Asunto(s)
Enfermedades Gastrointestinales/complicaciones , Hidrotórax/complicaciones , Derrame Pleural/epidemiología , Perforación del Esófago/complicaciones , Perforación del Esófago/diagnóstico , Perforación del Esófago/epidemiología , Femenino , Fístula Gástrica/complicaciones , Fístula Gástrica/diagnóstico , Fístula Gástrica/epidemiología , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Humanos , Hidrotórax/diagnóstico , Hidrotórax/epidemiología , Hidrotórax/cirugía , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico , Hipertensión Portal/epidemiología , Hipertensión Portal/cirugía , Incidencia , Fístula Intestinal/complicaciones , Fístula Intestinal/diagnóstico , Fístula Intestinal/epidemiología , Absceso Hepático/complicaciones , Absceso Hepático/diagnóstico , Absceso Hepático/epidemiología , Absceso Hepático/microbiología , Hepatopatías/complicaciones , Masculino , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Pancreatitis/epidemiología , Derrame Pleural/diagnóstico , Derrame Pleural/microbiología , Derrame Pleural/fisiopatología , Derivación Portosistémica Intrahepática Transyugular/métodos , Índice de Severidad de la Enfermedad , Absceso Subfrénico/complicaciones , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/epidemiología , Absceso Subfrénico/microbiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND DATA: The use of surgical drains after traditional splenectomy has been largely debated and several Authors have been unfavorable to their use. With the advent of laparoscopic splenectomy, their role has been re-discussed. The increased risk of undetectable pancreatic, gastric or colon injury in challenging laparoscopic removal of the spleen have induced some surgeons to reconsider the advantages related to their use. METHODS: One hundred seventeen consecutive cases of laparoscopic splenectomy with routine use of surgical drains have been reviewed. Indications for surgery, length of operations, post-operative day of drain removal, post-operative complications were retrospectively analyzed. RESULTS: Laparoscopic splenectomy was performed for idiopathic thrombocytopenic purpura in 77 patients (65,8%), splenic lymphoma in 11 (9,4%), hereditary spherocytosis in 12 (10,2%), ß-thalassemia in 6 (5.1%), other diseases in 11 (9,4%) cases. Conversion to open surgery was necessary in 11,1% of cases. Drains were removed 2-3 days after surgery in 95,8%, within 10 days in 3.4%, within 2 months in 0,8% of cases. In 2 cases a post-operative bleeding, detected through the drainage, required re-operation. One patient with myelofibrosis and massive splenomegaly developed a late post-operative subphrenic abscess, successfully treated by a percutaneous drainage. CONCLUSIONS: In Authors' experience, the use of drains after laparoscopic splenectomy helped detect early post-operative bleeding. Surgical drains could reduce the incidence of fluid intra-abdominal collections and infections. Their use should be recommended in the laparoscopic approach, especially in technically demanding surgical procedures. KEY WORDS: Laparoscopy, Surgical drainage, Splenectomy.
Asunto(s)
Laparoscopía/métodos , Hemorragia Posoperatoria/diagnóstico , Esplenectomía/métodos , Succión/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Conversión a Cirugía Abierta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Púrpura Trombocitopénica Idiopática/cirugía , Reoperación , Enfermedades del Bazo/cirugía , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/cirugía , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Síndrome de Chilaiditi/diagnóstico , Absceso Subfrénico/diagnóstico , Diagnóstico Diferencial , Factores de RiesgoRESUMEN
A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain settled with analgaesia and he was discharged with a course of oral co-amoxiclav. He was readmitted to the hospital 7â days later reporting cough and shortness of breath. His chest X-ray showed a raised right hemi-diaphragm, presumed consolidation and a right-sided effusion. As a result, he was treated for pneumonia. Despite antibiotic therapy his C reactive protein remained elevated, prompting an attempt at ultrasound-guided drainage of his effusion. Finding only a small amount of fluid, a CT of the chest was performed, and this showed a subphrenic abscess and free air under the diaphragm. A CT of the abdomen was then carried out, showing a perforated appendix. An emergency laparotomy was performed, the patient's appendix was removed and the abscess drained.
Asunto(s)
Dolor Abdominal/etiología , Apendicectomía , Apendicitis/diagnóstico , Tos/etiología , Neumonía/diagnóstico , Absceso Subfrénico/diagnóstico , Adulto , Apendicectomía/métodos , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Errores Diagnósticos , Drenaje/métodos , Humanos , Laparotomía , Masculino , Absceso Subfrénico/patología , Absceso Subfrénico/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of our study was to test the hypothesis that an intercostal approach to imaging-guided percutaneous subdiaphragmatic abscess drainage is as safe as a subcostal approach. MATERIALS AND METHODS: A cohort of 258 consecutive patients with one or more subdiaphragmatic abscesses referred for imaging-guided (CT or ultrasound) percutaneous drainage was identified. Demographic characteristics and clinical outcomes were compared between patients who underwent drainage catheter placement via an intercostal approach versus those who underwent drainage catheter placement via a subcostal approach. RESULTS: Percutaneous drainage was performed for 441 abscesses in 258 patients in 409 separate procedures (214 via an intercostal approach, 186 by a subcostal approach, and nine by a combined approach). The total number of pleural complications was significantly higher in the intercostal group (56/214 [26.2%]) than the subcostal group (15/186 [8.1%]; p < 0.001). These complications included a significantly higher pneumothorax rate in the intercostal group than the subcostal group (15/214 [7.0%] vs 0/186 [0%], respectively; p < 0.01) and a higher incidence of new or increased pleural effusions (38/214 [17.8%] vs 14/186 [7.5%]; p < 0.01). The incidence of empyema was low and similar between the two groups (intercostal vs subcostal, 3/214 [1.4%] vs 1/186 [0.5%]; p = 0.63). A few of the complications in the patients who underwent an intercostal-approach drainage were clinically significant. Four of the 15 pneumothoraces required thoracostomy tubes and eight of 38 (21.1%) pleural effusions required thoracentesis, none of which was considered infected. CONCLUSION: An intercostal approach for imaging-guided percutaneous drainage is associated with a higher risk of pleural complications; however, most of these complications are minor and should not preclude use of the intercostal approach.
Asunto(s)
Drenaje/estadística & datos numéricos , Empiema/epidemiología , Neumotórax/epidemiología , Complicaciones Posoperatorias/epidemiología , Absceso Subfrénico/terapia , Cirugía Asistida por Computador/métodos , Causalidad , Comorbilidad , Drenaje/métodos , Empiema/prevención & control , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Complicaciones Posoperatorias/prevención & control , Radiografía , Estudios Retrospectivos , Costillas/diagnóstico por imagen , Costillas/cirugía , Factores de Riesgo , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/epidemiología , Cirugía Asistida por Computador/estadística & datos numéricos , Resultado del Tratamiento , UltrasonografíaRESUMEN
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
The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics.
Asunto(s)
Infecciones por Escherichia coli/complicaciones , Dolor de la Región Lumbar/etiología , Absceso Subfrénico/complicaciones , Adulto , Infecciones por Escherichia coli/diagnóstico , Humanos , Masculino , Atención Primaria de Salud , Derivación y Consulta , Absceso Subfrénico/diagnósticoRESUMEN
El espacio subfrénico se define como la zona situada debajo del diafragma y encima del colon transverso. La mayoría de los abscesos subfrénicos se deben a contaminación directa relacionada con la cirugía, enfermedad local o traumatismo, pero persisten aún los de causa no definida o desconocida. Es un trastorno poco frecuente diagnosticado en atención primaria. Alrededor del 55% de los abscesos subfrénicos asientan en el lado derecho, el 25% en el izquierdo y el 20% son múltiples. Estos se pueden extender a la cavidad torácica, donde producen en ocasiones empiema, absceso pulmonar o neumonía. La mortalidad de los abscesos subfrénicos oscila entre el 11 y el 31%, y se debe a la infección no controlada, desnutrición y complicaciones de la hospitalización prolongada, como infecciones nosocomiales. El drenaje percutáneo bajo guía ecográfica o tomografía computarizada representa hoy el tratamiento de elección junto con los antibióticos (AU)
The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics (AU)
Asunto(s)
Humanos , Masculino , Adulto , Absceso Subfrénico/complicaciones , Absceso Subfrénico/diagnóstico , Absceso Piógeno Hepático/complicaciones , Diagnóstico Diferencial , Fiebre de Origen Desconocido/etiología , Absceso Subfrénico/fisiopatología , Absceso Subfrénico , Absceso Piógeno Hepático , Absceso Pulmonar/complicaciones , Absceso Pulmonar , Atención Primaria de Salud/métodos , Indicadores de Morbimortalidad , Radiografía TorácicaRESUMEN
An 86-year-old woman presented three years after laparoscopic cholecystectomy with right upper quadrant pain and raised inflammatory markers. Liver function tests were normal; however, a previous ultrasound scan suggested a common bile duct stone so she was treated for cholangitis secondary to choledocholithiasis. Repeat ultrasound scan again showed a common bile duct (CBD) stone and also a subdiaphragmatic abscess. CT scan confirmed the abscess, associated with a surgical clip from her previous surgery. There was no evidence of a persistent CBD stone on the CT scan. She was treated conservatively with intravenous antibiotics and her symptoms improved. Follow-up MRI did not show any choledocholithiasis. Surgical clips causing delayed abscess formation are very unusual. We discuss the presentation, investigations and treatment of this interesting case. Existing relevant literature is reviewed, and management strategies to treat such rare complications are suggested.
Asunto(s)
Colecistectomía Laparoscópica , Complicaciones Posoperatorias/diagnóstico , Absceso Subfrénico/diagnóstico , Instrumentos Quirúrgicos/efectos adversos , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Humanos , Complicaciones Posoperatorias/tratamiento farmacológico , Absceso Subfrénico/tratamiento farmacológicoRESUMEN
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)
Educación de Pregrado en Medicina , Observación , Lectura , Estudiantes de Medicina , Dolor Abdominal/etiología , Anciano , Fístula Arteriovenosa/diagnóstico , Competencia Clínica , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embolia Pulmonar/diagnóstico , Absceso Subfrénico/complicaciones , Absceso Subfrénico/diagnósticoAsunto(s)
Colecistectomía Laparoscópica , Enterococcus faecalis , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/cirugía , Dolor en el Pecho/etiología , Drenaje , Fiebre de Origen Desconocido/etiología , Humanos , Masculino , Persona de Mediana Edad , Pleura/cirugía , Reoperación , Tomografía Computarizada por Rayos XRESUMEN
Meckel's diverticulum (MD) occurs in 2-4% of the population and is the most common congenital abnormality of the gastrointestinal tract. A 67 year-old woman was admitted with acute abdomen. Abdominal X-ray showed pneumoperitoneum. During explorative laparoscopy a large perforated MD was found over the right hepatic lobe. CT-scans from an earlier admission revealed the MD but it was misinterpreted on that occasion. An MD in this place and in a person of this age is extremely rare. This case can primarily serve as differential diagnosis when CT-scans reveal mysterious subphrenic configurations.
Asunto(s)
Divertículo Ileal/diagnóstico , Dolor Abdominal/diagnóstico , Anciano , Colon/anomalías , Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Diagnóstico Diferencial , Femenino , Humanos , Divertículo Ileal/cirugía , Absceso Subfrénico/diagnóstico , SíndromeRESUMEN
The incidence of fungal infections such as Aspergillosis is increasing among immunocompromised patients. Demand for diagnosis of mycotic diseases is steadily raising among clinicians and treatment of these patients represents a continually growing challenge. The authors present a case of a 53-year-old male patient with Aspergillus peritonitis. This case deserves attention because its extreme rarity in the medical literature and complex therapy of coinfections during the hospital stay which was difficult and relatively expensive. The importance of consultation and microbiological sampling is emphasized.
Asunto(s)
Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Aspergilosis , Huésped Inmunocomprometido , Peritonitis , Aspergilosis/complicaciones , Aspergilosis/diagnóstico , Aspergilosis/tratamiento farmacológico , Clindamicina/uso terapéutico , Infección Hospitalaria/complicaciones , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Humanos , Masculino , Meropenem , Persona de Mediana Edad , Peritonitis/complicaciones , Peritonitis/tratamiento farmacológico , Peritonitis/microbiología , Absceso Subfrénico/complicaciones , Absceso Subfrénico/diagnóstico , Absceso Subfrénico/tratamiento farmacológico , Absceso Subfrénico/microbiología , Tienamicinas/uso terapéuticoRESUMEN
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/cirugíaRESUMEN
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.
Asunto(s)
Apendicitis/diagnóstico , Apéndice/anomalías , Diagnóstico Tardío , Infecciones por Enterobacteriaceae/diagnóstico , Absceso Subfrénico/diagnóstico , Antibacterianos/uso terapéutico , Apendicectomía , Apendicitis/complicaciones , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Niño , Terapia Combinada , Drenaje , Urgencias Médicas , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/cirugía , Humanos , Masculino , Choque Séptico/etiología , Choque Séptico/cirugía , Absceso Subfrénico/complicaciones , Absceso Subfrénico/tratamiento farmacológico , Absceso Subfrénico/cirugía , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Humanos , Masculino , Niño , Absceso Subfrénico/diagnóstico , Apéndice/anomalías , Apendicitis/diagnóstico , Diagnóstico Tardío , Infecciones por Enterobacteriaceae/diagnóstico , Apendicectomía , Absceso Subfrénico/complicaciones , Absceso Subfrénico/tratamiento farmacológico , Absceso Subfrénico/cirugía , Antibacterianos/uso terapéutico , Apendicitis/complicaciones , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Terapia Combinada , Choque Séptico/etiología , Choque Séptico/cirugía , Drenaje , Urgencias Médicas , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Colectomía , Neoplasias del Colon/cirugía , Duodenoscopios , Infecciones por Bacterias Gramnegativas/cirugía , Ileostomía , Complicaciones Posoperatorias/cirugía , Sepsis/cirugía , Absceso Subfrénico/cirugía , Succión/métodos , Cateterismo/instrumentación , Neoplasias del Colon/patología , Fluoroscopía , Estudios de Seguimiento , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Peritonitis/cirugía , Complicaciones Posoperatorias/diagnóstico , Reoperación , Sepsis/diagnóstico , Stents , Absceso Subfrénico/diagnóstico , Dehiscencia de la Herida Operatoria/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Liver abscesses are a relatively infrequent complication of inflammatory bowel disease. These abscesses are usually multiple and of polymicrobial origin. The development of primary sclerosing cholangitis in inflammatory bowel disease, although provoking alterations in biliary morphology and a higher incidence of infections, does not predispose patients to the development of liver abscesses. We describe a new case of primary sclerosing cholangitis and Crohn's disease with multiple fungal liver abscesses caused by Candida albicans. The patient had developed a duodenal-biliary fistula. Antibiotic therapy produced clinical response and surgery was performed to repair the fistula.