Meat Hook Injury Leading to Brain Abscess: A Rare Occurrence

Transorbital orbitofrontal penetrating injury by a nonmissile object is uncommon. The presentation of this injury varies. This injury can be easily missed during the initial clinical presentation, because the foreign body is sometimes not visible on local examination, the wound on the orbital skin is small, and very subtle signs are present. The patient can present with delayed complications of the primary injury. Our patient was a 33-year-old male who presented with an orbitofrontal injury with a meat hook. He had minor symptoms at the time of presentation, which were overlooked. Three weeks later, he developed signs and symptoms of raised intracranial pressure (ICP). Brain imaging revealed a peripheral rim of contrast-enhancing mass lesion in the right frontal lobe, extending into the right orbit with perilesional edema suggestive of posttraumatic brain abscess. Via right frontal craniotomy, pus was drained out and abscess wall was excised. The patient made good clinical recovery. A higher index of suspicion and sound knowledge of occult penetrating injury patterns is required in the cases of orbital injuries. Appropriate radiological imaging can lead to an earlier and accurate diagnosis, and can prevent its delayed sequela like brain abscess.

Unusual Abdominal Wall Abscess Post-Laparoscopic Cholecystectomy

Cholecystectomy is the most commonly performed operation worldwide nowadays. Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstones. We present a case of an 81-year-old male with a 3-months’ history of loss of appetite and weight with no associated symptoms. The patient had undergone an LC for symptomatic cholelithiasis 1 year previously, with an uneventful recovery. The clinical examination was essentially normal. A computed tomography (CT) of the abdomen and pelvis showed thickening of the right perihepatic peritoneum measuring 15 × 15 × 3.5 cm, suggestive of chronic granulomatous lesion or atypical mesothelioma. We performed a diagnostic laparoscopy and found the lesion to be an abdominal wall abscess. The abscess cavity was deroofed, the pus was drained and a thorough wash out given. Surprisingly no stones or any foreign body were found in the cavity. Histology of the abscess wall showed non-specific inflammation. We report this case as a post-LC abdominal wall abscess with two peculiar features – (a) no systemic or local symptoms, and (b) no association with spilt gallstones or other foreign bodies like sutures.

Penile aseptic abscess in the cavernous body at the base of the penis: a case report

We report a case of aseptic abscess in the cavernous body at the base of the penis. In our clinical observation, the patient underwent puncture and drainage of the corpus cavernosum abscess, followed by surgical resection of the abscess wall, with the incisions closed layer by layer with primary suture. In addition, we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema; the incision would not be covered with dressings from the third day after the operation, so as to keep the incision site dry in an open way. During the period of indwelling of the catheter after the operation, we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections. Finally, the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis. The patient recovered well after surgery and was discharged 1 week later. At 1.5 years after the operation, the shape of the penis returned to normal, and the erectile function was normal. It was seen that good nursing concept is of great help for prognosis, which could avoid infection and edema, and is conducive to wound healing.

A non-resolving splenic ‘abscess’ in an elderly male – An unusual manifestation of splenic lymphoma

Splenic abscess is a relatively uncommon condition, posing a diagnostic and therapeutic challenge for the treating physician. It occurs due to haematogenous spread from endocarditis or other septic foci, especially in immune-compromised individuals and diabetics. We describe an elderly male who presented with splenomegaly and low-grade fever with no predisposing factors. Examination revealed a tender splenomegaly. Ultrasonography (US) showed a hypoechoic area within the spleen from which guided aspiration of pus grew Staphylococcus aureus and Klebsiella pneumoniae. Percutaneous drainage and culture-based antibiotics failed to resolve the abscess, obligating surgical drainage. Intraoperative biopsy from the abscess wall was reported as splenic marginal lymphoma. This unusual presentation of lymphoma needs to be considered in splenic abscess without known risk factors.

Pott’s disease with extensive bilateral psoas abscesses in a Nigerian woman: an unusual case

Bilateral psoas abscesses are uncommon in Pott’s disease. We describe a 28-year-old Nigerian woman with a 2-year history of constitutional symptoms and a 1-year history of bilateral paravertebral masses. She had received anti-tuberculosis (TB) treatment in an interrupted manner. A computed tomography (CT) scan revealed T10–T12 spondylitis, wedge collapse and extensive bilateral psoas abscesses. Histology of the abscess wall was definitively diagnosed as soft tissue TB, and special staining for acid-fast bacilli was positive. She was successfully treated with anti-TB therapy and ultrasound-guided surgical drainage of 6 L of abscess fluid. Complicated cases of Pott’s disease may require multi-disciplinary interventions for optimal outcome.

Mixed brain abscess due to Streptococcus and Tuberculosis in a pregnant woman with favorable evolution. A case report

Tuberculosis is a global public health problem and is among the top ten causes of mortality in the world. We present the unusual case of a 37-year-old woman, referred for fever, progressive headache, nausea, vomiting and change in mental status. Brain imaging studies. showed a left frontal brain abscess with subfalcin herniation. As an urgent procedure, surgical drainage of the brain abscess was performed, and in the culture of pus there was growth of an anaerobic Streptococcus. The histopathological study of the abscess wall showed data on tuberculosis. The patient was pregnant at surgery, for about five weeks and received anti-tuberculous medications with close maternal fetal follow-up. Pregnancy came to term and was resolved by an elective cesarean section, both mother and child had a favorable evolution.

Outcome of management of brain abscess in children

Objective: To find out the outcome of management of brain abscess in children. Methods: This is prospective observational study conducted in the Department of Paediatric Neurosurgery at Children’s Hospital and Institute of Child Health, Multan from July 2014 to June 2017. Children up to the age of 14 years suffering from brain abscess were admitted. After taking clinical history, general and systemic physical examination and necessary investigations, abscess was evacuated and abscess wall excised after performing craniotomy. Data was collected on a predesigned performa. Results were analyzed and compared with national and international literature through statistical package for social sciences (SPSS-20). Results: Twenty five patients up to 14 years of age were included. Seventeen (68%) were male and eight (32%) female. Fever and vomiting were present in all 25 (100%) patients. Paranasal sinusitis was predisposing causative factor in 9(36%) followed by otitis media in 7 (28%). Abscess was present in frontal lobe in 9 (36%), temporoparietal region in 8 (32%), posterior fossa in 5 (20%) and multiple abscesses in 3 (12%). Craniotomy was performed, pus evacuated and abscess wall excised in all 25 (100%) patients. Three (12%) patients expired. Conclusion: Incidence of brain abscess can be decreased by treatment of its predisposing causes as sinusitis and otitis media. Small abscess less than 2cm can be treated with antibiotics. Complete evacuation of pus and excision of abscess wall after performing craniotomy along with appropriate antibiotics is gold standard management of brain abscess in children. doi: https://doi.org/10.12669/pjms.36.3.1087 How to cite this:Khan IU, Latif A, Ashraf M, Chishti MK, Sadiq S. Outcome of management of brain abscess in children. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1087 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Parapharyngeal abscess and vocal cord palsy caused by minor salivary gland sialadenitis: an atypical presentation treated using an endoscopic surgical approach

Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.

A Novel Magnetic Resonance Imaging Scoring System in Making Specific Diagnosis of Tubercular Spondylitis in Advanced Infection

Objective: The diagnosis of tuberculous spondylitis by microbiological and histopathological analysis is time consuming. Non-invasive methods such as magnetic resonance imaging (MRI) are useful for early diagnosis of infective spondylitis; however, the usefulness of MRI in accurate prediction of tuberculosis rather than non-specific infections is still not elucidated. There is a lacuna in the literature with regard to this. Non-invasive identification of tubercular etiology help in initiation of appropriate treatment and thus a better therapeutic response. We intend to devise a novel MRI score in making a confident diagnosis of tubercular spondylitis rather than non-specific infective spondylitis. Materials and Methods: A retrospective observational analysis was performed on 125 biopsy-proven infective spondylitis patients which included 70 tubercular (Group A) and 55 pyogenic (Group B) patients. Tubercular spondylitis was confirmed by either positive result of tissue gene expert test, histopathology or culture results. Eight MRI findings described in literature to be favorable for tubercular spondylitis were selected and analyzed for their predictive value, and a scoring system is derived based on the observations. Results: Statistically significant differentiation was noted in six out of selected eight MRI parameters, namely, (1) involvement of more than two contiguous vertebrae, (2) presence of para or intraosseous abscess, (3) subligamentous spread, (4) vertebral collapse, (5) large collection with thin abscess wall, and (6) presence of hypointense debris/wall on T2WI. Positive predictive value for tubercular spondylitis was obtained for the following MRI parameters by multivariate regression analysis: (1) Sub-ligamentous spread, (2) vertebral collapse, (3) large collection with thin abscess wall, and (4) presence of T2 hypointense debris. These MRI parameters having an independent prediction of tuberculosis were given two points score for each. Less significant MRI findings of more than two contiguous vertebral involvement and presence of intraosseous abscess were given a score of one for each. A total score of 10 was formulated and scoring for both groups was tabulated and analyzed. Contrary to that available in literature, no significant statistical correlation for differentiation was observed in our group for the presence of skip lesions and absence of intervertebral disc involvement. Hence, these were not included in our scoring system. Distribution of scores among the subjects aged 53.4 ± 17 years showed P < 0.001 (t-test and Mann–Whitney U-test) with mean of 7.4 for tubercular and 2.9 for pyogenic group (SD of 1.9). A score of 6 or above suggested tuberculosis and score below 6 suggested pyogenic infection (Chi-square value of 87.67 and P < 0.00001). Conclusion: MRI can thus be used for accurate diagnosis of spinal tuberculosis, and our novel MRI scoring system can be applied to exclude non-specific spondylodiscitis, help in reducing the burden of additional invasive investigations, expenditure and the time delay for initiating antitubercular treatment.

Port Site Infections Following Laparoscopic Cholecystectomy

Background: Port site infections (PSIs) following laparoscopic cholecystectomy is an infrequent complication. Among the causes of PSIs Mycobacterium tuberculosis is rare but it has been increasingly recognized in the recent years. Lack of awareness of this complication leads to prolonged morbidity. Early diagnosis and treatment is important for theresolution of the disease.Methods: This was an observational descriptive study carried out on patients who underwent laparoscopic cholecystectomy. In patients of PSIs, Gram and AFB staining with culture & sensitivity of pus and biopsy of abscess wall or sinus tract were obtained as per need to reach the diagnosis. Patients were treated accordingly.Results: The rate of PSIs was 3.92% in this study. Age, sex & body weight have no impact on PSIs. Diabetes mellitus, hypertension, hypothyroidism, acute cholecystitis & spillage of bile or stone during the procedure increases the rate of PSIs. Epigastric port was affected more than that of other ports. Among the causes of port site infections in 55.18% cases it was with Gram +ve bacteria, in 34.49% cases with Gram -ve bacteria, in 1.72% cases atypical mycobacteria, in 5.17% cases Mycobacterium tuberculosis & in 3.44% cases no organisms were found. Most of the PSIs developed early within one month & responded well with antibiotics. Diagnosisof port site tuberculosis was established by histopathological examination of tissue from abscess wall or sinus tract & treated as per WHO guide line. No recurrence noted at 2 years follow up.Conclusion: Port site tuberculosis after laparoscopic cholecystectomy is a rare entity. The present study is an attempt to make surgeons aware of this rare complication. Early diagnosis and proper treatment are prerequisites to the successful outcome. Strict adherence to well established sterilization protocol is a must for the prevention.Bangladesh J Medicine Jul 2018; 29(2) : 51-58