Percutaneous Drainage of a Diverticular Abscess Should be Limited to Two Attempts for a Resilient Diverticular Abscess

2014 ◽  
Vol 80 (7) ◽  
pp. 635-639 ◽  
Author(s):  
Gokulakkrishna Subhas ◽  
Gurteshwar Rana ◽  
Jasneet Bhullar ◽  
Kate Essad ◽  
Leela Mohey ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Healthcare Costs ◽  
Hartmann’S Procedure ◽  
Computed Tomography Scan ◽  
Hartmann's Procedure ◽  
Increased Risk ◽  
Definitive Surgery ◽  
Preoperative Hospital Stay ◽  
Drainage Group ◽  
Tomography Scan

Management of a resilient diverticular abscess poses a big challenge. Currently there are no guidelines for the number of percutaneous drainages to be performed in resilient diverticular abscesses before attempting surgery. All patients (n = 117) who presented with a computed tomography scan-proven diverticular abscess from July 2008 to June 2011 were studied. They were divided into four groups based on the number of percutaneous drainages they underwent for their diverticular abscess: six patients underwent three or more drainages, nine patients underwent two drainages, 27 patients had one drainage, and 75 patients had no drainage. Readjustment, flushing, and upgrading size of the drain were not considered as separate drainage procedures. The size of abscess cavity was significantly higher for the patients who had three or more drainages (mean 8 cm, P < 0.001). A Hartmann's procedure was performed in the majority of patients in the three or more drainage group (83%) but in decreasing frequency as the number of drainages performed dropped: two drainage group (44%), one drainage group (15%), and no drainage group (19%). There was a significantly higher preoperative hospital stay for drainage and antibiotics in the patients from the three or more drainage group ( P < 0.001). Patients with a resilient diverticular abscess are very likely to undergo a Hartmann's procedure after two attempted drainages. By performing additional percutaneous drainages in an attempt to avoid ostomy, patients are at an increased risk of sepsis and peritonitis with prolonged antibiotics and increased healthcare costs. We recommend limiting percutaneous drainage procedures to two attempts to cool down a resilient diverticular abscess before definitive surgery.

scholarly journals Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

2006 ◽  
Vol 20 (7) ◽  
pp. 1129-1133 ◽  
Author(s):  
Y. Durmishi ◽  
P. Gervaz ◽  
D. Brandt ◽  
P. Bucher ◽  
A. Platon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Percutaneous Drainage ◽  
Stage Ii ◽  
Computed Tomography Scan ◽  
Tomography Scan

scholarly journals Multiple Tracheal Diverticula in a COVID-19 Positive Patient

2021 ◽  
pp. 014556132110346
Author(s):  
Konstantinos Garefis ◽  
Konstantinos Tarazis ◽  
Konstantinos Gkiouzelis ◽  
Anastasia Kipriotou ◽  
Iordanis Konstantinidis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incidental Finding ◽  
Positive Patient ◽  
Computed Tomography Scan ◽  
Tracheal Diverticulum ◽  
Tomography Scan ◽  
Paratracheal Air Cyst

A tracheal diverticulum is a type of paratracheal air cyst and is usually an incidental finding after a computed tomography scan of the neck and thorax. With an incidence between 1% and 4% in adults, tracheal diverticula are rare entities that can be symptomatic in certain cases. We present a case of a COVID-19 positive patient who presented to our hospital and was diagnosed with multiple tracheal diverticula during his hospitalization.

scholarly journals Pulmonary coinfection of Mycobacterium tuberculosis and Tropheryma whipplei: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Binghua Zhu ◽  
Jing Tang ◽  
Rong Fang ◽  
Xuejie Fei ◽  
Qing Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mycobacterium Tuberculosis ◽  
Next Generation Sequencing ◽  
Tropheryma Whipplei ◽  
Diagnostic Methods ◽  
Next Generation ◽  
Computed Tomography Scan ◽  
Chest Computed Tomography ◽  
Tomography Scan ◽  
Generation Sequencing

Abstract Background We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. Case presentation A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient’s body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. Conclusions Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.

Numerical assessment of natural respiration and particles deposition in the computed tomography scan airway with a glomus tumour

2021 ◽  
pp. 095440892110240
Author(s):  
Digamber Singh
Keyword(s):  
Computed Tomography ◽  
Respiratory Tract ◽  
Particle Deposition ◽  
Flow Characteristics ◽  
Glomus Tumour ◽  
Computed Tomography Scan ◽  
Human Respiratory Tract ◽  
Airflow Pattern ◽  
Human Airways ◽  
Tomography Scan

The human respiratory tract has a complex airflow pattern. If any obstruction is present in the airways, it will change the airflow pattern and deposit particles inside the airways. This is the concern of breath quality (inspired air), and it is decreasing due to the unplanned production of material goods. This is a primary cause of respiratory illness (asthma, cancer, etc.). Therefore, it is important to identify the flow characteristics in the human airways and airways with a glomus tumour with particle deposition. A numerical diagnosis is presented with an asymmetric unsteady-state light breathing condition (10 l/min). An in vitro human respiratory tract model has been reconstructed using computed tomography scan techniques and an artificial glomus tumour developed 2 cm above a carina on the posterior wall of the trachea. The transient flow characteristics are numerically simulated with a realizable (low Reynolds number) k–ɛ turbulence model. The flow disturbance is captured around the tumour, which influenced the upstream and downstream of the flow. The flow velocity pattern, wall shear stress and probable area of inflammation (hotspot) due to suspended particle deposition are determined, which may assist doctors more effectively in aerosol therapy and prosthetics of human airways illness.

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