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Actinomyces odontolyticus is an uncommon cause of soft tissue infection and is usually regarded as a commensal microorganism of the oropharyngeal and gastrointestinal microbiota. This article reports the first documented case in the Republic of Kazakhstan of a postoperative wound infection caused by A. odontolyticus following surgery for acute phlegmonous appendicitis. This case emphasizes the diagnostic importance of including Actinomyces species in the differential diagnosis of postoperative soft tissue infections, particularly in cases of atypical wound healing.

Appendicitis is the most common emergency surgical condition of the abdomen in children. This study sought to delineate the presentation and the outcome of appendicitis in children younger than 5 years old. A retrospective review was conducted of all children younger than 5 years of age who underwent appendectomy for acute appendicitis over a 12-year period. One thousand eight hundred thirty-six patients younger than 19 years of age underwent appendectomy. Two hundred eighty-one children with an age range of 6 months to 4.9 years were included in this study. Perforation rates were higher in the younger patients (86% <1 year, 74% 1–1.9 years, 60% 2–2.9 years, 64% 3–3.9 years, and 49% 4–4.9 years), but the youngest children had fewer postoperative abscesses. In children less than 5 years old with appendicitis, age has a direct correlation to the stage of disease. The youngest children present with more advanced appendicitis but are less likely to develop postoperative abscesses.

The aims of this study were to assess the efficacy of percutaneous drainage of postoperative abscess after abdominal surgery and to identify factors predictive of failed drainage. Data from 81 patients with postoperative abdominopelvic abscesses treated with percutaneous drainage were reviewed. Percutaneous drainage failure was considered when surgery was needed to control the sepsis. Predictive variables were sought using univariate and multivariate analyses with logistic regression models. Successful drainage requiring 1 (n = 46) or 2 (n = 17) procedures was observed in 63 patients (78%; 95% confidence interval, 67%–86%). Surgery was needed in 18 patients (22%; 95% confidence interval, 14%–38%). Residual collection after a first percutaneous drainage was the single predictive factor for failed drainage on univariate and multivariate analyses (P = .0275). Percutaneous imaging-guided drainage is a feasible and effective method for the treatment of abdominopelvic abscess, with a success rate of 78%. Residual collection is an independent predictor of unfavorable outcome after percutaneous drainage.

In the surgical management of lower gastrointestinal tract peritonitis (LGTP), drainage of the peritoneal cavity is often recommended. The objective of the study was to evaluate the impact of drainage of the abdominal cavity during management of LGTP. From January 2009 to January 2012, patients undergoing surgery for LGTP were included. The study comprised 3 steps: (1) description of the overall population; (2) comparison of the “no drainage” and “drainage” groups; and (3) a propensity score-matched analysis. The primary end point was the major complications rate; secondary end points were the overall complication, risk factors for postoperative complications, and the length of hospital stay. A total of 205 patients underwent surgery for LGTP. Characteristics of the peritoneum were noted on the surgical report in 141 cases (68%). Abdominal drainage was implemented in 118 patients (83%). After propensity score matching, there was no difference between drainage and no drainage groups in the major postoperative complications (34.7% vs 34.8%; P = .89). Drainage of the abdominal cavity had no impact on postoperative abscess and reoperation rates. Standardization of drainage in this context is required.

Few studies have evaluated the role of computed tomography-guided percutaneous drainage (PD) in the management of gastrointestinal (GI) anastomotic leaks. Ten-year review of an interventional radiology database identified patients with symptomatic GI anastomotic leaks. Clinical, laboratory, radiographic, and operative characteristics following a technically successful PD which then failed and required reoperation for anastomotic leak were compared with those successfully treated with PD. Sixty-one patients met study inclusion criteria. Fifty patients (82%) successfully underwent therapeutic PD of a perianastomotic fluid collection, with median follow-up of 16 months. Eleven patients (18%), at a median interval of 16 days, required reoperation following PD. A forward logistic regression showed cardiopulmonary disease (P = .03) and cancer surgery (P = .01) to be factors independently associated with the need for reoperation. The level of the anastomosis, initial fecal diversion/stoma, fluid collection size, and microbiology of aspirate did not predict failure of PD. Cardiopulmonary disease and cancer surgery appear to be independent predictors for failure of PD and need for reoperation following a symptomatic GI anastomotic leak.

Background: Percutaneous drainage (PD) of complex postoperative abscesses associated with a variety of factors such as multiple location or enteric fistula remains a matter of debate. Accordingly, this retrospective study was designed to determine the predictive factors for failure of PD of postoperative abscess, in order to better select the patients who may benefit from PD. Methods: From 1992 to 2000, the data of 73 patients who underwent computed tomography (CT)-guided PD for postoperative intra-abdominal abscess, were reviewed. PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed. The possible association between failure of PD and 27 patient-, abscess-, surgical-, and drainage-related variables were assessed using univariate and multivariate analysis. Results: Successful PD was achieved in 59 of 73 (81%) patients. The overall mortality was 3% but no patient died after salvage surgery. Multivariate analysis showed that only an abscess diameter of less than 5 cm ( P = 0.042) and absence of antibiotic therapy ( P = 0.01) were significant predictive variables for failure of PD. Conclusions: CT-guided PD associated with antibiotic therapy could be attempted as the initial treatment of postoperative abdominal abscesses even in complex cases such as loculated abscess or abscess associated with enteric fistula.

BackgroundWe investigated the efficacy of broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis with our 3 risk factors:—WBC > 16.5 (× 103/µl), CRP > 3.1 (mg/dl) and appendix maximum short diameter on diagnostic imaging > 11.4 mm.MethodsFour hundred twenty-two patients were reviewed. Patients with 0–1 risk factors were assessed as low-risk and those with 2–3 were high-risk. In the low-risk group, Group A (n = 66) patients received broad-spectrum antibiotics and Group B patients (n = 265) received narrow-spectrum monotherapy. In the high-risk group, Group C patients (n = 63) received broad-spectrum antibiotics and Group D patients (n = 28), narrow-spectrum antibiotics. The outcomes were the incidence of postoperative abscess and the total duration of intravenous (IV) antibiotics.ResultsThe incidence of intra-abdominal abscess was 6.06% in Group A versus 1.89% in Group B (p = 0.08), and 19.05% in Group C versus 3.57% in Group D (p = 0.06). Total IV antibiotic duration (days) were 6.12 ± 2.87 in Group A versus 3.83 ± 0.69 in Group B (p < 0.01), and 7.84 ± 4.57 in Group C versus 4.00 ± 0.82 in Group D (p < 0.01).ConclusionBroad-spectrum antibiotics did not prevent postoperative intra-abdominal abscess in either low or high-risk groups.

Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

To determine if there is a role for routine abdominal imaging in predicting postoperative intraabdominal abscess after appendectomy for the pediatric ruptured appendix. From January 2000 to December 2003 inclusive, 44 consecutive pediatric patients with a ruptured appendix had an open appendectomy and were treated for a minimum of 5 days with triple antibiotics. On postoperative day 5, each patient was evaluated for symptoms (fever, abdominal pain, gastrointestinal dysfunction) and radiological evidence of an intraabdominal fluid collection. Further treatment was determined by the clinical evidence of continuing infection. On postoperative day 5, 36 (82%) of the 44 patients were asymptomatic, had an intraabdominal fluid collection less than 5 cm, diagnosed by ultrasound or computed tomography and received no further treatment. Two of these 36 patients (6%) returned within a week, symptomatic and with a larger collection suspicious for an intraabdominal abscess and requiring further treatment. The other 8 (18%) were symptomatic, and had an intraabdominal abscess more than 5 cm on imaging. All required further treatment, and recovered well. The use of routine abdominal imaging on postoperative day 5, (compared with clinical evaluation), did not improve the ability to predict the development of an intraabdominal abscess.

Postoperative pancreatic fistula is a common complication of pancreatic surgery. In this trial, patients undergoing pancreatic resection who received pasireotide, a somatostatin analogue, had a decreased occurrence of postoperative pancreatic fistula, leak, or abscess. Although mortality after pancreatectomy has decreased to approximately 2% at high-volume centers, the operative morbidity after these procedures has remained between 30% and 50%. 1 , 2 Postoperative pancreatic fistula, leak, and abscess are complications that result from leakage of pancreatic exocrine secretions at the anastomosis or closure of the pancreatic remnant. Postoperative pancreatic fistula is the most common major complication after pancreatectomy, with reported rates between 10% and 28%. Studies suggest that patients in whom postoperative pancreatic fistula develops have a risk of death that is approximately doubled. 3 , 4 Because of the magnitude of this problem, numerous studies have investigated methods . . .