Cases reported "Subphrenic Abscess"

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1/12. 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.
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keywords = empyema
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2/12. 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.
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keywords = empyema
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3/12. 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.
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keywords = empyema
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4/12. Pleural empyema in association with renal sepsis.

    Five cases of pleural empyema in association with perinephric abscess or renal infection are presented. This represents 4 per cent of a series of 122 pleural empyemas, or 30 per cent of empyemas with subdiaphragmatic aetiology. It is suggested that the renal tract should be investigated in all cases of recurrent or non-resolving pleural empyema of uncertain aetiology.
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5/12. 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.
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keywords = empyema
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6/12. 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.
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keywords = empyema
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7/12. 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.
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keywords = empyema
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8/12. Subpulmonic empyema masquerading as subphrenic abscess.

    Since the therapeutic management of an empyema is significantly different from that for a subphrenic abscess it is important to define the location of the diaphragm in relation to an abscess cavity. A patient is presented who underwent unnecessary laparotomy due to misinterpretation of the clinical and radiographic findings.
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keywords = empyema
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9/12. Cholelithoptysis and empyema formation after laparoscopic cholecystectomy.

    Thoracic complications of laparoscopic operations are rare. We describe a case of cholelithoptysis due to a gallstone sequestered in the middle lobe after laparoscopic cholecystectomy.
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keywords = empyema
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10/12. Lost gallstones during laparoscopic cholecystectomy: are they really benign?

    The long-term effect of stones spilled into the peritoneal cavity during laparoscopic cholecystectomy is unknown. The course of a 58-year-old man who had recurrent right subphrenic abscesses and a right empyema secondary to spilled gallstones during laparoscopic cholecystectomy is described. The authors outline techniques for minimizing the spillage of stones during laparoscopic cholecystectomy: the application of hemoclips, endoloops and sutures, and placement of the necrotic, friable gallbladder in an endoscopic bag immediately upon completion of the dissection, before extraction of the gallbladder. They conclude that spillage of stones during laparoscopic cholecystectomy may lead to serious infection and should be recorded in the operative notes so that stones may be suspected when a patient presents with abdominal infection after laparoscopic cholecystectomy.
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keywords = empyema
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