Query: usg appendix abscess journal

title: Role of USG Guided Percutaneous Needle Aspiration in Pyogenic Liver Abscess
abstract: Liver abscess has been a condition of high mortality and morbidity in past but since there is work done over decades with use of percutaneous aspiration and percutaneous drainage along with antibiotics; percutaneous drainage is currently the treatment of choice in liver abscess. Percutaneous needle aspiration (PNA) as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of PLA has never been popular.  To analyze the role of ultrasound (USG) guided percutaneous needle aspiration in the treatment of PLA.  A total number of 25 patients over a time period from March 2016 to February 2017 irrespective of their age. All patients with PLAs underwent PNA with ultrasound (USG) guidance and antibiotic therapy. Complete pus removal from each abscess was attempted with 18 gauge thin walled trocar needles with USG guidance.  The rate of success was unrelated to the large size or number of abscess in the patient. A complete cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in all the patients (100% Imaging guided percutaneous catheter drainage or open surgery was not needed in any of the patient. Neither complications nor deaths ensued. Recurrence rate was nil.  PNA with USG guided in treatment for PLA is a low cost, safe and effective procedure. It should be considered as a first line alternative to catheter drainage. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery.  Pyogenic liver abscess, ultrasonography, percutaneous needle aspiration Cite this Article Arun Dhankhar, Ravi Mathur. Role of USG Guided Percutaneous Needle Aspiration in Pyogenic Liver Abscess.

title: Tubercular Appendicitis With Abscess In Hernial SacA Case Report
abstract: A 55 year old male, presented with pain and right inguinal lump for 5 days, with long standing history of inguinal hernia. A diagnosis of obstructed inguinal hernia was made. Intraoperatively, perforated appendix with mesenteric lymphadenopathy was found, with 2 litre of pus, trickling to hernial sac, through deep inguinal ring. Sac contained no bowel contents. An appendicectomy and a modified Bassini's repair of hernia was performed with satisfactory postoperative outcome. HPE of appendix, mesenteric lymph nodes, Pus reports and HPE of hernial sac revealed tubercular etiology.  Signs and symptoms of abdominal TB are nonspecific. High index of suspicion is required in detection of abdominal/peritoneal cold abscess. Tubercular appendicitis is rare and seen only in 0.1 0.3% of cases.   A 55yr old male, presented in surgery emergency at RIMS, Ranchi with complain of pain and swelling over right inguinal region for 5 days, and inability to reduce his hernia, which he had been doing for 25 years. On examination, he had right indirect irreducible inguinal hernia, which was not strangulated. There was no clinical or radiological evidence of intestinal obstruction. His vital signs were normal. Emergency blood reports and ultrasound abdomen was requested, which showed Hb 10.7g/dl, TLC 11400/cmm( N 55% L39%,RBS 117mg/dl, USG whole abdomenRt inguinal hernia,Appendicitis andRtpyocele. A provisional diagnosis of Right obstructed inguinal hernia was made and patient was shifted to operating room after taking consent. Under general anesthesia, inguinal canal exploration was done. A large hernial sac with thick fibrous wall extending upto scrotum was found. On opening the sac, thick, white, non foulsmelling about 2L of pus was aspirated, communicating to peritoneal cavity through deep inguinal ring. There was no contents in the sac. By separate lower midline incision, peritoneal cavity was explored, which revealed perforation at base of appendix with no signs of ischemia/ gangrene. Few enlarged lymph nodes about 2*2 cm were present in paracaval, mesenteric and periappendicular region. From the base of perforated appendix, pus was found to be trickling. Pus was evacuated completely, appendicectomy done, followed by thorough peritoneal wash. The anatomy of inguinal canal was distorted due to pus and necrotic tissue. Testis and cord structures were atrophied and could not be separated from hernial sac. Excision of hernial sac with (Rt) orchidectomy was done. A bassini repair of hernia was performed. Wound was closed after placement of corrugated drain. Date of Submission: 09 10 2018 Date of acceptance: 24 10 2018  Perforation at appendicular base with pus Tubercular Appendicitis With Abscess In Hernial SacA Case Report.  10.9790/0853 1710087274 www.iosrjournals.org 73 Page {2}Hernial sac excision withorchidectomy, with later repair of hernia. OUTCOME AND FOLLOW UP: 1)Pus reports(a) culture and sensitivityno organism (b) Pus for AFBno growth (c) Pus for ADA102 U/l (normal range <40U/l) (d) Pus for CB NAATpositive for tuberculosis. 2) HPE of excised appendix with lymphnodesGranulomatous inflammation with necrotizing lymphadenitis 3) HPE of hernial sacgranulomatous inflammation. Cat 1 ATT was started on 5 th postoperative day after consultation with chest and TB dept. Postoperative period was uneventful and patient was well on discharge on 10 th postoperative day. {3} HPE of appendix showing granulomatous inflammation. I.  Contrary to Amyand's hernia, the pathophysiology of tubercular cold abscess is distinct. Amyand's hernia is due to extraluminal obstruction of appendix subsequent trauma and retention by adhesions within the hernial sac, followed by ischemia sepsis[0] In our case, there was no contents in hernial sac, exept pus. There was no signs of ischemia of bowel or appendix. Histopathology and pus reports further confirmed tubercular etiology. Gastrointestinal tuberculosis(GTB) is the sixth most frequent site of extrapulmonary involvement in tuberculosis (TB) with rising trends seen with ever increasing incidence of Human Immunodeficiency Virus (HIV) infection[2] In decreasing order gastrointestinal involvement include: the ileocecal region, ascending colon, jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon, and rectum,[3] A recent study from India found that GTB was seen in 11.2% of children affected with TB of which over 50% have extra abdominal manifestations,[4] Inguinal hernia is one of the commonest surgical problems encountered in day to day practice. It is quite surprising, that with such wide prevalence of GTB,[4] involvement of sac or its contents is not common in patients with inguinal hernia in our country,[5] even though the omentum is a common content of the sac. A review of rather meagre literature about Hernial tuberculosis (HT)[6] states that it involves sac, its contents or both. In children it affects only the sac because the sac is usually empty and the concomitant visceral Tubercular Appendicitis With Abscess In Hernial SacA Case Report.  10.9790/0853 1710087274 www.iosrjournals.org 74 Page involvement usually affects the visceral organs. As a rule when tuberculosis affects the viscera, the hernia sac is always involved and when it affects the hernia sac the entire peritoneal surface is also involved[6] The probable mechanism can be that, the congenital groin sac, as in the present case, is the lower most part of the peritoneal sac into which the seeding of the tuberculous bacterium from the peritoneal cavity can occur through gravitational forces. There are three forms of HT :Miliary or ascitic, ulcerocasseous and fibrous,[6] The clinical findings of HT are pain, change in size consistency of hernia bulge and incarceration which is the most constant finding besides the usual constitutional symptoms of tuberculosis. We describe here an unreported physical finding of presence of palpable nodule at the hernial site. Histopathological examination of tissue samples like the sac wall for mycobacterium tuberculosis is essential for the confirmation of diagnosis,[6] Surgery involves repair of inguinal hernia, wide resection of the sac and resection of the involved omentum. Bowel resection can be necessary in presence of strictures, firm adhesions, localized ulcerative lesions as well as strangulation and incarcerations. All cases must receive full course of antituberculous therapy,[6] If at operation the hernia sac is seen to be abnormal or is thickened, then histology should always be performed. However routine histological examination of hernia sacs is not recommended. Kasson and colleagues routinely examined 1020 hernial sacs after surgery[7] The incidence of unexpected findings, the discovery of an occult tumor in those specimens which appeared normal at operation was 1 in 1020(0.098% As pointed by Vashist et al,[8] presence of tubercles in omentum or hernia sac during hernia surgery should be biopsied and sent for histopathology to rule out tuberculosis. In our patient there was preoperative suspicion of HT which lead to close visual inspection of the sac tissue and later histopathological examination to confirm our suspicion of HT.

title: Perforated Appendicitis with Appendicular Abscess
abstract: Most patients with acute appendicitis can be easily diagnosed, but there are many in whom the signs and symptoms are quite variable, and a firm clinical diagnosis is often very difficult to establish. Difficulties in the early diagnosis of appendicitis, particularly in children, often lead to life threatening complications, such as gangrene or perforation of the appendix. Here we report a case where a nine year old boy presented to the Paediatric Department at Anwer Khan Modern Medical College Hospital in Dhaka in April 2016 with a history of abdominal pain, vomiting fever that began nine days before admission. Anwer Khan Modern Medical College Journal Vol. 8, No. 1: Jan 2017, P 73 75

title: Tubercular thyroid abscess: A case report
abstract: Thyroid gland tuberculosis is a very rare extrapulmonary presentation of tuberculosis even in countries where pulmonary tuberculosis is endemic. Thyroid gland tuberculosis was reported in 19th century. Thyroid gland tuberculosis presenting as abscess is very rare with occasional case reports in literature. A case of thyroid gland abscess is presented here.  A young girl presented with swelling in right lobe of thyroid. Ultrasound (USG) revealed a swelling in right lobe of thyroid with central necrosis. Contrast enhanced computed tomography scan (CECT) and magnetic resonance imaging (MRI) scan of neck could not make a definite diagnosis. Fine needle aspiration (FNA) from the swelling could provide the diagnosis of tubercular thyroid abscess. Pus aspirated from the swelling did not reveal any acid fast bacilli. The patient was treated by antitubercular therapy, thus avoiding surgery of thyroid.  The accurate diagnosis of tubercular thyroid abscess is essential by using USG, CECT, MRI scan and FNA. The surgery of thyroid gland has been limited, because of availability of antitubercular therapy. (This page in not part of the published article.   3198  Tubercular thyroid abscess: A case report

title: International Journal of Medical and Biomedical Studies (IJMBS)
abstract: Undoubtedly, most ovarian lesions, endometrial pathology and uterine lesions are best detected with ultrasound. Computed tomography (CT) imaging offers better diagnostic capabilities for large pelvic masses, tuboovarian abscesses, postoperative and postpartum complications. In some cases, Computed Tomography (CT) is employed to achieve optimal differential Diagnosis to determine the clinical pathway to follow. Hence based on above findings the present study was planned for Assessment of Suspicious Ovarian Masses by Comparative Study of USG and CT Techniques. The present study was planned in Department of RadioDiagnosis, Katihar Medical College, Katihar (Al Karim University) Bihar, India. In the present study 50 females were enrolled having Suspicious Ovarian Masses. Computed tomography (CT) and USG characteristics of different lesions were noted and recorded. The histopathological diagnosis was followed up and recorded. The results of this study were analysed and compared with other available studies in literature. The data generated from the present study concludes that Ultrasonography is usually the first imaging modality in evaluation of female patients suspected to have pelvic pathology. Computed tomography is superior diagnostic imaging modality than USG prior to treatment which improved detection and characterization of tumour due to better diagnostic accuracy and consequently reduction of invasive procedure which lead to significant reduction of mortality and morbidity from tumour.

title: International Journal of Medical and Biomedical Studies (IJMBS)
abstract: Ultrasonography (USG) of abdomen remains one of the commonly asked investigations by the surgeon in patients with suspected acute abdomen. The advantage of USG over other radiological investigation is that it is easily available, cost effective, portable, no known side effects, non invasive and requires minimal patient preparation for carrying out the examination. The present study aimed at evaluating ultrasonography findings of appendicitis and to correlate with operative and histo pathological findings.  In our study, USG evaluation was done by the investigators for 61 clinically diagnosed patients, so as to achieve 50 radiologically confirmed appendicitis cases which was the required sample. The study was carried out from December 2013 to September 2015. Data was analysed using the statistical software SPSS version 21.0. Chi Square test was applied to test statistically significant difference in proportion.  In the present study the mean age the study participants was 26.42 years. Majority of the study participants were males 29 (58% while females represented 42%.The average size of the appendix among the study participants was observed to be 7.08 mm with a standard deviation of 1.07 mm. Among all the study participants with acute appendicitis in our study 22% of the patients had perforation of appendix. In our study, we proved that all USG diagnosed appendicitis cases (100% were histo pathologically correct but the variations found in diagnosing the perforation status. We found that the USG had 73.33% and 100% sensitivity and specificity in finding the perforation status.

title: Early versus interval appendicectomy for localised perforated appendicitis in children: A best evidence review
abstract: A best evidence topic in general surgery was written according to a structured protocol. The question addressed was whether early or interval appendicectomy provides a superior clinical outcome for children presenting with localised perforated appendix. Altogether 204 papers were found using the search strategy reported below; of which 5 were identified to provide the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We concluded that for children presenting with localised perforated appendix without abscess formation, early appendicectomy provides better clinical outcome in terms of lower complication and re admission rate and shorter length of hospital stay.

title: The Value of Ultrasonography in Diagnosis of Acute Appendicitis in Pediatric Age Group
abstract: Acute appendicitis is one of the most common surgical emergency condition in pediatric age group that need admission to pediatric surgery unit for emergent operation of appendectomy Any delayed in the diagnosis and operation lead to very serious outcome ,including perforation abscess formation and appendiceal mass formation and other complications which may lead to high mortality and morbidity rate in case of absence timely performed operation of appendectomy Ultrasound (USG)is one of the most helpful and informative tool in diagnosis of acute appendicitis in children.it is simple fast available and with less complications of ionizing radiation that may associated with other modality of radiological methods like CT Aims of the study Evaluate the role of USG examination in 1 diagnosis of children with suspected appendicitis 2 defining the sensitivity specificity and the accuracy rate of acute appendicitis in pediatric age group. 3 Decreasing the normal appendectomy in pediatric age group/ patients and method This prospective study has been achieved in the central child teaching hospital in Baghdad during the period from February 2015 to December 2015, that enrolled 110 patients that were admitted pediatric surgery Center in Central Child Hospital in Baghdad who were complained from right lower abdominal pain and acute appendicitis was highly suspected at time of examination .USG examination had been done to these patients.  Clinical presentation and USG criteria of acute appendicitis had been found in 57 cases out of 110 patients and those underwent appendectomy operation in the Central Child Teaching Hospital in Baghdad Unvisualization of appendix or normal ultrasonography criteria had been found in 53 patients. 6 patients out of the those of 53 patients with negative USG finding underwent appendectomy operation due to persistence of clinical finding, 3 of them were with normal appendix while the 3 others were with inflamed appendix according to histopathological examination. The other 47 patients from 53 cases who were complain from right lower abdominal pain, but with negative USG findings kept for observation for 24 hours and then discharged home with follow up these cases by clinical examination and USG once weekly for 2 weeks. The overall result of a study is as follow Specificity 100% Sensitivity 95% Accuracy rate =97.27% Positive predictive value =100% negative predictive value 50% conclusion ultrasonographic examination have effective role in diagnosis of acute appendicitis in pediatric age group.  Acute appendicitis ultrasonogaphy in acute appendicitis sensitivity specificity accuracy rate.

title: THE LOCATION OF THE APPENDICULAR ABSCESS.
abstract: That the appendix is extremely variable in its location, and that abscesses formed about it may occupy areas widely remote from the usually described appendicular region, are facts which the surgeon who has operated often in cases of appendicitis has frequently encountered. Attempts have already been made, particularly by Gerster (New York Medical Journal July, 1890) and v. Sonnenberg Deutsch Zeitsch. fur Chir. Bd. XXXVIII, Heft. 2 u. 3) to classify these abscesses according to location, accessibility, etc. Gerster describes five types of these abscesses, classified according to the point where they come in immediate contact with the abdominal wall, and are accessible to the knife without traversing the free peritoneal cavity: Ilio inguinal Type The abscess lying anterio, externally beneath the parietal layer. Anterior Type Lying more internally, in direct contact with the anterior abdominal wall. Posterior Type Lying in contact with the posterior peritoneal wall. Rectal Type Accessible through

title: Subphrenic Abscess Complicating Appendicitis.
abstract: Stoughton, Wis. March 21, 1908.  He had never been ill before. He had the symptoms of a bad case, and became steadily worse until the second day, when his temperature and pulse dropped to nearly normal and vomiting stopped. The pain, however, became worse. I therefore diagnosed gangrene of the appendix. He was at once removed to the hospital on a stretcher and I operated on him within an hour. The appendix was found gangrenous, black with greenish flakes and with a perforation near the tip; it was lying in a collection of thin, very bad smelling serum,