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July 2013 Case Presentation

JULY 22, 2013


Perianal Abscess Most common type of anorectal abscess. Any delay in surgical drainage (incision and drainage) of anorectal abscesses prolongs infection, augments tissue damage, and may impair sphincter continence function. Follow-up evaluation of an incised anorectal abscess is important not only for determining whether healing is adequate, but also for assessing the potential development of anorectal fistulas. Anorectal fistulas occur in 30-60% of patients with anorectal abscesses. The intersphincteric glands lie between the internal and external anal sphincters and are associated most commonly with abscess formation. Approximately two thirds of patients with rectal abscesses who are treated by incision and drainage or by spontaneous drainage will develop a chronic anal fistula. Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats. Recurrent abscesses from fistulas may lead to significant short term morbidity from pain, and create a systemic spread of infection. After Surgery, The incision is not closed (stitched), as the damaged tissues must heal from the inside toward the skin over a period of time. Fistulas often develop four to six weeks after an abscess is drained. Sometimes a fistula may not occur until months or even years later. Complications of surgery include Systemic Infection, Anal fissure, an abscess returning, Scarring. Systemic Infection signs and symptoms include Fever above 101.3 F (38.5 C) or below 95 F (35 C), Heart rate higher than 90 beats a minute, Respiratory rate higher than 20 breaths a minute, Probable or confirmed infection, Significantly decreased urine output, Abrupt change in mental status, Decreased platelet count, Difficulty breathing, Abnormal heart pumping function, Abdominal pain. Also, laboratory tests reveals abnormal liver or kidney function, impaired oxygen availability, and electrolytes imbalances.

Pseudomonas Aeruginosa Pseudomonas Aeruginosa is primarily a nosocomial pathogen. Commonly found in soil and water. However, it occurs regularly on the surfaces of plants and occasionally on the surfaces of animals Pseudomonas Aeruginosa has become increasingly recognized as an emerging opportunistic pathogen of clinical relevance. Several different epidemiological studies track its occurrence as a nosocomial pathogen and indicate that antibiotic resistance is increasing in clinical isolates. Pseudomonas Aeruginosa is an opportunistic pathogen, meaning that it exploits some break in the host defences to initiate an infection. The bacterium almost never infects uncompromised tissues, yet there is hardly any tissue that it cannot infect if the tissue defences are compromised in some manner. It causes urinary tract infections, respiratory system infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections and a variety of systemic infections, particularly in patients with severe burns and in cancer and AIDS patients who are immunosuppressed. Pseudomonas is one of the most vigorous, fast-swimming bacteria seen in hay infusions and pond water samples. One of the most worrisome characteristics of P. Aeruginosa is its low antibiotic susceptibility. AMINOGLYCOSIDES (gentamicin, amikacin, tobramycin, but not kanamycin), QUINOLONES (ciprofloxacin, levofloxacin, but not moxifloxacin), CEPHALOSPORINS (ceftazidime, cefepime, cefoperazone, cefpirome, ceftobiprole, but not cefuroxime, ceftriaxone, cefotaxime), PENICILLIN (carboxypenicillins: carbenicillin and ticarcillin), and (ureidopenicillins: mezlocillin, azlocillin, and piperacillin), CARBAPENEMS (meropenem, imipenem, doripenem, but not ertapenem), POLYMYXINS (polymyxin B and colistin), MONOBACTAMS (Aztreonam) Resources: