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Purpose Deep neck infection is a potentially life-threatening condition, and thus, early identification and treatment are essential. This study explored the diagnostic challenges and preceding treatment in patients with repeated healthcare contacts due to an odontogenic or a peritonsillar abscess. Methods A retrospective study of oropharyngeal abscesses in hospitalized patients was conducted. Included were inpatients with an odontogenic or a peritonsillar abscess during 2019. Excluded were patients with other infection type and patients with an odontogenic abscess preceded by tooth removal. The main outcome variable was repeated healthcare visit(s) due to the current infection prior to hospitalization. The primary predictor variable was source of infection. Explanatory variables comprised age, sex, duration of symptoms (days), clinical findings, and referring unit. Additional analyses were conducted for patients with repeated healthcare visits. Study groups were compared using Fisher’s exact test, Student’s t -test, test where appropriate. A 2 × 2 risk analysis was performed. Results Altogether 294 patients, 153 (52.0%) with an odontogenic abscess and 141 (48.0%) with a peritonsillar abscess, were included in the study. Source of infection was unidentified more often in patients with an odontogenic than a peritonsillar abscess ( P  < .001). In all, 106 patients (36.1%) had repeated healthcare visits prior to hospitalization, which was significantly associated with an odontogenic abscess ( P  = .039). Active intervention was conducted in only 34.0% of the patients with repeated healthcare visits. Conclusions Clinicians have challenges in recognizing a developing odontogenic abscess, which remains essential for prompt and effective surgical intervention.

Multiple Candida glabrata (C. glabrata) brain abscesses are an exceptionally rare central‐nervous‐system infection. Clinical data on diagnosing and managing multiple Candida glabrata brain abscesses are still scarce. Here we reported a 66‐year‐old patient with multiple C. glabrata brain abscesses confirmed by cerebrospinal‐fluid puncture. The patient showed marked improvement following intracranial pressure‐lowering therapy and antifungal therapy. By detailing the relevant MRI findings and therapeutic approach, this article aimed to provide a reference for the future clinical diagnosis and management of similar cases. Key Clinical Message This article introduced a rare case of multiple brain abscesses caused by C. glabrata. We analyzed the MRI manifestations and summarized the related treatment methods. Clinical Message In this case, we reported a 66‐year‐old patient with multiple C. glabrata brain abscesses confirmed by cerebrospinal‐fluid puncture. The patient showed marked improvement following intracranial pressure‐lowering therapy and antifungal therapy. By detailing the relevant MRI findings and therapeutic approach, this article aimed to provide a reference for the future clinical diagnosis and management of similar cases.

Objectives To analyze the correlation of diabetes mellitus and hyperglycemia with severe odontogenic abscesses. Materials and methods Records of all patients in the Department of Oral and Maxillofacial Surgery of the Medical Center of the Johannes Gutenberg-University who underwent inpatient treatment for severe odontogenic abscesses between 2010 and 2016 were evaluated retrospectively regarding diabetes anamnesis, maximum and fasting blood sugar count, and duration until discharge. In order to compare the numbers to a general maxillofacial group, all patients who received inpatient treatment in 2013 for any diagnosis other than an abscess of the head and neck region were analyzed as well, and the numbers were correlated. Results In total, 977 abscess patients were found in the analyzed period. 7.0% of the patients had a known diagnosis of diabetes mellitus type II and 0.6% of type I. Correlation with the general group showed that abscesses were significantly more likely in diabetics as well as patients with abnormal maximum and fasting blood sugar counts. These patients also needed significantly longer inpatient treatment. Conclusions Diabetics and patients with abnormal glucose tolerance show significantly higher numbers of severe odontogenic abscesses and might therefore benefit from earlier escalation of antibiotic medication. Clinical relevance Severe odontogenic abscesses are one of the most frequent diagnoses in maxillofacial practice. Adjusting the therapeutic approach for diabetics or patients with abnormal blood sugar counts might help to prevent the development of abscesses.

Background It is well known that breastfeeding plays an important role in the health of women and children. However, women are not always given optimal support and most do not reach their breastfeeding goals. About one in five, breastfeeding women report mastitis and a small proportion of these develop a breast abscess. Our aim was to describe the experiences of a group of Swedish breastfeeding women who developed a breast abscess. Methods A qualitative cross-sectional study with 18 study participants was undertaken in Sweden in 2017–2018. Potential participants were identified through electronic medical records at a university hospital and invited to participate in audio-recorded telephone interviews. Women were between 2 and 24 months postpartum at the time of the interview, on average 8 months. We conducted a thematic analysis in six steps according to Braun and Clark. Results Our analysis identified two themes: 1) Seeking care and receiving treatment was long and unpleasant, and 2) Importance of adequate professional care. Women who experienced a breast abscess were uncertain about where to ask for professional help. They often had a long wait for the right time to undergo the unpleasant and painful procedure of draining their breast abscess. The women felt it was important to receive professional care with respectful communication, continuity of care, and to receive adequate information, but they did not always receive this level of care. Conclusions Women with puerperal breast abscesses often fall between medical specialty areas. No longer under the care of obstetricians and maternity services, their problem is too complicated for general practitioners or emergency departments, but not regarded as serious by breast surgeons. Healthcare professionals urgently need adequate training in order to deal with breastfeeding problems and be able to offer women-centred care.

INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22-25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.

Les fistules anales sont dans la plupart des cas d’origine cryptoglandulaire. Elles peuvent se présenter sous forme d’abcès aigu qu’il est alors nécessaire de drainer ou sous forme de fistule chronique. Le bilan topographique de la fistule est primordial pour guider la prise en charge. Il faut caractériser l’orifice interne, l’orifice externe et la complexité du trajet fistuleux qui les relie. En cas de fistule basse, une fistulotomie simple peut être envisagée et est le traitement le plus efficace. Si la fistule est haute et complexe, la prudence est de mise, et il faudra fractionner les temps opératoires pour limiter le risque de troubles de la continence postopératoire. Anal fistulas arise in most cases from cryptoglandular origin. They may be in the form of acute abscess that is necessary to drain or chronic fistula. The topographical fistula characterization is then essential to guide the management. It is necessary to research the internal orifice, the external orifice, and characterize the fistulous tract which releases them. In case of low fistula, a fistulotomy may be considered and is the most effective treatment. If the fistula is high and complex, caution is used and it will be necessary to divide the operative times to limit the risk of anal incontinence.

IntroductionSkin and soft-tissue infections (SSTI) present regularly as cutaneous abscesses which require surgical drainage. These abscesses often affect younger patients and interfere with their independency substantially. Existing guidelines display heterogeneous recommendations concerning surgical aftercare. Primary aim of this survey was to present a nomogram for standard abscess therapy based on international expert opinions.MethodAn online survey dealing with standard of care protocols for cutaneous abscesses concerning surgical treatment and aftercare was created. The survey was conducted in 2017 during two international conferences held in Switzerland.Result490 surgeons originating from 66 nations participated in this survey with the majority coming from Europe and Asia. Indication for surgery, operation type, and wound rinsing were answered homogeneously. Perioperative setting (45% sterile, 55% semi-sterile), anesthesia (45% local, 55% general), antibiotic therapy (38% always, 35% never, 27% other), irrigation fluid (54% sterile, 32% non-sterile, 14% antiseptic), irrigation frequency (55% once daily, 30% twice daily), and wound dressing (69% packing, 31% coverage) were heterogeneously answered topics.ConclusionTreatment and aftercare of simple primary skin abscesses are processed heterogeneously throughout the world. Focus should be on optimal patient focused treatment with minimal socio-economic impact. Future studies should focus on the validation of the different postoperative treatment options with the aim to develop a socio-economically accepted algorithm.

Background: Treatment of brain abscess is still a subject of controversy. Simple therapeutic approaches like twist drill/burr hole aspiration with or without insertion of a drain are also quite effective. There are reports of encouraging results following endoscopic treatment. We are reporting our results of endoscopic approach on 24 patients. Materials and Methods: This is a prospective study on 24 patients of brain abscesses treated between January 2004 and January 2007. All the cases except those with small abscesses (less than 1.0 cm in diameter) and multiloculated abscesses were included. Gabb 6-degree rigid endoscope was used. Repeat CT scan was done in all cases within 7 and 30 days after surgery. Ten patients (42%) had small residual abscess on 7 th post-operative day′s CT scan, while 30 th post-operative day′s CT scan did not show any significant lesion in all the cases. Results: There were 23 patients of chronic otitis media and one of congenital cyanotic heart disease. Glasgow coma score (GCS) was 3 in one patient, 13 in two cases, 14-15 in 21 cases. There were 14 cerebellar, 8 temporal and 1 frontal and thalamic abscess each. All the patients recovered completely except one who died (GCS 3). There was no procedure-related complication. Hospital stay ranged from 7 to 12 days with an average of 8.2 days. Follow-up ranged between 6 and 42 months. Conclusion: Endoscopic aspiration of brain abscess appears to be a safe and effective alternative method of treatment. There is direct visualization of abscess cavity, completeness of aspiration can be assessed, and perioperative bleeding can be controlled.

To describe percutaneous maneuvers to treat the unusual entity symptomatic pseudomyxoma peritonei (PMP). Four patients with PMP were treated by interventional radiology techniques that included large catheters (20-30 Fr) alone (n = 3), multiple catheters (n = 4), and dextran sulfate as a catalytic agent through smaller catheters (n = 1). The causes of the PMP were tumors in the ovary (2 patients), appendix (1 patient), and colon (1 patient). Each patient previously had undergone at least two operations to remove the PMP, and all patients had symptomatic recurrence. An in vitro analysis of catalytic agents also was performed. All four patients improved symptomatically. Follow-up CT scans demonstrated marked reduction of PMP material in all cases. One patient underwent another interventional radiology session 5 months after the first; the other three patients had no recurrence of symptoms. One patient had reversible hypotension 2 hr after the procedure. The amount of material removed varied from 3 to 6 L. These interventional radiology techniques were effective and safe for PMP and suggest options for this difficult medical and surgical problem.

Abdominal actinomycosis may appear as an abdominal mass and/or abscess. This mass can mimic a malignant tumour. The diagnosis and management of abdominal actinomycosis will be discussed through a review of the literature and a case report from our own institution. The patient was a 17-year-old boy who presented with abdominal discomfort and a palpable right lower quadrant mass defined on CT scan. He underwent en bloc resection of the mass for a presumed diagnosis of tumour of uncertain type with intestinal involvement. The diagnosis was reversed, when histology revealed filamentous organisms consistent with actinomyces. He was treated with high dose penicillin for several weeks and was discharged from the hospital taking penicillin orally. Preoperative diagnosis of abdominal actinomycosis is difficult. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical resection. Recognition is important because successful treatment requires combined surgery and prolonged penicillin treatment.