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Primary mesenteric abscess caused by Klebsiella pneumoniae: A case report
Peng Wang1, Fengfeng Zhu1, Mingming Wang2
1Department of General Surgery, Jincheng General Hospital, Shanxi Medical University, Jincheng, China.
Rationale:
Mesenteric abscess, a rare abdominal infection, is regularly mostly secondary to inflammatory bowel disease, diverticula of the small intestine, or tuberculosis. Primary mesenteric abscesses are extremely rare. If not diagnosed and treated in a timely manner, it may lead to serious consequences; computerized tomography is highly beneficial for the diagnosis of this disease; timely surgical intervention, judicious use of antibiotics, and adequate nutritional support are crucial in the management of this disease.
Patient Concerns:
A 59-year-old male patient from China was admitted to hospital for intermittent abdominal pain accompanied by poor appetite for 10 days. One week before admission, the patient had been infected with corona virus disease 2019. Past history includes type 2 diabetes and post-operative gastric cancer.
Diagnosis:
The emergency abdominal computerized tomography examination results of the patient suggested that the mesentery was cloudy with a large amount of effusion and visible bubble. Mesentery abscess was considered, but duodenal perforation could not be excluded.
Interventions:
We adopted exploratory laparotomy to further clarify the diagnosis. Intraoperatically, after fully exposing the duodenum, we found extensive abscess formation in the mesentery, but no duodenal perforation. After operation, the patient developed duodenal leakage and was treated with gastric tube and jejunal nutrition tube.
Outcomes:
Postoperatively, due to poor general condition, the patient was transferred to intensive care unit; after anti-infective treatment, the condition improved on the 5th postoperative day, and duodenal leakage appeared on the 9th postoperative day, and conservative treatment was ineffective, and the patient eventually died.
Lessons:
Primary mesenteric abscess is a local tissue infectious disease. Whereas we should consider the physical basic condition of the patient during therapeutic process. We believe adequate postoperative drainage, rational use of antibiotics based on bacterial culture, early ambulation after surgery, and adequate nutritional support might be key points for successful therapy.
Insights
A rare primary mesenteric abscess in a patient with COVID-19 and diabetes led to fatal duodenal leakage despite surgical intervention. This case highlights the importance of considering patient comorbidities in managing abdominal infections.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Mesenteric abscess is a rare abdominal infection, often secondary to inflammatory bowel disease, diverticula, or tuberculosis.
- Primary mesenteric abscesses are exceptionally rare and can lead to severe complications if not promptly diagnosed and treated.
- Computerized tomography is crucial for diagnosis, while surgical intervention, antibiotics, and nutritional support are key management components.
Observation:
- A 59-year-old male with a history of type 2 diabetes and gastric cancer presented with abdominal pain and poor appetite, shortly after a COVID-19 infection.
- Abdominal CT revealed mesenteric cloudiness, effusion, and bubbles, suggesting an abscess but not ruling out duodenal perforation.
- Exploratory laparotomy confirmed extensive mesenteric abscess formation without duodenal perforation.
Findings:
- Postoperatively, the patient developed duodenal leakage, which was unresponsive to conservative treatment.
- Despite initial improvement with anti-infective therapy in the ICU, the patient's condition deteriorated, leading to death.
Implications:
- This case underscores the critical need to consider a patient's underlying health conditions when managing primary mesenteric abscesses.
- Optimal outcomes may depend on adequate postoperative drainage, culture-guided antibiotic therapy, early mobilization, and robust nutritional support.
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