Non-Resolving Perihepatic Abscess Following Spilled Gallstones Requiring Surgical Management.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis and is among the most frequently done procedures in United States. Spillage of gallstones occurs in up to 30 percent of these procedures and is associated with rare but important complications including abscess formation. CASE DESCRIPTION: We present a case of 44-year-old man with a peri-hepatic abscess developed three years after a laparoscopic cholecystectomy. Multiple percutaneous drainages and antibiotic courses had failed to provide a definitive resolution. CT scan showed signs of a developing abscess but no stones. A diagnostic laparoscopy was performed, and multiple retained stones were visualized. It was converted to open laparotomy and the abscess was drained along with resection of portions of liver and diaphragm. The patient remained vitally stable with no fever spikes following the procedure. DISCUSSION: Spillage of gallstones should be seriously considered in all patients presenting with peri-hepatic abscess with a history of previous LC, even if the imaging studies do not provide evidence of stones. Percutaneous drainage and antibiotics may provide temporary relief, but a surgical intervention is often the definitive management.

COPD Assessment Test: A Review of Extant Literature.

Chronic obstructive pulmonary disease (COPD) is a major health burden worldwide. Reasons for poor management include lack of awareness regarding COPD among healthcare providers and patients, insufficient use of diagnostic tests (such as spirometry), poor treatment decisions. Another major issue is poor doctor-patient communication which can lead to inaccurate assessment of a patient's clinical picture. The COPD Assessment Test (CAT) is a clinical tool which provides a quantitative measure of the severity of a patient's symptoms and their pulmonary health status. It is a brief patient-filled questionnaire that only takes a few minutes to fill out. This has the potential to help bridge deficiencies in the clinical history that may be left by any communication gap between the patient and the physician. Various studies have investigated the effectiveness of CAT in clinical settings. Herein we review these studies to examine the sensitivity, validity and reliability of the CAT as a clinical diagnostic and assessment tool in light of the existing literature.