Native valve infective endocarditis due to ampicillin-resistant Escherichia coli in the postoperative period of a right radical nephrectomy due to xanthogranulomatous pyelonephritis. / Endocarditis infecciosa sobre válvula nativa por Escherichia coli resistente a ampicilina en el postoperatorio de una nefrectomía radical derecha por pielonefritis xantogranulomatosa.

Infective endocarditis (IE) due to Escherichia coli is a rare disease, although increasingly frequent. Persistent fever in septic patients despite adequate treatment raises the need to consider IE as a differential diagnosis. We present the case of a 36-year-old male patient who underwent a radical right nephrectomy as a result of diagnosis of xanthogranulomatous pyelonephritis, presenting in the postoperative period a state of septic shock with persistent fever of 41°C. Given the finding of a new-onset murmur, he was diagnosed with a mitroaortic IE by means of a transesophageal echocardiogram (TEE), having to undergo cardiac surgery for valve replacement. After multiple postoperative complications, he is successfully discharged.

Unilateral diaphragmatic paralysis after laparoscopic cholecystectomy. / Parálisis diafragmática unilateral tras colecistectomía laparoscópica.

Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery.