Intraabdominal Abscess after Acupuncture
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《新英格兰医药杂志》
A 64-year-old Korean woman had a four-week history of dull pain in the lower abdomen that was worse on movement; she had no gastrointestinal or urogenital symptoms. The previous year, the patient had regularly undergone abdominal acupuncture with the use of gold-tipped needles to treat dyspeptic epigastric pain. The last treatment was two weeks before presentation. In the two days before presentation, the pain had worsened and localized in the suprapubic region.
On examination, the patient's temperature was 37.6°C and her abdomen was tender in the suprapubic region. The white-cell count was 15,800 per cubic millimeter. A plain abdominal film revealed more than 100 needles (Panel A). A computed tomographic scan showed a round mass, 2 cm by 2 cm in diameter, containing thick fluid and gas anterior to the bladder (Panel B); acupuncture needles are visible in the subcutaneous fat (arrowheads). An 8.5-French Cope drainage catheter (Panel B, arrows) was inserted, and 15 ml of foul-smelling pus was obtained. Microbiologic culture of the abscess fluid grew two bowel commensal organisms, Bacteroides fragilis and Escherichia coli. The patient was treated with intravenous cefotaxime and metronidazole during the next three days; her temperature normalized, her pain improved, and there was minimal drainage. At follow-up three weeks after discharge, the patient was well.
In this form of acupuncture, which is common in Northeast Asia, gold-tipped needles are inserted in the body and then intentionally broken off, to be left in place permanently. The abdomen is a common site for acupuncture; in this case, it was chosen because of the patient's epigastric discomfort from peptic ulcer disease.
Rodney C. Studd, M.B., Ch.B.
Peter J. Stewart, F.R.A.C.S.
Concord Hospital
Sydney, NSW, Australia
On examination, the patient's temperature was 37.6°C and her abdomen was tender in the suprapubic region. The white-cell count was 15,800 per cubic millimeter. A plain abdominal film revealed more than 100 needles (Panel A). A computed tomographic scan showed a round mass, 2 cm by 2 cm in diameter, containing thick fluid and gas anterior to the bladder (Panel B); acupuncture needles are visible in the subcutaneous fat (arrowheads). An 8.5-French Cope drainage catheter (Panel B, arrows) was inserted, and 15 ml of foul-smelling pus was obtained. Microbiologic culture of the abscess fluid grew two bowel commensal organisms, Bacteroides fragilis and Escherichia coli. The patient was treated with intravenous cefotaxime and metronidazole during the next three days; her temperature normalized, her pain improved, and there was minimal drainage. At follow-up three weeks after discharge, the patient was well.
In this form of acupuncture, which is common in Northeast Asia, gold-tipped needles are inserted in the body and then intentionally broken off, to be left in place permanently. The abdomen is a common site for acupuncture; in this case, it was chosen because of the patient's epigastric discomfort from peptic ulcer disease.
Rodney C. Studd, M.B., Ch.B.
Peter J. Stewart, F.R.A.C.S.
Concord Hospital
Sydney, NSW, Australia