Sneak peek 4 handbook of family medicine volume 1

                                Lactational breast abscess (acute bacterial mastitis)

           

Etiology:

Ø  Most common in lactating mothers.

Ø  Due to cracked nipples fissure in nipples.

Ø  Retracted nipples.

Ø  Oral cavity infection of neonate.

Pathology:

Ø  Common organism staphylococcus aureus which enters through nipple proliferate intraductually and leads to stage of cellulitis if not treated form a breast abscess. Non lactating abscess can be due to  duct ectasia or periductal mastitis. When they rupture, they form mammary duct fistula.

Clinical features:

Ø  Sever throbbing pain in breast due to inflammation.

Ø  Swollen, tense, tender, warm to touch breast-stage of  cellulitis.

Ø  High grade  fever with chills and rigors.

Ø  If both breast involved milk to express boil and then to give to infant.

Ø  Deep seated abscess difficult to elicit fluctuation sign.

Treatment:

Conservative:

Ø  Not to feed on affected side.

Ø  Cloxacillin 500m g 6 hourly or amoxicillin clavulanic acid combination orally or IV  as per genera l condition.

Ø  Anti-inflammatory drugs.

Ø  Good supporting bras to use.

Ø  If suspecting anaerobic organism then can add metronidazole.

 Surgical:

Ø  Incision and drainage is treatment of choice. Semicircular incision is preferred.

Ø  Pus should be aspirated and sent for culture and sensitivity.

Complication:

Ø  abscess ,Toxemia, Skin necrosis.

Ø  Antibioma-when abscess is not drained and antibiotics are given abscess cavity becomes fibrous and it results in firm to hard lump in breast. It requires excision.