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.
Abdomen ; Abdominal Abscess* ; Abdominal Pain ; Abdominal Wall ; Abscess ; Animals ; Central Nervous System ; Colon ; Colon, Ascending ; Diagnosis ; Diverticulitis* ; Egg Shell ; Eggs ; Granuloma ; Humans ; Intestines ; Korea ; Liver ; Lung ; Ovum ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Parasites ; Parasitic Diseases ; Peritoneal Cavity

Pylephlebitis, or suppurative thrombophlebitis of the portal venous system, is a rare condition occurring secondary to abdominal infections such as diverticulitis. Pylephlebitis can be diagnosed via ultrasonography or CT scan, and is characterized by the presence of a thrombus in the portal vein and bacteremia. However, the diagnosis may be delayed due to the vague nature of the clinical symptoms, causing morbidity and mortality due to pylephlebitis to remain high. Early diagnosis and immediate antibiotic therapy are important for favorable prognosis. Therefore, pylephlebitis should be considered in the differential diagnosis for cases of nonspecific abdominal pain and fever. We report a case of pylephlebitis secondary to diverticulitis, associated with Pseudomonas aeruginosa sepsis. Such cases have not been widely reported.
Abdominal Pain ; Bacteremia ; Diagnosis ; Diagnosis, Differential ; Diverticulitis* ; Early Diagnosis ; Fever ; Liver Abscess* ; Liver* ; Mortality ; Portal Vein ; Prognosis ; Pseudomonas aeruginosa* ; Pseudomonas* ; Sepsis* ; Thrombophlebitis ; Thrombosis ; Tomography, X-Ray Computed ; Ultrasonography

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of intractable psoas abscess due to delayed diagnosis of colon tuberculosis. SUMMARY OF LITERATURE REVIEW: Most psoas abscesses occur primarily or secondarily due to infection of the vertebral body or discs; however, in rare cases, the etiology is not musculoskeletal in nature. In such cases, since diagnosis and treatment of the causal factor can be delayed, the psoas abscess may recur multiple times and eventually become difficult to treat. MATERIALS AND METHODS: An 18-year-old female patient visited our institution complaining of right lower quadrant abdominal pain and right hip pain. On abdominal computed tomography (CT), a psoas abscess was observed and colon tuberculosis was suspected. She was treated with a ultrasonographically guided percutaneous drainage procedure. Considering the possibility of colon tuberculosis and related fistulae, a barium enema was performed; nonetheless, no fistula was found. After 2 months, the psoas abscess recurred, and thus incision and drainage were performed. Symptoms redeveloped 4 months after the incision and drainage; the patient was further evaluated with magnetic resonance imaging and recurrence of psoas abscess was again observed; incision and drainage were performed once again. A gross draining sinus developed on the right lower abdomen 11 months after the last procedure. On barium enema and abdominal CT scan, an enterocutaneous draining sinus was spotted at the right ascending colon, and right hemicolectomy was thus performed. RESULTS: The psoas abscess did not recur during an 8-year follow-up period after right hemicolectomy. CONCLUSIONS: In treatment of secondary psoas abscess, diagnosis and treatment of the etiology is crucial.
Abdomen ; Abdominal Pain ; Adolescent ; Barium ; Colon* ; Colon, Ascending ; Delayed Diagnosis* ; Diagnosis ; Drainage ; Enema ; Female ; Fistula ; Follow-Up Studies ; Hip ; Humans ; Magnetic Resonance Imaging ; Psoas Abscess* ; Recurrence ; Tomography, X-Ray Computed ; Tuberculosis*

BACKGROUND: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis. METHODS: We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014. RESULTS: The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise. CONCLUSION: In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.
Abdominal Pain ; Abscess ; Aged* ; Cervical Intraepithelial Neoplasia ; Comorbidity ; Diabetes Mellitus ; Diagnosis ; Drainage ; Endometrial Neoplasms ; Female ; Fever ; Genital Diseases, Female ; Gynecologic Surgical Procedures ; Humans ; Hypertension ; Labor Stage, First ; Mortality ; Myoma ; Ovarian Neoplasms ; Peritonitis ; Polyps ; Postmenopause ; Pregnancy ; Pyometra* ; Retrospective Studies ; Sepsis ; Uterine Hemorrhage ; Uterine Prolapse ; Vaginal Discharge

Iliopsoas abscess (IPA) is rare in neonates. We present a case of neonatal IPA that was initially believed to bean inguinal hernia. A 20-day-old male infant was referred to our hospital for herniorrhaphy after a 2-day history of swelling and bluish discoloration of the left inguinal area and leg without limitation of motion. Abdominal and pelvic ultrasonography suggested a femoral hernia, but the anatomy was unclear. Abdominal computed tomography revealed a multi-septated cystic mass extending into the psoas muscle from the lower pole of the left kidney to the femur neck. Broad spectrum antibiotics were initiated, and prompt surgical exploration was planned. After opening the retroperitoneal cavity via an inguinal incision, an IPA was diagnosed and surgically drained. Culture of the abscess fluid detected Staphylococcus aureus, sensitive to methicillin. The patient was discharged without complication on the 17th postoperative day.
Diagnosis, Differential ; Drainage ; Hernia, Inguinal/*diagnosis ; Humans ; Infant, Newborn ; Male ; Psoas Abscess/*diagnosis/*therapy ; Radiography, Abdominal/methods ; Rare Diseases ; Republic of Korea ; Staphylococcal Infections/*diagnosis/*therapy ; Tomography, X-Ray Computed/methods ; Treatment Outcome