Thursday, December 4, 2008

Pus - it is everywhere

In my time here, the other docs have always told me that abscesses were more common and to err on the side of giving antibiotics due to the incidence of infections. This has sure proved true in my time here. I have seen a lot of soft tissue abscesses and at least a few times a week I drain an abscess on someone. There have been lots of kids with pyomyositis (pus in the muscle) that I have drained down to the bone, which often then forms osteomyelitis. I have seen a few kids with retroperitoneal abscesses and lung abscesses also. Recently, these abscesses seem to be more common and more severe, where the kids are septic as a result and look like they could die.
About 3 wks ago, I admitted William, who had a lot of pus in his pericardium (sac around his heart). Just last week we did surgery on him to drain the pericardium, and praise God, he is now doing much better and should be going home tomorrow.
While rounding on Saturday, I had a kid, Tangamb, with worsening RUQ pain, fever, high HR, and looked very sick. The family told me to do whatever I could, he was their only child. I did an ultrasound of his liver, and knew it looked abnormal, but I didn't localize a definite abscess. Later, Bill and I repeated the US and we found pus and lots of it. That night, Kevin, our volunteer surgeon and I went in to drain the abscess. I got to do an ultrasound guided aspiration first, which was a good opportunity to do something I may need to use in the future. We got out a lot of pus in the surgery and he is getting better. He is still very sick, but looks better than when he came in. I thought that pus in the liver and the pericardium was pretty neat, but then I found more.
Tues on rounds, another 7 yo girl was admitted with RUQ pain. She wasn't as sick as Tangamb, but on ultrasound she sure has an abscess. She is doing okay on antibiotics for now, so we are just waiting on her. That is 2 in 1 wk, amazing.
Wednesday things got even more interesting. Tofa, a girl I had seen in the clinic 2 times in the last week and wanted to admit, but the family refused returned to the ER. She was having continued abd pain with LUQ tenderness and swelling. On ultrasound, she has a huge splenic abscess, which I had never seen before. She went to surgery that day and Kevin got out a lot of pus.
So this is a lot of pus that we have here. Not sure where it is coming from, or why they are getting it, but we keep finding it and will keep looking for more.