1/104. Perforation of the gallbladder: analysis of 19 cases. Perforation of the gallbladder occurred in 19 (3.8%) of 496 patients with acute cholecystitis treated at one hospital in an 8-year period. The average age of the 19 patients was 69 years and the female:male ratio was 3:2. Most had a history suggestive of gallbladder disease and most had coexisting cardiac, pulmonary, renal, nutritional or metabolic disease. The duration of the present illness was short, perforation occurring within 72 hours of the onset of symptoms in half the patients; the diagnosis was not suspected preoperatively in any. In the elderly patient with acute cholecystitis who has a long history of gallbladder disease, cholecystectomy should be performed early, before gangrene and perforation of the gallbladder can occur. ( info) |
| A case of an hepatic abscess that developed after percutaneous transhepatic drainage of a subphrenic abscess is presented. The location of the abscess immediately along the tract of the drainage catheter and the similar organisms recovered from bacteriologic culture suggest that the abscess was related to direct contamination along the tract of the drainage catheter. The potential for abscess formation within the liver should be considered in the choice of access route for percutaneous drainage of retroabdominal abscesses. It may be preferable to avoid transhepatic drainage in patients in whom it is anticipated that the catheter drainage will require considerable length of time. ( info) |
3/104. Cholelithoptysis and pleural empyema. We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy. ( info) |
| We treated a case of bronchoperitoneal fistula secondary to a klebsiella pneumoniae subphrenic abscess. This fistulous communication and the surgical procedure used to treat it are described. ( info) |
| subphrenic abscess is a recognised complication of splenectomy, but fistulation into the stomach is extremely rare. This report describes a delayed complication of splenectomy presenting as offensive and socially disabling halitosis. ( info) |
6/104. Esophagobronchial fistula following redo Nissen fundoplication. Gastrobronchial fistula is a rare complication of antireflux surgery, whereas esophagobronchial fistula as a complication of Nissen fundoplication has, to the best of our knowledge, not been reported previously. We report on a case of esophagobronchial fistula in a patient with left subphrenic abscess following redo Nissen fundoplication. Chest radiographs suggested an unresponsive pneumonia of the left lower lobe. Computed tomography (CT) of the abdomen showed partial consolidation of the left lower lobe and contrast filling of the left bronchial tree from a left subphrenic abscess. CT diagnosis of fistula originating from the region of fundoplication was confirmed by Gastrografin follow-through. ( info) |
| We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess. ( info) |
8/104. Conservative management of a transdiaphragmatic fistula. case reports of transdiaphragmatic fistulas connecting subphrenic collections and empyemas are uncommon. We report the rare complication of a fistulous connection between a subphrenic collection and the bronchial tree. ( info) |
9/104. CT findings in post-operative subphrenic abscess with teratomatous inclusions. A 39-year-old woman presented with abdominal pain after tubal sterilization. CT showed a subphrenic abscess with fatty inclusions owing to laceration or rupture of a mature ovarian teratoma. Although subphrenic abscess is a well recognized post-operative complication, and ovarian teratomas are frequent, a teratomatous inclusion within a subphrenic abscess is a unique finding. ( info) |
10/104. 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. ( info) |