Thigh pain due to obturator internus phlegmon: A diagnostic challenge

A 9-year-old boy with thigh pain, high fever, hyperleukocytosis and positive blood cultures forStaphylococcus aureus had a left obturator internus phlegmon. Lack of evidence for hip infection or osteomyelitis in a child with thigh pain, high fever and hyperleukocytosis points to a possible infection of pelvic structures. Abscess or phlegmon of the obturator internus muscle is a very rare condition. The most frequent agent isStaphylococcus aureus. CT of the pelvis is the procedure of choice to show diffuse swelling of the muscle or collection of pus. Conservative treatment with adequate antibiotics is the treatment of choice.     

Liver abscess in childhood

Seventy-five children with pyogenic liver abscess are reviewed and compared with 21 with amoebic liver abscess occurring within the same 13-year period (1974–1986). Both groups presented with a similar syndrome complex. Noted differences were age at presentation (pyogenic: mean age 4.5 years and amoebic: mean age 2 years), the association of dysentery in 43% of the amoebic group, and the 76% incidence of Ascaris infestation in the pyogenic group. Predisposing disease was uncommon. Diagnosis was often delayed, which led to 4 deaths in the pyogenic group (overall mortality 4%). Diagnosis was confirmed with ultrasound or nucleotide liver scan. Non-operative management with antibiotics and metronidazole was successful in 37% of pyogenic and 43% of amoebic abscesses. Laparotomy and open drainage was performed for clinical evidence of peritonitis or failure to improve within 48–72 h of commencing therapy. There was no operative mortality and little morbidity in both groups. Offprint requests to: S. Cywes     

Feasibility of C-Arm-Supported CT Fluoroscopy in Percutaneous Abscess Drainage Procedures

Purpose: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures. Methods: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed. Results: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 ± 3.7 min versus 14.8 ± 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test). Conclusion: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.     

先天性背部皮肤窦道与硬脊膜内脓肿

目的：探讨隐性脊柱裂中背部皮肤窦道引起硬脊膜内脓肿原因，以及如何早期诊断，及时治疗。方法：本组6例，年龄1－4岁，均为皮肤窦道伴椎客内皮样囊肿继发脓肿形成，诊断领先临床表现及影像学检查，手术行囊肿剥离及窦道切除，术后随访6－20个月，平均15个月。结果：6例患儿中，3例脊髓发育正常患儿，术后2例神经功能恢复正常，1例明显好转；3例脊髓低和，1例双下肢功能恢复，大小便失禁无明显好转，另2例神经功能无明显改善。结论：先天性脊部皮肤窦道可伴有硬脊膜下或髓内皮样囊肿，并感染形成脓肿，因此，对于中枢感染，应及时检查有否背部皮下窦道以及相应的椎管内病变，以利于及时手术，早期诊断，早期治疗有利于神经功能恢复。     

Brain abscesses in cyanotic heart disease

Sixty cases of brain abscesses in patients with cyanotic heart disease is reported. Forty four (73.3%) belonged to pediatric age group. There was only single case of infratentorial abscess located in the cerebellar paravermian region. The abscesses were multiloculated in 42%, multiple in 10% and solitary in 48% cases. Streptococci was the commonest (77%) micro-organism isolated from pus culture. Forty eight patients were treated by aspiration through twist drill, 7 patients conservatively and 5 had primary excision of abscesses. Forty four patients improved in their neurological status, three had fixed neurological deficits and 5 patients deteriorated further. There were 8 deaths. Complication like cyanotic spells was recorded in 17% cases treated by aspiration. None of the patients treated by twist drill aspiration had seizure. It is suggested that aspiration of abscesses through twist drill hole and antibiotic therapy could be the treatment of choice. Vascular slowing in a localised area resulting in infraction and thus preparing the focus for abscess formation is the possible mechanism in the evolution of these abscesses.     

Unusual complication—VP shunt coming out per rectum and brain abscess

VP shunt is the most common pediatric neurosurgical procedure. It has been shown to result in variety of complications, which may have devastating consequences. Discussed below is one of the rare complications and the strategy to manage it successfully.     

Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic

Background: The risk for intraabdominal abscess (IAA) after laparoscopic appendectomy (LA) is still a matter of debate. The aim of the present study was to evaluate postoperative complications after open (OA) and laparoscopic appendectomy, in particular in perforated appendicitis (PA).Methods: In the period 1999–2002, 331 appendectomies were performed for histological proven appendicitis, 144 by the open and 187 by the laparoscopic technique. Parameters were conversion rate, perforation, wound infection, and IAA.Results: Conversion to OA was done in 20 cases (10.7%). Perforated appendicitis led more frequently to conversion than simple appendicitis (23.5 vs 7.8%; p = 0.007). Perforated appendicitis was equally seen in the open and laparoscopic technique (15 vs 18%). Wound infections after OA, converted and LA for acute appendicitis were 3 of 144 (2.1%), 1 of 20 (5.0%) and 1 of 167 (0.6%), respectively (NS). IAA formation did not differ among the three procedures (3.5 vs 0 vs 3.6%). In PA the rate of IAA formation was increased. However, the risk was not influenced by the technique: Two patients after the OA, none after a converted procedure, and two patients after LA formed an abscess (9.5 vs 0 vs 7.7% [NS]).Conclusion: LA does not lead to more intraabdominal abscesses than the open technique; even for perforated appendicitis the laparoscopic technique can be used safely.     

Deep neck infection due to<Emphasis Type="Italic"> Lactococcus lactis cremoris</Emphasis>: a case report

This report describes the first case of deep neck infection resulting from Lactococcus lactis subsp. cremoris. The case is associated with the consumption of unpasteurized milk and occurred in a patient with a buccal mucosa tumor. Anti-infective therapy with ceftriaxone and metronidazole resulted in complete resolution.     

Splenic abscess associated with endocarditis in a patient on hemodialysis: a case report

Splenic abscess is an unusual condition usually seen in immunocompromised patients or associated with intravenous drug abuses. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess. Splenic abscess in a patient on hemodialysis is a rare but life-threatening condition if not corrected. We describe a case of splenic abscess with bacterial endocarditis on maintenance hemodialysis. He had staphylococcal septicemia secondary to bacterial endocarditis at the mitral valve from the dialysis access-site infection. Although hematologic seeding from endocarditis has been the predisposing factor for splenic abscess, we postulate that access-site infections may predispose hemodialysis patients to splenic abscess. Splenic abscess may be considered as one of the causes when patients on hemodialysis develop unexplained fever.     

Tissue plasminogen activator for the treatment of intraabdominal abscesses in a neonate

Fibrinolytic agents have been used successfully in the management of loculated empyema; however, their use in the treatment of intraabdominal abscesses is limited. The authors describe the case of a 4-week-old girl with intraabdominal abscesses secondary to intestinal perforation that were not amenable to percutaneous drainage, but were managed successfully with intracavitary administration of tissue-plasminogen activator. This case represents the first report in a human, in which tissue-plaminogen activator was used to facilitate percutaneous drainage of an intraabdominal abscess. It is also the first time a fibrinolytic agent has been used for this purpose in a child.