MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY
FACULTY OF MEDICINE
DEPARTMENT OF SURGERY
NAME: KAWESI FRANCISCO
REG NO: 2015/MBR/040/PS
YEAR OF STUDY: 5
CASE WRITE UP: BREAST ABSCESS.
PATIENT DEMOGRAPHICS
Name: Bainomugisha Annet.
Age: 30 years old
Sex: Female.
Address: Nyamitanga, Mbarara.
Tribe: Munyankole.
Religion: Anglican
Occupation: Hair dresser.
Marital status: Not married
Education: S .1
Next of kin: Natukunda Eve (Sister)
Presenting Complaint.
Painful swollen right breast for 3 weeks.
History of presenting complaint.
She was well until three weeks prior to admission when she developed a painful swollen right
breast. The pain and the swelling progressively increased. The pain was throbbing in nature and
more severe in lateral lower quadrant initially but later it became evenly distributed thought the
whole breast. Initially there was breast engorgement but no skin lesion or ulceration.
The breast started draining pus. She got intravenous ceftriaxone, diclofenac from Buhweju HC
III as per treatment document. There was no improvement. She was breastfeeding on the left
breast. She reported no history of any breast swelling.
Review of other system.
Cardiovascular system;
No awareness of abnormal heart beat, no easy fatigability, no chest pain, no breathlessness, no
swelling of legs.
Respiratory system.
No cough, no hemoptysis.
Gastrointestinal system.
No diarrhea, no constipation, no vomiting, no nausea, no anorexia.
Central nervous system.
No headache, no convulsions, no unconsciousness.
Musculoskeletal system.
She reported general body weakness but no muscle pain or weakness, neither joint pain nor
stiffness.
Past surgical history.
No history of any surgical procedures, fractures and no blood transfusions.
Past medical history.
She is HIV negative (last tested 3 months ago), No history of any chronic illness like
hypertension, diabetes mellitus, sickle cell anemia, asthma . No known drug allergies.
Family-social history.
She is the last born out of 5 other siblings who are all alive and well. No history of hereditary
illness.
She does not smoke or drink alcohol. She lives with her husband and two children.
Summary.
Annet, a 30 year old woman presented with three weeks history of a painful swollen right breast
associated with fever and pus discharge. She is breastfeeding a 1 year old baby.
Examination.
A sick a looking young woman in pain and fair nutritional status has normal capillary refill, no
finger clubbing, no conjunctival pallor, no sclera jaundice, no dehydration. No central cyanosis,
no dehydration. Palpable lymphadenopathy in the axilla.
130
Vitals; Temperature – 37℃ , Pulse rate- 78bpm, Bp - mmHg
80
Breast examination.
Breasts were asymmetrical, left breast smaller, nipple erect and no palpable mass, no pus
discharge. Right breast was tender, warm and had purulent discharge.
Cardiovascular pressure.
130
Blood pressure was mmHg, jugular pressure not raised.
80
Heart sounds I and II were heard with no added murmurs.
Respiratory examination.
Chest had no scars, no deformity. The chest was symmetrical and moving with respiration. Equal
air entry, no crackles, no stridor and no wheezes. Respiratory rate was 20 breaths per minute.
Central nervous system:
The patient was fully alert and well oriented in time and place.
15
The pupils dilated equally in response to light. Glasgow coma scale .
15
Abdominal examination.
The abdomen was normally distended, moving with respiration, no scars, and no obvious
masses. Bowel sounds normal and presents.
No tenderness and no organomegally on palpation. Tympanic sound on percussion.
Diagnosis; Breast abscess.
Differential diagnosis.
- Cellulites, benign breast carcinoma, mastitis.
Follow up.
She was admitted to emergency ward and underwent incision and drainage plus dressing. She
was dressed for 5 days after being transferred to the female ward.
She was also given the following drugs;
- Intravenous metronidazole 500mg twice a day for 5 days.
- Intravenous ampiclox once daily for 5 days.
- Diclofenac 75 mg 8 hourly for 3 days.
On the fifth day she was discharged and advised to continue wound dressing at the nearest health
centre.
Discussion.
A breast abscess is a painful collection of pus in the breast.
Breast abscess is often linked to mastitis, a condition affecting breast feeding mother. During
breast feeding, the milk ducts can be blocked leading to engagement. Or infectious organisms
can enter through fissured nipple. If engorgement is not reduced or infection left untreated for
24 hours, an abscess usually develops due to inflammation.
Clinical manifestations.
I. Localized breast swelling.
II. Unilateral pain.
III. Warmth.
IV. Fever
V. Pus discharge from nipple.
VI. Tenderness.
VII. Enlarged regional lymph node.
In this case, the patient had unilateral pain, pus discharge from the nipple, swollen breast.
Investigations.
I. Ultrasonography to determine whether masses are solid or cystic. Abscess appears as ill
defined masses with central hypo echoic areas.
II. Complete blood count.
III. Fine needle aspiration for cytological examination.
IV. Pus aspiration for culture and sensitive.
Management.
Surgical management.
I. Incision and drainage done under local anesthesia..
II. Needle aspiration may be considered if the abscess is less than 3 cm diameter although
re-occurrence of abscess may occur.
In this case, the patient was managed surgically by incision and drainage.
Medical management.
This done to eradicate the infection and minimize complications.
The most common causative agent is staphylococcus aurous.
Penicillinase- resistant antibiotics such as ampiclox , cloxacillin,
Oxacillin, cephalosporin are used.
In this case, the patient was given intravenous ampiclox 500mg once a day for 5 days..
Reference.
1. Bailey and Love; short practice of surgery.
