Intra-abdominal Infection

2015 ◽  
Author(s):  
Robert G. Sawyer ◽  
Zachary C. Dietch ◽  
Puja M. Shah
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Ct Scans ◽  
Emphysematous Cholecystitis ◽  
Abdominal Infection ◽  
Cdc Guidelines ◽  
Upper Abdominal ◽  
Abdominal Infections ◽  
Extraluminal Air

The basic principles of rapid diagnosis, timely physiologic support, and definitive intervention for intra-abdominal infections have remained unchanged over the past century; however, specific management of these conditions has been transformed as a result of numerous advances in technology. This review covers clinical evaluation, investigative studies, options for intervention, early source control and duration of antimicrobial therapy, infections of the upper abdomen, infections of the lower abdomen, other abdominal infections, and special cases. Figures show an algorithm outlining the approach to a suspected upper abdominal infection, abnormal abdominal ultrasounds showing calculi in the gallbladder and confirming the diagnosis of acute acalculous cholecystitis, endoscopic retrograde cholangiopancreatographies showing a distal common bile duct stone in acute pancreatitis, extrinsic compression of the common hepatic duct by a stone in the Hartmann pouch, and endoscopic sphincterotomy for acute biliary decompression in acute obstructive cholangitis, air outlining the gallbladder and bile ducts in emphysematous cholecystitis, abdominal and pelvic CT scans showing pancreatic findings graded by Ranson into five categories, a splenic abscess, an inflamed and thickened appendix with surrounding fat stranding, appendiceal perforation and abscess formation, diverticulitis with a small amount of extraluminal air, left lower quadrant fluid collection consistent with peridiverticular abscess, diffuse inflammation and right upper quadrant extraluminal air, and thickening of the colonic wall with both intramural and extramural air, an algorithm outlining the approach to the patient with a suspected lower abdominal infection, upright chest x-ray and abdominal CT scans of patients with sudden-onset diffuse abdominal pain, and an omental (Graham) patch. Tables list diagnostic indicators of upper abdominal pain and fever, comparison of acute cholecystitis and emphysematous cholecystitis, Hinchey system for classification of perforated diverticulitis, Centers for Disease Control and Prevention (CDC) guidelines for diagnosis of pelvic inflammatory disease, and CDC guidelines for antibiotic treatment of pelvic inflammatory disease. This review contains 16 highly rendered figures, 5 tables, and 238 references

Intra-abdominal Infection

2016 ◽  
Author(s):  
Robert G. Sawyer ◽  
Zachary C. Dietch ◽  
Puja M. Shah
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Ct Scans ◽  
Emphysematous Cholecystitis ◽  
Abdominal Infection ◽  
Cdc Guidelines ◽  
Upper Abdominal ◽  
Abdominal Infections ◽  
Extraluminal Air

The basic principles of rapid diagnosis, timely physiologic support, and definitive intervention for intra-abdominal infections have remained unchanged over the past century; however, specific management of these conditions has been transformed as a result of numerous advances in technology. This review covers clinical evaluation, investigative studies, options for intervention, early source control and duration of antimicrobial therapy, infections of the upper abdomen, infections of the lower abdomen, other abdominal infections, and special cases. Figures show an algorithm outlining the approach to a suspected upper abdominal infection, abnormal abdominal ultrasounds showing calculi in the gallbladder and confirming the diagnosis of acute acalculous cholecystitis, endoscopic retrograde cholangiopancreatographies showing a distal common bile duct stone in acute pancreatitis, extrinsic compression of the common hepatic duct by a stone in the Hartmann pouch, and endoscopic sphincterotomy for acute biliary decompression in acute obstructive cholangitis, air outlining the gallbladder and bile ducts in emphysematous cholecystitis, abdominal and pelvic CT scans showing pancreatic findings graded by Ranson into five categories, a splenic abscess, an inflamed and thickened appendix with surrounding fat stranding, appendiceal perforation and abscess formation, diverticulitis with a small amount of extraluminal air, left lower quadrant fluid collection consistent with peridiverticular abscess, diffuse inflammation and right upper quadrant extraluminal air, and thickening of the colonic wall with both intramural and extramural air, an algorithm outlining the approach to the patient with a suspected lower abdominal infection, upright chest x-ray and abdominal CT scans of patients with sudden-onset diffuse abdominal pain, and an omental (Graham) patch. Tables list diagnostic indicators of upper abdominal pain and fever, comparison of acute cholecystitis and emphysematous cholecystitis, Hinchey system for classification of perforated diverticulitis, Centers for Disease Control and Prevention (CDC) guidelines for diagnosis of pelvic inflammatory disease, and CDC guidelines for antibiotic treatment of pelvic inflammatory disease. This review contains 16 highly rendered figures, 5 tables, and 238 references

scholarly journals Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yu Chen ◽  
Shaobin Wei ◽  
Li Huang ◽  
Mei Luo ◽  
Yang Wu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Meta Analysis ◽  
Lower Abdominal Pain ◽  
Effective Rate ◽  
Chinese Patent ◽  
Meta Analyses

Background. Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID. Methods. Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate. Results. Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I2 = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I2 = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I2 = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I2 = 0%). Conclusions. Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

scholarly journals Bali Belly: Salmonella senftenberg Found in an Infected Ovarian Endometrioma

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
P. D. M. Pathiraja ◽  
Junaid Rafi ◽  
Emily Woolnough ◽  
Anna Clare
Keyword(s):  
Septic Shock ◽  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Antibiotic Treatment ◽  
Bacterial Translocation ◽  
Inflammatory Disease ◽  
Peritoneal Fluid ◽  
Ovarian Endometrioma ◽  
Surgical Evacuation ◽  
Salmonella Senftenberg

Salmonella is an extremely rare cause of an infected endometrioma. We present a case of a 30-year-old immunocompetent woman presenting with fevers and abdominal pain, on a background of prior endometriosis. Initial antibiotic treatment for pelvic inflammatory disease failed, and the patient progressed to septic shock requiring surgical evacuation of an infected ovarian endometrioma. Microbiological samples from stool, ovary, and peritoneal fluid revealed infection with Salmonella senftenberg. The likely diagnosis was Salmonella enterocolitis with bacterial translocation to an ovarian endometrioma.

scholarly journals Pelvic inflammatory disease by actinomyces: report of 1 case and review of the literature

2020 ◽  
Vol 9 (2) ◽  
pp. 804
Author(s):  
Cesar Giovanni Camacho Herrera ◽  
Raul D. Lara Sanchez ◽  
Narmy Olivera Garcia ◽  
Karla E. Abundiz Bibiano
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Intrauterine Device ◽  
Fibrous Tissue ◽  
Pain Syndrome ◽  
Exploratory Laparotomy ◽  
Abdominal Hysterectomy ◽  
Histopathological Diagnosis ◽  
Persistent Abdominal Pain

Actinomycosis is a chronic disease that is characterized by the formation of abscesses, fistulas and dense fibrous tissue at the site of involvement. Its distribution is worldwide. However, pelvic actinomycosis has increased in frequency and has been associated with abdominal surgery, intestinal perforation or trauma, due to the destruction of the muscular barrier. The clinical elements of suspicion are the latency of months and even years of symptoms and the history of being a carrier of an intrauterine device. Actinomyces israelli is a rare etiological agent of pelvic inflammatory disease, so it is difficult to reach the diagnosis. A case report is made of a 48-year-old patient with an intrauterine device older than 5 years, who entered the emergency department with abdominal pain syndrome and 7-day evolutionary fever accompanied by dyspareunia. She was hospitalized for antibiotic treatment, presenting an unsatisfactory evolution, with increased leukocytosis and persistent abdominal pain. An exploratory laparotomy with abdominal hysterectomy was performed. The histopathological diagnosis was pelvic inflammatory disease due to actinomyces. We must always suspect in the presence of a pelvic inflammatory disease in any of its clinical forms, the presence of actinomyces as one of the possible causative germs, especially in patients with intrauterine device for more than 5 years.

Abdominal Pain in the Female Adolescent

1983 ◽  
Vol 4 (9) ◽  
pp. 281-289
Author(s):  
Ronald G. Barr
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Acute Pain ◽  
Inflammatory Disease ◽  
Clinical Judgment ◽  
Good Evidence ◽  
Relative Likelihood ◽  
Presenting Symptoms ◽  
Symptoms And Signs

The diagnosis of abdominal pain is difficult. It requires additional skills and care when the patient is an adolescent. Although the approach required to diagnose a specific disease entity known to be causing the pain symptom is easy, the decisions to take when the patient has the complaint without specific signposts pointing to one entity or another is difficult. In the acute presentation, the decision as to which tests to order or which therapies to initiate must be made almost totally on presenting symptoms and signs. Often the definitive test necessary for the differential (eg, urine culture, cervical culture for gonococcus) will not be reported by the time a clinical decision must be made. In the recurrent presentation, more time is available, but the yield from invasive and expensive tests is lower and more difficult to justify. There are no data prospectively collected in a representative sample of adolescents presenting with abdominal pain in whom a systematic approach to diagnosis was utilized. Thus the relative likelihood of finding urinary tract infection or pelvic inflammatory disease accounting for the symptom, or the relative usefulness of a barium enema examination vs laparoscopy for evaluation of right lower quadrant pain is unknown. As a result, emphasis in this description has been placed on presenting symptoms and signs. Recognizing that diagnostic clinical judgment often involves "pattern recognition," typical presentations have been stressed. However, it should be apparent that this will be insufficient to guarantee diagnostic accuracy. Two of the main reasons for this are the similarity of presentation of so many entities, and the prevalence of atypical presentations. However, a number of principles can be recommended (Table 2): (1) adolescents have different presentations than do younger children; (2) contrary to common belief, adolescents have different presentations than do adults; (3) be aware of increasing prevalence in adolescents of entities that cause abdominal pain at all ages; (4) be aware of entities relating to the genitourinary tract entering into the differential diagnosis; (5) be aware of entities related to life-style changes and exposure to environmental precipitants; (6) appropriate evaluation of the problem of abdominal pain includes assessment of the symptom, the anxiety secondary to the symptorm, and the dysfunction secondary to the symptom; (7) history taking requires excellent communication to overcome shyness relating to patient's self-awareness of sexuality or outright denial of the symptom's significance; (8) appropriate evaluation most often includes a sensitive, expertly performed pelvic examination by an experienced examiner (Cowell) (9) in acute pain presentations, clinical judgment requires consideration of the potential negative consequences of missed "surgical" abdomen, and surgical/gynecologic consultation is often indicated; (10) in recurrent pain presentations, evaluations other than base line tests (history, physical, and pelvic examinations, blood count, ESR, urinalysis, and culture) should not be "shotgun" but used selectively and staged according to relative likelihood of the entity being sought, and usefulness of the procedure in detecting it. Enrollment of the patient as a "coinvestigator" and use of a diary has been found to be helpful in detecting patterns and focusing secondary anxiety about the symptom. It has been estimated that well over 100 entities may present as abdominal pain. Many common (eg, stool retention, gastroenteritis, Mittelschmerz) and less common (eg, abdominal tumors, endometriosis) entities that enter the differential diagnosis agnosis have not been discussed. In the face of these possibilities, I usually adopt the following strategy: (1) with acute pain presentations, to consider first entities with potentically severe consequences requiring early definitive treatment (eg, appendicitis, ectopic pregnancy, ovarian torsion, pelvic inflammatory disease) and to move "down" the differential only when there is good evidence that these first entities are not implicated; and (2) with recurrent presentations, to consider first entities that are most common (eg, nonspecific recurrent abdominal pain, irritable bowel syndrome) and to move "up" the differential to further investigation only when there is good evidence implicating other specific entities. However, no strategy will be appropriate for all situations, and we are far from having a successful recipe for diagnostic success with abdominal pain in adolescents.

scholarly journals Epidemiology and Risk Factors of Pelvic Inflammatory Disease.

2015 ◽  
Vol 13 (1) ◽  
pp. 4-8
Author(s):  
Bandana Pandey
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Rural Areas ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Modern Contraceptive ◽  
Age Group ◽  
Increased Risk ◽  
Reproductive Age Group

Introduction: Knowledge of pelvic inflammatory disease and its epidemiology is essential to understand reproductive morbidity in women. This paper estimates the level of association between demographic factors and pelvic inflammatory disease in women in their reproductive age. Methods: A descriptive study done in Humla, Kritipur and Baudha by organizing a health camp. Women of reproductive age group and who have lower abdominal pain, pervaginal discharge, fever, and dysparunia were included in the study after taking informed verbal consent from the patient. Patients who have lower abdominal pain and pervaginal discharge were diagnosed as pelvic inflammatory disease. Results: Diagnoses of pelvic inflammatory disease were made in 30% of attendances amongst women aged between 16 to 48. Increased risk of pelvic inflammatory disease was associated with smoking (P<0.0001), age groups 31 – 40 yrs (44.6%),in rural areas(45%) and people who are illiterate (P<0.0001). Among 400, 383(95%) were reported ever using a modern contraceptive. Conclusion: The prevalence of pelvic inflammatory disease was 30% in reproductive age group and was significantly associated with smoking.doi: http://dx.doi.org/10.3126/mjsbh.v13i1.12992 

scholarly journals A 41-Year-Old Patient with a Rare Cause of Severe Abdominal Sepsis Misdiagnosed as PID

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Anastasia Mikuscheva ◽  
David Becker ◽  
Mark Thompson-Fawcett
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Negative Impact ◽  
Bowel Perforation ◽  
Abdominal Sepsis ◽  
Young Female ◽  
Persistent Abdominal Pain ◽  
Pouch Of Douglas ◽  
Low Threshold

Infectious pelvic inflammatory disease is a common condition and a frequent cause of abdominal pain in a young female patient. In a patient who has not completed family planning, the diagnosis is often made with a low threshold and treatment started on a low suspicion of diagnosis to avoid a negative impact on fertility. Here, we present a case of a 41-year-old woman who was misdiagnosed with infectious pelvic inflammatory disease and treated ineffectively with antibiotics when the underlying condition of her persistent abdominal pain was a midgut neuroendocrine tumor that had caused bowel perforation and formation of an abscess in the pouch of Douglas.

scholarly journals Accuracy of Five Different Diagnostic Techniques in Mild-to-Moderate Pelvic Inflammatory Disease

2002 ◽  
Vol 10 (4) ◽  
pp. 171-180 ◽  
Author(s):  
Hernando Gaitán ◽  
Edith Angel ◽  
Rodrigo Diaz ◽  
Arturo Parada ◽  
Lilia Sanchez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Clinical Diagnosis ◽  
Inflammatory Disease ◽  
Performance Test ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Diagnostic Methods ◽  
Cross Sectional

Objective:To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures.Study design:A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n= 31) was compared with a group (n= 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods.Results:All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity.Conclusions:Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.

scholarly journals Unique Presentation of Urachal Cyst Disease: Incidental Finding to Complicated Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Seong K. Lee ◽  
Chauniqua Kiffin ◽  
Rafael Sanchez ◽  
Eddy Carrillo ◽  
Andrew Rosenthal
Keyword(s):  
Abdominal Pain ◽  
Adult Patient ◽  
Computerized Tomography ◽  
Incidental Finding ◽  
Ct Scans ◽  
Urachal Cyst ◽  
Unique Case ◽  
Urachal Remnant ◽  
Abdominal Infection

Urachal remnant disease is uncommon in adults and can present with symptoms ranging from drainage near the umbilicus to a severe abdominal infection. Most cases are referred for treatment once diagnosed either clinically or radiographically with ultrasound or computerized tomography. We present a unique case of an infected urachal cyst visualized on a series of CT scans in an adult patient with abdominal pain over a period of years.

scholarly journals Idiopathic Ovarian Vein Thrombosis: A Rare Case in Nonpregnant Woman

2020 ◽  
pp. 1-3
Author(s):  
Tamires de Menezes França ◽  
Natália Monteiro Cordeiro ◽  
Arlley Cleverson Belo da Silva ◽  
Caio Kzan Geyer Nogueira ◽  
Marair Gracio Ferreira Sartori ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Rare Case ◽  
Diagnosis And Treatment ◽  
Nonpregnant Woman ◽  
Ovarian Vein ◽  
Vein Thrombosis ◽  
Prompt Diagnosis ◽  
Ovarian Vein Thrombosis

Ovarian vein thrombosis (OVT) is a rare cause of abdominal pain, is an entity most commonly diagnosed after pregnancy. It is also associated with gynecological malignancies, caesarean deliveries, abortions, hypercoagulability and pelvic inflammatory disease. Prompt diagnosis and treatment is warranted to avoid serious complications [1]. We report the rare case of idiopathic ovarian right vein thrombosis.

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