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Giant horseshoe intra-abdominal abscess.

W A Altemeier, W R Culbertson, J P Fidler

    Annals of Surgery
    |May 1, 1975
    PubMed
    Summary

    Giant horseshoe abscesses are complex abdominal and pelvic infections often diagnosed late. Early diagnosis and surgical drainage are crucial for successful treatment and preventing sepsis.

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    Area of Science:

    • Abdominal Surgery
    • Infectious Diseases
    • Surgical Pathology

    Background:

    • Giant horseshoe abscesses are rare, complex infections involving abdominal and pelvic cavities.
    • These extensive lesions often extend across multiple anatomical spaces, including subphrenic and paracolic areas.
    • Infrequent occurrence and advanced presentation complicate recognition and diagnosis.

    Purpose of the Study:

    • To highlight the diagnostic and therapeutic challenges posed by giant horseshoe abscesses.
    • To emphasize the importance of early and accurate diagnosis for improved patient outcomes.
    • To review the management strategies and outcomes in patients with these complex infections.

    Main Methods:

    • Retrospective review of 12 patients with giant horseshoe abscesses at the University of Cincinnati Medical Center.
    • Analysis of clinical presentation, diagnostic methods, etiologic factors, and treatment approaches.
    • Evaluation of patient outcomes, including morbidity and mortality.

    Main Results:

    • The study identified 12 cases of giant horseshoe abscesses, characterized by extensive communication between abdominal and pelvic compartments.
    • Diagnostic difficulties were noted, often obscured by prior surgeries or complex underlying conditions.
    • Etiologic factors included biliary tract issues, hemorrhage, and perforated peptic ulcers.
    • Nine out of 12 patients were successfully treated; 3 patients died.

    Conclusions:

    • Giant horseshoe abscesses require a high index of suspicion due to their complex and often insidious nature.
    • Early and accurate diagnosis, coupled with prompt and adequate surgical drainage, is paramount.
    • Effective management necessitates a multimodal approach including antibiotics and supportive care.
    • Failure in early recognition and comprehensive drainage contributes to persistent sepsis and poor prognosis.

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