Search

BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. METHODS: Between 1993 and 1995, 1,130 laparoscopic cholecystectomies were performed at two major metropolitan medical centers. Of these patients, we know of 3 (0.3%) who subsequently developed abscesses as a consequence of dropped stones during the laparoscopic cholecystectomy. One additional patient who underwent prior laparoscopic cholecystectomy at another institution developed late infection as well. RESULTS: All 4 patients developed late purulent abscesses that ultimately required open surgical drainage, and 1 patient developed trocar site 'tumor' masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. Significant costs were involved in the diagnosis, management, and duration of therapy for these problems. CONCLUSIONS: This experience closely resembles that of other centers and points out the existence of a late postoperative complication following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies for avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of laparoscopic cholecystectomy with or without placement of a drain in the subhepatic space does not prevent this complication. Am J Surg. 1998;175:375-379. [C] 1998 by Excerpta Medica, Inc.

Zyderm or Zyplast Collagen Implants are devices containing collagen, a fiber-like protein found in connective tissue, which are injected into the body to augment, or enhance tissue. These implants were used by 470,000 patients between 1981 and 1989. Recent reports have indicated that injection of these implants may be complicated by the formation of abscesses and local necrosis, or tissue death. The incidence, causes, and treatment of these complications are discussed. The incidence of abscess formation ranges from 0.01 to 0.07 percent. Abscesses may form as a result of hypersensitivity to collagen. The abscess should be drained of pus and the steroids, such as triamcinolone acetonide, injected within the abscess. Resulting scars can be removed by light dermabrasion (scraping away of surface dead tissue) or by surgery. The incidence of local necrosis is 0.09 percent, and may result from cessation of blood supply to the affected tissue. The blood flow may be blocked by collagen, or by injury or compression of the blood vessel. Obstruction of blood flow should be treated by discontinuing injections of collagen and gentle massage of the affected area. Wounds resulting from tissue necrosis should be carefully observed and treated; the scars can be removed by light dermabrasion or surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pyogenic hepatic abscesses (pockets of pus within the liver with evidence of inflammation in surrounding tissue) remains difficult to diagnose and treat. Although these abscesses do not occur frequently, an increased incidence may be expected to accompany the more aggressive surgical treatment of cancers. A review was undertaken of 17 years' experience in treatment of nonparasitic liver abscess, in an effort to improve the diagnostic approach and assess the impact of changing patient population, and newer methods of diagnosis and treatment. The records of 73 patients were reviewed. The study period was divided into two periods, 1970-1978 and 1979-1986. The incidence of noncancerous biliary (gallbladder-related) disease was lower in the first period (1970-1978); the incidence of biliary cancer and noncancerous disease of the colon (including diverticulitis and appendicitis) increased in the second period. Diagnostic use of imaging changed; ultrasound sound use decreased in the second period (from 63 percent of patients to 48 percent), while CT scanning was performed on 88 percent of patients treated during the second period. There were 14 deaths (19 percent) during the study period. The risk of death was 45 percent for patients treated with only antibiotics, 25 percent for those receiving percutaneous treatment and 9.5 percent for patients treated surgically. In the later period, the incidence of hepatic abscess was twice that seen in the earlier period. The main factor determining outcome appeared to be the underlying disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infections of the skin and soft tissues commonly occur in hospital patients. The choice of initial antibiotic treatment is made before cultures are available which identify the specific organism causing the infection. The selection of this initial antibiotic is based upon knowledge of those organisms which commonly cause such infections. In order to provide more insight into these organisms, a retrospective study was undertaken of 584 wounds and 676 skin or soft tissue abscesses. The anaerobic and aerobic microbiologic characteristics were correlated with the infection site. Aerobic organisms live and grow in the presence of free oxygen, while anaerobic organisms live in the complete or almost total absence of oxygen. The results indicated that anaerobic bacteria play an important role in skin wounds and abscesses. The location of the wound or abscess was useful in determining which organisms were involved in the infection. Infections located around the oral, rectal and vaginal regions tended to have organisms similar to those that are part of the normal flora at the adjacent mucous membrane. Infections occurring far from these areas usually involved organisms found in the skin. Mixed aerobic and anaerobic infections were more often found in the breast area and fingers and nail beds. Cultures for both aerobic and anaerobic organisms should be obtained. Antibiotics play an important role in the prevention of postoperative infections. The best treatment for skin wounds and abscesses is surgical drainage, and some cases may require systemic administration of antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abscesses in the head and neck frequently have odontogenic sources. As bacterial pathogens and antibiotic resistance patterns may change over time and based on location, we describe the current common [...]

Frontal sinusitis, an inflammation of the sinuses just above the eyes, does not often cause problems within the cranium (the part of the skull that surrounds the brain), especially with the widespread use of antibiotics today. But in this reported case, the patient developed an abscess on the frontal lobe of his brain without any distinct (focal) neurological signs. He was seen and treated with antibiotics for his sinusitis, but he had persistent headaches and fever. The patient was judged to be uncooperative when he signed himself out of the hospital. He was readmitted a week later with fever, and a CT (computed tomography) scan was done, which showed the brain involvement. The patient was sent to a neurosurgical unit, put on intravenous antibiotics, and operated upon to drain the brain abscess; the sinuses were also treated. He responded well to this treatment, and was sent home after five weeks of hospitalization, but failed to keep his follow-up appointments. (Consumer Summary produced by Reliance Medical Information, Inc.)

Table of Contents Abstract Introduction Case Report Discussion References Abstract Nasal septal abscesses caused by dental infection are rare. We report a case of a nasal abscess caused by dental [...]

Although psoas abscesses are a rare clinical entity, they are a significant cause of mortality and morbidity, especially in view of their varied clinical presentations, which often lead to misdiagnosis [...]

Intracranial complications of otitis media are rare in the age of antiobiotics and in the developed world, but they can be life threatening when they occur. We present a case [...]

EDITOR--O'Rourke et al report on a patient who, after root canal therapy, developed an epidural abscess from which Staphylococcus aureus was grown. (1) They contend that there is a causal [...]