Subject(s)
Cholecystectomy, Laparoscopic , Enterococcus faecalis , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Subphrenic Abscess/diagnosis , Subphrenic Abscess/surgery , Chest Pain/etiology , Drainage , Fever of Unknown Origin/etiology , Humans , Male , Middle Aged , Pleura/surgery , Reoperation , Tomography, X-Ray ComputedABSTRACT
Acute appendicitis is the most common abdominal surgical emergency. Atypical presentations lead to a late diagnosis with a higher complication rate. Given its rarity, we report a case of a thoracic empyema due to subphrenic appendicitis.
Subject(s)
Appendicitis/complications , Empyema, Pleural/etiology , Subphrenic Abscess/etiology , Acute Disease , Aged , Appendicitis/diagnosis , Appendicitis/surgery , Drainage , Empyema, Pleural/diagnosis , Humans , Male , Subphrenic Abscess/diagnosis , Subphrenic Abscess/surgeryABSTRACT
BACKGROUND: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. When these conditions are met, accurate diagnosis and early management decisions are delayed. CLINICAL CASE: We present the case of a 10-year-old male who had diarrhea without mucus or blood for 5 days. He was treated with antibiotics. Afterwards, he presented with vomiting, abdominal pain, and fever. Physical examination of the abdomen demonstrated a soft and depressible mass and pain in the lower right abdomen. Abdominal ultrasound and tomography reported image of subdiaphragmatic abscess. Percutaneous puncture and drainage were performed without results. Exploratory laparotomy was then performed, revealing a subhepatic perforation of the appendix. The patient evolved with abdominal sepsis and septic shock, resulting in a new surgical intervention for drainage of serohematic fluid. The patient improved and was discharged on day 40. DISCUSSION: It is very important to consider the position of the anatomic appendix during appendicitis because it contributes to the various clinical symptoms, of which 30% are atypical. Diagnosis is masked, leading to complications such as perforations and/or abscesses that extend the hospital stay. CONCLUSIONS: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. Delay in treatment due to atypical symptoms caused by the abnormal position of the appendix conditioned complications that implied a prolonged hospital stay, with the risk of increasing morbidity and mortality of the patient.
Subject(s)
Appendicitis/diagnosis , Appendix/abnormalities , Delayed Diagnosis , Enterobacteriaceae Infections/diagnosis , Subphrenic Abscess/diagnosis , Anti-Bacterial Agents/therapeutic use , Appendectomy , Appendicitis/complications , Appendicitis/drug therapy , Appendicitis/surgery , Child , Combined Modality Therapy , Drainage , Emergencies , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/surgery , Humans , Male , Shock, Septic/etiology , Shock, Septic/surgery , Subphrenic Abscess/complications , Subphrenic Abscess/drug therapy , Subphrenic Abscess/surgery , Tomography, X-Ray ComputedABSTRACT
Introducción: Los cuadros de apendicitis aguda subhepática en niños son raros y no siempre se acompañan de malrotación intestinal, lo que dificulta el diagnóstico y manejo temprano. Caso clínico: Niño de 10 años de edad, con padecimiento de cinco días de evolución caracterizado por evacuaciones diarreicas, tratado con antibióticos. Posteriormente presentó vómito, dolor abdominal tipo cólico y fiebre de 39 °C. El abdomen se encontró blando y depresible, con escaso dolor en flanco derecho. El ultrasonido y la tomografía mostraron imagen compatible con absceso subdiafragmático. Se manejó con drenaje externo. Al no obtener respuesta se realizó laparotomía exploradora, encontrando apéndice inflamada, de 10 cm de longitud, en posición ascendente sobre la corredera parietocólica derecha y perforación del extremo distal a nivel subhepático. El paciente evolucionó con sepsis abdominal y choque séptico, requiriendo nueva intervención quirúrgica para drenaje de líquido serohemático. A los 40 días el paciente fue dado de alta. Conclusiones: La consideración anatómica del apéndice es importante, por las múltiples presentaciones clínicas, de las cuales 30 % son atípicas y el diagnóstico se enmascara ocasionando complicaciones como perforación y abscesos. Los casos de apendicitis aguda de localización subhepática son raros y por lo general se asocian a malrotación del intestino. El retraso del tratamiento relacionado con el cuadro atípico, ocasionado por la posición poco habitual del apéndice, implica estancia hospitalaria más prolongada y riesgo de incrementar la morbilidad y mortalidad.
BACKGROUND: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. When these conditions are met, accurate diagnosis and early management decisions are delayed. CLINICAL CASE: We present the case of a 10-year-old male who had diarrhea without mucus or blood for 5 days. He was treated with antibiotics. Afterwards, he presented with vomiting, abdominal pain, and fever. Physical examination of the abdomen demonstrated a soft and depressible mass and pain in the lower right abdomen. Abdominal ultrasound and tomography reported image of subdiaphragmatic abscess. Percutaneous puncture and drainage were performed without results. Exploratory laparotomy was then performed, revealing a subhepatic perforation of the appendix. The patient evolved with abdominal sepsis and septic shock, resulting in a new surgical intervention for drainage of serohematic fluid. The patient improved and was discharged on day 40. DISCUSSION: It is very important to consider the position of the anatomic appendix during appendicitis because it contributes to the various clinical symptoms, of which 30% are atypical. Diagnosis is masked, leading to complications such as perforations and/or abscesses that extend the hospital stay. CONCLUSIONS: Acute subhepatic appendicitis in children is an uncommon presentation. It is usually associated with intestinal malrotation. Delay in treatment due to atypical symptoms caused by the abnormal position of the appendix conditioned complications that implied a prolonged hospital stay, with the risk of increasing morbidity and mortality of the patient.
Subject(s)
Humans , Male , Child , Subphrenic Abscess/diagnosis , Appendix/abnormalities , Appendicitis/diagnosis , Delayed Diagnosis , Enterobacteriaceae Infections/diagnosis , Appendectomy , Subphrenic Abscess/complications , Subphrenic Abscess/drug therapy , Subphrenic Abscess/surgery , Anti-Bacterial Agents/therapeutic use , Appendicitis/complications , Appendicitis/drug therapy , Appendicitis/surgery , Combined Modality Therapy , Shock, Septic/etiology , Shock, Septic/surgery , Drainage , Emergencies , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/surgery , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Female , Subphrenic Abscess/classification , Subphrenic Abscess/diagnosis , Subphrenic Abscess/therapyABSTRACT
Os traumatismos e as agressöes cirúrgicas abdominais representam, pelo menos na experiência dos autores, as causas que levam mais freqüentemente à formaçäo de abscessos na cavidade peritoneal. Näo obstante os progressos da antibioticoterapia e das técnicas de assepsia, a sua freqüência torna-se alvo de interesse. A presença de febre e leucocitose no pós-operatório ou em paciente politraumatizado devem sempre fazer suspeitar do aparecimento de tal complicaçäo. Um tratamento precose e adequado torna-se fundamental para eliminar o estado tóxico que a coleçäo purulenta produz e permitir a sobrevida do paciente
Subject(s)
Humans , Male , Female , Subphrenic Abscess/etiology , Leukocytosis/complications , Peritoneal Cavity/pathology , Postoperative Complications , Subphrenic Abscess/diagnosis , Leukocytosis/complicationsABSTRACT
Os autores relatam um caso de abscesso subfrenico pos-esplectomia, causado por Salmonella typhi, em paciente submetida a laparotomia exploradora durante evolucao de febre tifoide, com reacao de Widal e coproculturas negativas.