Endoscopic ultrasound-guided drainage of postoperative intra-abdominal abscesses

Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.

Intra-abdominal hemorrhage during pregnancy: Four case reports

BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy.In this article,we report 4 cases of intra-abdominal hemorrhage during pregnancy,including the spontaneous rupture of uterine veins,spontaneous rupture of liver,rupture of external iliac vessel branch,and rupture of right renal hamartoma.CASE SUMMARY The clinical manifestations of three patients lacked specificity,and the localization of the bleeding was not clear prior to surgery.All 4 pregnant women were successfully treated,while only one full-term infant survived.CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic,and it is clinically characterized by acute abdominal pain during pregnancy.Clear diagnosis before surgery is rather difficult.Early diagnosis,timely and appropriate treatment and surgery,and multidisciplinary cooperation are key to saving pregnant females’lives and improving the outcomes of perinatal infants.

Laparoscopic treatment of perforated appendicitis

The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.

Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.

The microbiology of infected pancreatic necrosis

Background: Acute pancreatitis(AP) continues to cause significant morbidity and mortality, especially when it leads to infected pancreatic necrosis(IPN). Modern treatment of IPN frequently involves prolonged courses of antibiotics in combination with minimally invasive therapies. This study aimed to update the existing evidence base by identifying the pathogens causing IPN and therefore aid future selection of empirical antibiotics. Methods: Clinical data, including microbiology results, of consecutive patients with IPN undergoing minimally invasive necrosectomy at our institution between January 2009 and July 2016 were retrospectively reviewed. Results: The results of 40 patients(22 males and 18 females, median age 60 years) with IPN were reviewed. The etiology of AP was gallstones, alcohol, dyslipidemia and unknown in 31, 2, 2 and 5 patients, respectively. The most frequently identified microbes in microbiology cultures were Enterococcus faecalis and faecium(22.5% and 20.0%) and Escherichia coli(20.0%). In 19 cases the cultures grew multiple organisms. The antibiotics with the least resistance amongst the microbiota were teicoplanin(5.0%), linezolid(5.6%), ertapenem(6.5%), and meropenem(7.4%). Conclusion: The carbapenem antibiotics, ertapenem and meropenem provide good antimicrobial cover against the common, mainly enteral, microorganisms causing IPN. Culture and sensitivity results of acquired samples should be regularly reviewed to adjust prescribing and monitor for emergence of resistance.

Emergency Atypical Resection for Perforated Gastric Gist

We report the case of a 77-year-old male who came to the emergency department with epigastric pain accompanied by fever and chills. After the diagnosis of intra-abdominal abscess and gastric tumor, emergency surgery was performed with resection of the tumor and abscess drainage. The patient had a good postoperative course.

合并自发性腹腔脓肿的克罗恩病患者需早期手术的影响因素分析

目的 探讨合并自发性腹腔脓肿的克罗恩病患者需早期手术干预的危险因素。方法 回顾性分析2008年5月至2015年12月中山大学附属第六医院收治的克罗恩病合并自发性腹腔脓肿94例患者的临床资料，通过单因素和多因素Logistic回归模型分析患者需行早期手术干预（脓肿发生后60 d内接受的手术治疗）的危险因素。结果 94例患者中男性70例，女性24例；诊断克罗恩病时的年龄平均28.4岁；自发性腹腔脓肿发生的年龄平均30.4岁，腹腔脓肿平均病程为3年，其中回结肠型（L3）占81.9%（77/94），单发脓肿占76.6%（72/94）。有33例（35.1%）既往接受过腹部手术；52例（55.3%）合并肠狭窄；71例（75.5%）合并肠瘘。克罗恩病合并自发性腹腔脓肿后60 d内，有44例（46.8%）患者接受了手术治疗。Logistic多因素分析显示，既往有腹部手术史（OR=3.23，95%CI：1.12 ~ 9.31，P = 0.030）、合并肠狭窄（OR = 3.52，95%CI：1.26 ~ 9.85，P = 0.017）和合并肠瘘（OR = 4.31，95%CI：1.25 ~ 14.80，P = 0.020）为早期手术的独立危险因素，而肠内营养（OR= 0.18，95%CI：0.05 ~ 0.62，P = 0.007）则为早期手术的独立保护因素。结论 合并自发性腹腔脓肿的克罗恩病患者如果既往有腹部手术史、合并肠狭窄或肠瘘，则具有较高的手术风险，而使用肠内营养可降低早期手术干预的风险。

经皮穿刺双置管引流在细菌性肝脓肿自发性破裂中的应用

目的探讨经皮穿刺双置管引流在细菌性肝脓肿自发性破裂中的应用价值。方法回顾性分析2001年6月至2015年12月在佛山市第一人民医院行经皮穿刺双置管引流治疗的9例细菌性肝脓肿自发性破裂患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男7例,女2例;年龄38~66岁,中位年龄51岁。6例发生在肝左叶,3例肝右后叶;脓肿破裂导致膈下脓肿5例,肝左外叶-胃间隙脓肿2例,右侧膈下-右侧结肠旁沟脓肿2例;均采用经皮肝内脓肿及肝周腹腔脓肿双置管引流治疗,联合应用敏感抗生素。结果9例肝内脓肿均于超声引导下经皮穿刺置入1条8 F引流管,8例肝周腹腔脓肿各置入1条10 F引流管,1例患者肝周腹腔脓肿置入2条10 F引流管。肝内脓肿引流管平均放置时间(14.2±3.9)d,肝周腹腔脓肿引流管放置时间(5.0±0.7)d。9例患者均成功治愈,随访6个月,无腹腔脓肿、肠粘连等并发症发生。结论经皮穿刺双置管引流治疗细菌性肝脓肿自发性破裂简便、安全、可行,避免了开腹或腹腔镜手术,具有微创优势,尤其适用于腹腔脓肿局限者。

Role of ultrasound in the treatment of pediatric infectious diseases:case series and narrative review

Background Infectious diseases are common in pediatric patients.In these patients,ultrasound is a useful imaging modality that involves no irradiation or sedation and can be performed repeatedly at the patient's bedside.The purpose of this review was to show pediatric cases with infectious disease that used ultrasound to decide the methods of treatment.Data sources Literature review was performed using Pubmed as the medical database source.No year-of-publication restric-tion was placed.The mesh terms used were:"ultrasound","sonography","infectious disease","treatment","antibiotics","surgical intervention","pediatric","children","deep neck abscess","pyothorax","empyema","pneumonia","urinary tract infection","intra-abdominal abscess","soft tissue infection","septic arthritis","osteomyelitis",and"surgical site infection".Results We presented pediatric case series with infectious diseases,including deep neck abscess,pyothorax and empyema,pneumonia,urinary tract infection,intra-abdominal abscess,soft tissue infection,septic arthritis and osteomyelitis,and surgical-site infection.Ultrasound was useful for evaluating the extent and location of inflammation and abscess and for decision-making concerning surgical intervention.Conclusion Knowledge of these sonographic findings is important for sonographers during examinations and for physicians when determining the treatment plan and period of antibiotic therapy for infected lesions.