1/19. Extraction of retained gallstones from an abscess cavity: a percutaneous endoscopic technique.A novel technique to retrieve spilled gallstones in an abscess cavity with the use of minimally invasive techniques is described.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/19. Gastropleural fistula originating from the lesser curve: a recognised complication, an uncommon pathway of communication.Fistulous communications between the abdominal and the pleural cavity are rare; they implicate intra-abdominal sepsis. We present a rare case of subphrenic abscess following gastric perforation, which resulted in thoracic empyema. This report emphasises that gastropleural fistulas, although uncommon, should be considered in differential diagnoses of thoracic empyema, especially when there is a longstanding history of peptic ulceration.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
3/19. Cholelithoptysis: an unusual delayed complication of laparoscopic cholecystectomy.We report the case of a 54-year old woman who presented with a persistent right lower lobe pneumonia followed by cholelithoptysis, 11 months after a laparoscopic cholecystectomy. It is postulated that this was a result of the formation of a subphrenic abscess secondary to intraoperative spillage of gallstones. It is concluded that spillage of gallstones at laparoscopic cholecystectomy is not as benign as previously thought and that efforts to prevent spillage should include scrupulous operative technique, especially in the presence of gallbladder inflammation, and especial care when removing the gallbladder from the abdominal cavity.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
4/19. Transphrenic fistulization of a subphrenic abscess to lung parenchyma.A 53-year-old woman was admitted with respiratory distress. For several years, she had chronic alcoholic pancreatitis with ductal stones that were treated with a stent and with shockwave lithotripsy. Both treatments were unsuccessful, and the pancreatitis was complicated with an infected pseudocyst. The pancreatic head had to be resected, which was complicated with recurrent subphrenic abscesses. She then was admitted with respiratory distress and initially diagnosed with pneumonia of the right lower lobe. Further investigations showed supradiaphragmatic and subdiaphragmatic air-fluid levels. In both collections streptococcus milleri was cultured, and subsequently the patient was diagnosed with a fistula connecting the subdiaphragmatic abscess with pulmonary tissue. This was treated with intravenous amoxicillin/clavulanate and drainage of the subdiaphragmatic collection. She did not develop a pulmonary empyema, because multiple adhesions, which were due to recurrent abscesses after pancreatic surgery, prevented breakthrough into the pleural cavity.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
5/19. Subphrenic and pleural abscess due to spilled gallstones.BACKGROUND: A 70-year-old male approximately 3 years after laparoscopic cholecystectomy presented to his primary care physician with a 4-month history of generalized malaise. methods: A workup included magnetic resonance imaging that revealed a perihepatic abscess. The patient underwent ultrasound-guided drainage, with the removal of 1400 mL of purulent fluid and placement of 2 drains. Computed tomographic scanning showed resolution, and he was discharged home on oral antibiotics. At 2-month follow-up, the patient was asymptomatic, denying any constitutional symptoms. However, abdominal computed tomographic scanning revealed recurrence of the abscess, which measured approximately 18 x 9 x 7.5 cm, with mass effect on the liver. The patient was placed on intravenous antibiotics and scheduled for operative drainage. The abdomen was entered with a right subcostal incision, and 900 mL of purulent fluid was drained. We also noted abscess erosion through the inferolateral aspect of the right diaphragm into the pleural space. The pleural abscess was loculated and isolated from the lung parenchyma. palpation within the abscess cavity revealed 9 large gallstones. Following copious irrigation and debridement of necrotic tissue, 3 drains were placed and the incision was closed. RESULTS: The patient had an uneventful recovery and was discharged home on postoperative day number 6. Follow-up imaging at 3 months demonstrated resolution of the collection. CONCLUSION: Spillage of gallstones is a complication of laparoscopic cholecystectomy, occurring in 6% to 16% of all cases. Retained stones rarely result in a problem, but when complications arise, aggressive surgical intervention is usually necessary.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
6/19. Complications of retained intraperitoneal gallstones from laparoscopic cholecystectomy.Laparoscopic cholecystectomy is now the gold standard procedure for the treatment of symptomatic gall bladder stones. Spillage of gall bladder stones into the peritoneal cavity may occur due to inadvertent iatrogenic gall bladder perforation during dissection of the gall bladder. We report a case of a 66 year old woman who had to return to theatre three times over two years to deal with complications from retained intra-peritoneal gallstones that were spilt at her initial laparoscopic cholecystecomy.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
7/19. Is "primary" subphrenic abscess caused by streptococcus milleri a result of unrecognized gastrointestinal perforation?An unusual case of subphrenic abscess presenting as empyema of the pleural cavity is described. The abscess developed secondarily to an occult perforation of the gastrointestinal tract, which was, diagnosed indirectly by the discovery of a fishbone within the abscess. Isolation of streptococcus milleri from the pus was an important clue for the existence of an underlying gastrointestinal pathology.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
8/19. Repositioning catheters in surgically drained abscesses.Primary percutaneous drainage of intraabdominal abscesses under local anesthesia is an accepted method of treatment, with low morbidity and mortality. This technique was extended to patients with recurrent or secondary abscesses after initial primary surgical drainage. Four patients had abscesses drained operatively but were reevaluated several weeks later for recurrent fever. Sinography demonstrated an inadequately drained abscess cavity. Under fluoroscopic control and using local anesthesia, new drains were inserted and repositioned to provide better drainage. Resolution of the abscess cavity was documented radiographically, with improvement in the patients' clinical status.- - - - - - - - - - ranking = 0.4keywords = cavity (Clic here for more details about this article) |
9/19. liver/pleural cavity scan for diagnosis of subphrenic abscess.The interpretation of a combined liver/lung scan can be difficult in patients with pleural or pulmonary disease. A procedure is suggested to circumvent these difficulties by injecting 99mTc-sulfur colloid into the pleural cavity. A scan of the pleural cavity can then replace the lung scan in the conventional liver/lung scan. Two examples of liver/pleural cavity scans are shown.- - - - - - - - - - ranking = 1.4keywords = cavity (Clic here for more details about this article) |
10/19. Aspiration of intrathoracic abscess. Resultant acute ventilatory failure.Three cases illustrate that acute respiratory failure may be precipitated by spontaneous drainage of lung abscess or pleural empyema intrabronchially with diffuse aspiration of the contents bilaterally. This condition is especially hazardous if the cavity is large and the patient is debilitated or obtunded. The acute onset may mimic aspiration of gastric contents. Immediate studies of tracheal aspirate and roentgenograms of the chest should define the aspiration of intrathoracic abscess contents as the cause of acute respiratory failure.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
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