RESUMEN
Gallbladder inflammation is most often determined by the presence of gallstones. Acalculous cholecystitis usually occurs in patients with multiple comorbidities or with an immunosuppressed status, and therefore its evolution is faster and more severe compared to acute calculous cholecystitis. The presence of a fish bone into the peritoneal cavity, through a gastrointestinal fistula is not very rare, but acute cholecystitis caused by a fish bone is unexpected. Here, we present the case of a 75-year old woman who had eaten fish two months before and presented at the Emergency Room with perforated acalculous cholecystitis and a right subphrenic abscess. The laparoscopic approach permitted the evacuation of the subphrenic abscess, bipolar cholecystectomy and removal of a fish bone from nearby the cystic duct. Postoperative evolution was uneventful, with hospital discharge after five days. The patient was in good clinical condition at two months follow-up.
Asunto(s)
Colecistitis Alitiásica/etiología , Huesos , Peces , Migración de Cuerpo Extraño/etiología , Alimentos Marinos/efectos adversos , Absceso Subfrénico/etiología , Colecistitis Alitiásica/diagnóstico por imagen , Colecistitis Alitiásica/cirugía , Anciano , Animales , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Laparoscopía , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND Perforated gastric cancer accounts for less than 1% of patients who present with an acute abdomen and for up to 16% of all gastric perforations. A two-stage laparoscopic procedure may be the therapeutic strategy of choice in selected patients, and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) can reduce the incidence of peritoneal recurrence. A rare case of subphrenic abscess and gastric perforation due to carcinoma of the gastric fundus, followed by two-stage gastrectomy and adjuvant HIPEC is presented. CASE REPORT A 65-year old man presented with a left subphrenic abscess secondary to perforated gastric carcinoma. Laparoscopic drainage of the abscess was performed. Ten days later, following recovery from sepsis, the patient underwent total laparoscopic gastrectomy, and adjuvant HIPEC followed by a Roux-en-Y esophagojejunostomy. Histopathology showed an intestinal-type gastric adenocarcinoma. The tumor was staged as pT4aN0. The postoperative course was uneventful except for transient atrial fibrillation. The patient was discharged home on postoperative day 11. Systemic adjuvant chemotherapy was begun one month later. At six-month follow-up, the patient had no discomfort on eating or any other symptoms. CONCLUSIONS In this case, a two-stage laparoscopic treatment for perforated gastric carcinoma combined with adjuvant HIPEC was feasible and safe and may be considered at the time of laparoscopic gastrectomy in selected patients with perforated gastric carcinoma.
Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias Peritoneales/terapia , Neoplasias Gástricas/terapia , Rotura Gástrica/terapia , Absceso Subfrénico/terapia , Adenocarcinoma/complicaciones , Adenocarcinoma/secundario , Anciano , Anastomosis Quirúrgica , Quimioterapia Adyuvante , Drenaje , Esófago/cirugía , Gastrectomía , Humanos , Hipertermia Inducida , Infusiones Parenterales , Yeyuno/cirugía , Laparoscopía , Masculino , Neoplasias Peritoneales/secundario , Rotura Espontánea , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Rotura Gástrica/etiología , Absceso Subfrénico/etiologíaRESUMEN
BACKGROUND: An intra-abdominal abscess can sometimes become serious and difficult to treat. The current standard treatment strategy for intra-abdominal abscess is percutaneous imaging-guided drainage. However, in cases of subphrenic abscess, it is important to avoid passing the drainage route through the thoracic cavity, as this can lead to respiratory complications. The spread of intervention techniques involving endoscopic ultrasonography (EUS) has made it possible to perform drainage via the transmural route. CASE PRESENTATION: We describe two cases of subphrenic abscess that occurred after intra-abdominal surgery. Both were treated successfully by EUS-guided transmural drainage (EUS-TD) without severe complications. Our experience of these cases and a review of the literature suggest that the drainage catheters should be placed both internally and externally together into the abscess cavity. In previous cases there were no adverse events except for one case of mediastinitis and pneumothorax resulting from transesophageal drainage. Therefore, we consider that the transesophageal route should be avoided if possible. CONCLUSIONS: Although further studies are necessary, our present two cases and a literature review suggest that EUS-TD is feasible and effective for subphrenic abscess, and not inferior to other treatments. We anticipate that this report will be of help to physicians when considering the drainage procedure for this condition. As there have been no comparative studies to date, a prospective study involving a large number of patients will be necessary to determine the therapeutic options for such cases.
Asunto(s)
Drenaje/métodos , Endosonografía/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/cirugía , Anciano , Colectomía/efectos adversos , Neoplasias del Colon/cirugía , Drenaje/efectos adversos , Endosonografía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Colon Sigmoide/cirugía , Absceso Subfrénico/etiologíaRESUMEN
A 40-year-old woman was admitted to our hos- pital with cough and sputum production. A chest computed tomography (CT) scan revealed a diffuse nodular shadow in the upper lung. The patient was diagnosed with pulmonary tuberculosis, based on a positive T-SPOT®.TB test result of peripheral blood and a positive polymerase chain reaction (PCR) test result for Mycobacterium tuberculosis in gastric aspirates. M.tuberculosis was subsequently isolated from the gastric aspirate specimen. After 2 months of treatment with antituberculous medication, the patient developed a low grade fever and left-sided chest pain. A CT scan revealed a left pleural effusion and a right subphrenic abscess. Tuber- culous pleurisy with paradoxical response was diagnosed on the basis of an increased lymphocyte count and increased adenosine deaminase activity in the pleural fluid exudate. A percutaneous ultrasound-guided needle biopsy of the sub- phrenic abscess was performed. Histological analysis revealed epithelioid cell granulomas with necrosis and PCR for M. tuberculosis using puncture needle washing fluid returned positive results. Based on these findings, a diagnosis of subphrenic abscess with paradoxical response, caused by M. tuberculosis, was made. Subphrenic abscess caused by M. tuberculosis is an important consideration during antituber- culous therapy.
Asunto(s)
Mycobacterium tuberculosis/efectos de los fármacos , Absceso Subfrénico/etiología , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Antituberculosos/uso terapéutico , Progresión de la Enfermedad , Combinación de Medicamentos , Femenino , Humanos , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnósticoRESUMEN
A 65-year-old male visited our hospital because of fever and difficulty in walking. He was suffering from left-sided hypochondrial pain for a month. Laboratory tests performed on admission revealed a white blood cell count of 1700/µl and C-reactive protein level of 9.51mg/dl, which were suggestive of severe inflammation. Contrast-enhanced computed tomography revealed a subphrenic abscess around the spleen, which we considered to be caused by gastric penetration into the gastrosplenic ligament. Upper esophagogastroduodenoscopy revealed a gastric ulcer together with a fistula that connected to the left subphrenic abscess. We thus performed endoscopic transgastric drainage through the fistula. Antibiotics and a proton pump inhibitor were administered, and drainage was continued. The patient's clinical and inflammatory symptoms subsequently improved. We thus consider that endoscopic transgastric drainage is an appropriate treatment option for subphrenic abscesses.
Asunto(s)
Drenaje , Úlcera Gástrica/complicaciones , Absceso Subfrénico/terapia , Anciano , Endoscopía del Sistema Digestivo , Humanos , Masculino , Úlcera Gástrica/diagnóstico por imagen , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/etiología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the risk factors and clinical outcomes in patients with spontaneous rupture of pyogenic liver abscess (PLA). METHODS: A total of 602 patients diagnosed with PLA between January 2004 and July 2013 were retrospectively analyzed. Among them, 23 patients experienced a spontaneous rupture of liver abscess (SRLA). RESULTS: The prevalence of SRLA was 3.8%. Using multivariate analysis, liver cirrhosis (OR 4.651, P = 0.009), gas-forming abscesses (OR 3.649, P = 0.026), abscess ≥6 cm in diameter (OR 10.989, P = 0.002) and other septic metastases (OR 1.710, P = 0.047) were risk factors for SRLA. Regarding the site of rupture, 20 (87.0%) patients had a localized rupture, specifically, subphrenic abscess in 3 (13.0%), peri-hepatic abscess in 10 (43.5%), localized peritoneal abscess in 3 (13.0%) and empyema in 4 (17.5%); and the other 3 (13%) had peritonitis. Ruptures resulting in peritonitis require urgent surgery, whereas localized ruptures were managed with surgical or percutaneous drainage in addition to appropriate antibiotics. The in-hospital mortality rate of SRLA was 4.3%. CONCLUSION: Patients with cirrhosis, having abscess ≥6 cm in diameter, gas-forming abscesses and other septic metastases in those with PLA should be monitored closely and may need early intervention for SRLA.
Asunto(s)
Absceso Abdominal/etiología , Empiema/etiología , Absceso Piógeno Hepático/complicaciones , Absceso Hepático/etiología , Peritonitis/etiología , Absceso Subfrénico/etiología , Absceso Abdominal/terapia , Anciano , Antibacterianos/uso terapéutico , Drenaje/métodos , Empiema/terapia , Femenino , Gases , Mortalidad Hospitalaria , Humanos , Absceso Hepático/terapia , Absceso Piógeno Hepático/terapia , Cirrosis Hepática/etiología , Cirrosis Hepática/terapia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Cavidad Peritoneal/patología , Peritonitis/cirugía , Estudios Retrospectivos , Factores de Riesgo , Rotura Espontánea/etiología , Rotura Espontánea/terapia , Absceso Subfrénico/terapiaAsunto(s)
Colecistectomía/efectos adversos , Gastrectomía/efectos adversos , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/etiología , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/etiología , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Reacciones Falso Positivas , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed.
Asunto(s)
Dolor Abdominal/etiología , Apéndice , Enfermedades del Ciego/complicaciones , Disnea/etiología , Fiebre/etiología , Litiasis/complicaciones , Apendicitis/complicaciones , Enfermedades del Ciego/diagnóstico , Humanos , Litiasis/diagnóstico , Masculino , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/etiología , Adulto JovenRESUMEN
A 48-year-old man presented with a 2-month history of polyuria, polydypsia, chest pain, fever, cough and extreme weight loss. He was diagnosed with diabetic ketoacidosis and investigations revealed widespread infection with an empyema complicated by bronchopleural fistula, and iliopsoas, suprapubic and periarticular abscesses. Streptococcus milleri was cultured from all sites. A multidisciplinary medical and surgical approach was required for treatment. This case highlights the immunosuppression, and life-threatening complications arising from undiagnosed diabetes mellitus.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Empiema Pleural/etiología , Absceso del Psoas/etiología , Absceso Subfrénico/etiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Empiema Pleural/diagnóstico , Empiema Pleural/terapia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Absceso del Psoas/diagnóstico , Absceso del Psoas/terapia , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/terapiaAsunto(s)
Fuga Anastomótica , Cardias , Gastrectomía , Gastropatías/cirugía , Absceso Subfrénico , Adulto , Fuga Anastomótica/etiología , Fuga Anastomótica/fisiopatología , Fuga Anastomótica/cirugía , Cardias/patología , Cardias/cirugía , Femenino , Gastrectomía/efectos adversos , Gastrectomía/métodos , Humanos , Necrosis , Reoperación , Índice de Severidad de la Enfermedad , Gastropatías/diagnóstico , Gastropatías/fisiopatología , Absceso Subfrénico/etiología , Absceso Subfrénico/fisiopatología , Absceso Subfrénico/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a safe and frequently performed bariatric procedure. Unfortunately, re-operations are often necessary. Reports on the success of revisional procedures are scarce and show variable results, either supporting or declining the idea of revising LAGB. This study describes a large cohort of re-operations after failed LAGB to determine the success of revision. METHODS: By use of a prospective cohort, all LAGB revisions performed between 1996 and 2008 were identified. From 301 primary LAGB procedures in our centre, 43 patients (14.3%) required a band revision. In addition, 51 patients were referred from other centres. Our analysis included in total 94 patients with a mean follow-up period of 38 months after revision. RESULTS: Revision was mainly necessary due to anterior slippage (46%) and symmetrical pouch dilatation (36%), which could be resolved by replacing (70%) or refixating the band (27%). Weight loss significantly increased after revision (excess BMI loss (EBMIL), 37.2 ± 36.3% versus 47.5 ± 30.4%, P < 0.05). After revision, 23 patients (24%) needed a second re-operation. Patients converted to other procedures (16%) during the second re-operation showed larger weight loss than the revised group (EBMIL, 64.3 ± 28.1% versus 44.3 ± 28.7%, P < 0.05). CONCLUSIONS: We report on a large cohort of LAGB revisions with 38 months of follow-up. Revision of failed LAGB by either refixation or replacement of the band is successful and further increases weight loss.
Asunto(s)
Gastroplastia/efectos adversos , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Absceso Subfrénico/etiología , Absceso Subfrénico/cirugía , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Adulto , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Gastroplastia/métodos , Gastroplastia/estadística & datos numéricos , Humanos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Masculino , Obesidad Mórbida/epidemiología , Estudios Prospectivos , Reoperación , Absceso Subfrénico/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Resultado del Tratamiento , Vómitos/etiología , Vómitos/cirugía , Pérdida de PesoAsunto(s)
Úlcera Duodenal/diagnóstico por imagen , Úlcera Péptica Perforada/diagnóstico por imagen , Absceso Subfrénico/etiología , Úlcera Duodenal/complicaciones , Úlcera Duodenal/terapia , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Perforada/complicaciones , Úlcera Péptica Perforada/terapia , Radiografía , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/terapiaRESUMEN
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.
Asunto(s)
Apendicitis/complicaciones , Empiema Pleural/etiología , Absceso Subfrénico/etiología , Enfermedad Aguda , Anciano , Apendicitis/diagnóstico , Apendicitis/cirugía , Drenaje , Empiema Pleural/diagnóstico , Humanos , Masculino , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/cirugíaAsunto(s)
Cesárea/efectos adversos , Insuficiencia Multiorgánica/etiología , Absceso Subfrénico/complicaciones , Coagulación Intravascular Diseminada/terapia , Drenaje/métodos , Femenino , Humanos , Insuficiencia Multiorgánica/terapia , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/etiología , Absceso Subfrénico/cirugía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented.
Asunto(s)
Actinomicosis/etiología , Colecistectomía Laparoscópica/efectos adversos , Infecciones por Klebsiella/etiología , Absceso Subfrénico/microbiología , Infección de la Herida Quirúrgica/microbiología , Actinomyces/aislamiento & purificación , Actinomicosis/complicaciones , Actinomicosis/tratamiento farmacológico , Anciano , Antiinfecciosos/uso terapéutico , Humanos , Klebsiella/aislamiento & purificación , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/tratamiento farmacológico , Masculino , Absceso Subfrénico/etiología , Infección de la Herida Quirúrgica/tratamiento farmacológicoRESUMEN
About 0.2 % of patients undergoing laparoscopic cholecystetomy will suffer from complications caused by lost gallstones. Diagnostic and therapeutic measures are correlated to the symptoms. At different locations, abscesses can arise, which can be treated by direct access through the -abdominal wall, laparotomy or laparoscopy. Two cases are presented with the especially grave sequels of subphrenic abscess, infiltration of the thoracic wall, and pleural empyema, which -respectively needed several successive operations -after ten years. In laparoscopic cholecystectomy, all detected stones should be removed. In the case of a failure, conversion to laparotomy is not essential. The loss of stones has to be formally -documented, the patient and family doctor are to be informed.
Asunto(s)
Absceso Abdominal/etiología , Colecistectomía Laparoscópica/efectos adversos , Empiema Pleural/etiología , Enterobacter cloacae , Infecciones por Enterobacteriaceae/etiología , Infecciones por Escherichia coli/etiología , Migración de Cuerpo Extraño/etiología , Cálculos Biliares , Hafnia alvei , Absceso Hepático/etiología , Complicaciones Posoperatorias/etiología , Absceso Subfrénico/etiología , Instrumentos Quirúrgicos , Absceso Abdominal/cirugía , Anciano , Diagnóstico Diferencial , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/cirugía , Infecciones por Enterobacteriaceae/diagnóstico por imagen , Infecciones por Enterobacteriaceae/cirugía , Infecciones por Escherichia coli/diagnóstico por imagen , Infecciones por Escherichia coli/cirugía , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Reoperación , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To determine the effectiveness of percutaneous balloon dilation of benign postoperative biliary strictures. MATERIALS AND METHODS: We received approval from our institutional review board to undertake this retrospective HIPAA-compliant study, and informed consent was waived. From April 1, 1977, to April 1, 2007, percutaneous biliary balloon dilation (PBBD) was performed in 85 patients with benign biliary strictures. In the 75 patients with follow-up (31 male, 44 female; mean age, 56 years; mean follow-up, 8 years), 205 PBBD procedures were performed during 112 treatments of 84 biliary strictures. PBBD of the stricture was performed with a noncompliant balloon (8-12-mm diameter). PBBD procedures were repeated at 2- to 14-day intervals until cholangiography demonstrated free drainage of contrast material to the bowel and no residual stenosis. An internal-external biliary drain was left in situ for a mean of 14-22 days and removed after a clinical trial of catheter clamping and a normal cholangiogram. RESULTS: All procedures were technically successful, and 52, 11, 10, and two patients underwent a total of one, two, three, and four PBBD treatments, respectively. Four of 205 procedures (2%) led to major complications: two subphrenic abscesses, one hepatic arterial pseudoaneurysm, and one case of hematobilia treated with transfusion. Six patients died from unrelated causes and three from hepatitis C-related liver failure. The probability of a patient not developing clinically significant restenosis at 5, 10, 15, 20, and 25 years was 0.52, 0.49, 0.49, 0.41, and 0.41, respectively, after the first PBBD treatment and 0.43, 0.30, 0.20, 0.20, and 0.20, respectively, after the second PBBD treatment. No significant difference was found in the rate of clinically significant restenosis after the first PBBD between strictures at anastomotic and nonanastomotic sites (P = .75). During the follow-up period, 56 of 75 patients (75%) had successful management with PBBD. CONCLUSION: PBBD of benign strictures demonstrates long-term effectiveness. No significant difference was found in the rate of clinically significant restenosis after PBBD of biliary strictures at anastomotic and nonanastomotic sites.