PubMed · 7837600
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S Maruyama, C Hirayama. 1994. [Pericecal abscess].. https://pubmed.ncbi.nlm.nih.gov/7837600/
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A 2-year-old bull was examined because of intermittent anorexia, signs of mild colic, and weight loss of 3 weeks' duration. A tympanitic resonance (ping) could be heard during simultaneous auscultation and percussion of the right paralumbar fossa, and a mass could be felt in the right dorsal quadrant of the abdominal cavity during palpation per rectum. Right flank laparotomy was performed, and intraoperative ultrasonography and ultrasound-guided fine-needle aspiration were used to determine that the mass was an abscess. However, the abscess could not be removed or drained into the colon because of extensive adhesions to other organs. Because the owner refused to pursue continued medical treatment, the bull was euthanatized. At necropsy, the abscess was found to be connected to a caudal mesenteric lymph node through a fistula. Histologic evaluation of the lymph node revealed hyperplastic lymphadenitis, and an alpha-hemolytic streptococcus was recovered from the abscess fluid. The most likely possibility for the findings in this bull were that the lymphadenitis was of hematogenous origin and that the abscess developed as a direct extension of the infectious process, similar to development of mesenteric abscesses in horses with chronic streptococcal infection (i.e., strangles).
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During laparoscopic cholecystectomy the frequency of lost stones due to torn gallbladder is from 9-40%. We have had occasion to treat three such complications: one giant right side abscess 27 months after the operation, one abscess of a port site which became a sinus with discharge of pus until complete evacuation of the stones 6 months later, and one case of dyspareunia and tenesmus cured only 33 months later by extraction of two stones from the pelvis. The first represents one case out of our first 480 laparoscopic cholecystectomies, while the other two were first operated on in another hospital. In the literature we have found 39 publications involving 53 cases. We have also noticed three medical papers written before 1987 with this type of complication, once 10 years after the initial operation. Since intraperitoneal lost gallstones have increased in frequency we expect more of these cases in the future. We conclude that it is reasonable to try to evacuate the spilled stones through laparoscopy and not to convert, except in the case of a large stone or a number of stones. Tearing of the gallbladder with lost stones must be mentioned in the protocol, so that it can be raised and included in differential diagnosis of any complications. Treatment must aim for retrieval of all stones, simple drainage being usually insufficient.