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PubMed1985

Capnocytophaga species: infections in nonimmunocompromised and immunocompromised hosts.

Retrospective review of isolates of Capnocytophaga, a genus of capnophilic gram-negative bacilli, referred to the Massachusetts State Laboratory Institute in Boston revealed 31 patients with infection due to Capnocytophaga, 16 in nonimmunocompromised hosts. These infections included empyema (three patients), lung abscess (one), sinusitis (one), conjunctivitis (three), subphrenic abscess (one), wound (three), osteomyelitis (one), and bacteremia (three). Two of the wound infections were closed-fist injuries involving bone or soft tissue. Capnocytophaga was frequently isolated as part of a polymicrobial infection with other oral flora. There was only one death in the nonimmunocompromised group. In contrast, of 15 immunocompromised patients with 16 episodes of bacteremia due to Capnocytophaga, 87% had leukopenia and 73% had significant oral pathology such as gingivitis, mucositis, or ulceration. Five immunocompromised patients died. Thus, Capnocytophaga species may cause disease in both nonimmunocompromised and immunocompromised hosts. Isolation of this organism should suggest an oral source for infection.

Abscess↗
PubMed1986

CT features of intraabdominal abscesses: prediction of successful percutaneous drainage.

Fifty-three patients with 71 intraabdominal abscesses identified on computed tomography (CT) and treated with percutaneous abscess drainage were evaluated for the possible predictive value of any particular CT feature in relation to the outcome of percutaneous drainage. Features analyzed included the presence of a "rind," sharp exterior margin, air-fluid level, scattered internal gas bubbles, and internal septations, as well as size, site, and the presence or absence of fistulas as determined by sinography. Statistical analysis revealed that only site has predictive value; liver and subphrenic abscesses were more likely to have a successful outcome than abscesses in other locations (84% vs 47% complete cure). The presence of a long air-fluid level denoted communication with the gastrointestinal tract, which led to significantly longer drainage times and larger drainage volumes. Since there are no CT features that can strongly predict a poor outcome, all intraabdominal abscesses should be considered candidates for percutaneous drainage.

Abdomen↗
PubMed1992

Duodenal perforation after laparoscopic cholecystectomy.

A case is reported of duodenal perforation complicating laparoscopic cholecystectomy performed by laser dissection. The importance of investigating a patient with persistent shoulder-tip pain following this technique to exclude a subphrenic abscess is emphasised.

Cholecystectomy, Laparoscopic↗
PubMed1991

[Chilaiditi syndrome].

The paper deals with a patient who was admitted through the surgical emergency service under the suspicion of subphrenic abscess. From the moment of admittance the patient was carefully followed. Laboratory tests were repeated several times. The following examinations were performed within a very short period of time: a posteroanterior X-ray of the chest and both subphrenic spaces, an ultrasonogram of the upper abdomen, a CT scan of the upper abdomen, roenthgenography of the gastroduodenum with gastrografin, an esophagogastroduodenoscopy and irrigography. Apart from the interposition of the colon between the liver and the diaphragm, no other pathological changes were found. Clinical follow-ups of the lungs and the abdomen were normal. The patient was discharged in a good general condition.

Aged↗
PubMed1985

CT evaluation of pancreatic injury following splenectomy.

A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst.

Adult↗
PubMed1995

Rupture of splenic artery pseudoaneurysm.

Pseudoaneurysms of the splenic artery have been well described in association with pancreatic pseudocysts secondary to pancreatitis. We present a case of a ruptured splenic artery pseudoaneurysm 14 years after splenectomy for trauma which, at that time, was complicated by a subphrenic abscess.

Aneurysm, Ruptured↗
PubMed1991

Bronchobiliary fistula detected by cholescintigraphy.

We present a case of a bronchobiliary fistula initially detected by hepatobiliary scintigraphy. The patient developed bilioptysis 18 mo after undergoing a right hepatic lobectomy and resection of the common bile duct for cholangiocarcinoma. The procedure was complicated by the development of a subphrenic abscess that required percutaneous biliary drainage.

Adult↗
PubMed1995

[Hepatectomy under liver normothermic ischemia in primary liver cancer patients associated with cirrhosis].

From Aug 1984 to Aug 1990, under one-shot normothermic interruption of Porta Hepatis, hepatectomy was performed in 115 patients with primary liver cancer (PLC). The incidence of associated cirrhosis was 82.8% with liver function in Grade A in 59.4% of patients and in Grade B in 40.6% of patients according to Pugh's ranking criteria. Hemihepatic vascular occlusion was preferred. Due precautions were taken to prevent postoperative hepatic failure, including continuous low-pressure oxygen inhalation, the use of antioxidants and dexamethasone. Post-operative complications were: Hydrothorax (7.8%), subphrenic abscess (3.5%), bite leakage and gastrointestineal bleeding (0.9%). There was no operative mortality and hospital mortality.

Adult↗
PubMedDate not supplied

Infectious complications of hepatic artery catheterization procedures in patients with cancer.

A total of 353 hepatic artery catheterization procedures were carried out in 211 patients with cancer over a 1-year period (January-December 1988). The procedures included 49 embolizations in 32 patients, 123 chemoembolizations in 73 patients, and 181 chemoinfusions in 106 patients. The overall infection rate was 3.4%. Infectious complications occurred in 3.1% of patients undergoing hepatic artery embolization alone, 1.9% of patients undergoing hepatic artery chemoinfusion, and 4.1% of patients undergoing hepatic artery embolization followed by chemoinfusion. Four patients had infectious complications that included four episodes each of cholangitis, liver abscess, and septicemia. One patient developed a subphrenic abscess in addition to a liver abscess. Enteric gram-negative bacilli (aerobic and anaerobic) were isolated from all four patients. None of the patients had received prophylactic antibiotics. All patients responded to antimicrobial therapy and percutaneous drainage of abscesses.

Bacteremia↗
PubMed1986

Postoperative complications: how much do they cost?

Complications following major abdominal surgery incur considerable expense. The aims of this study were to analyse prospectively the costs of complications following major abdominal surgery and to compare such costs with those of elective distal large bowel resection. Six patients undergoing elective resection for large bowel cancer were studied at the Royal South Hants Hospital between January and March 1983. The mean cost of resection and primary anastomosis, without postoperative complications, was pounds 1,364 (n = 4). Indirect costs accounted for 38%, nursing 25%, medical staff 13%, investigations 8% and consumables 16%. The operation itself accounted for 12% of the total. Complications following major abdominal surgery were studied in a further ten patients. The costs of complications not prolonging hospital stay were: wound infection pounds 64-146; chest infection pounds 21-27; urinary infection pounds 3-6. Complications prolonging hospital stay resulted in considerably greater cost: pelvic abscess pounds 1245; myocardial infarction pounds 476; subphrenic abscess pounds 857; colostomy retraction pounds 764; wound dehiscence pounds 599; incisional hernia pounds 1723, and major chest infection pounds 258. Owing to high fixed costs, the main factor in determining cost for bowel resection and complications was length of hospital stay.

Abdomen↗
PubMed1986

[Complications following splenectomy].

In a retrospective (n = 570) and prospective study (n = 86) early complications following splenectomy were registered in 127/570 (22.3%) resp. 33/86 (38.4%). The mortality rate was 6.6% resp. 6.9%. Recurrent hemorrhage was the most dangerous, infections (pleuropulmonary, wound healing, subphrenic abscess) were the most frequent complications. Their rate is related only to the underlying disease or operative indication (elective splenectomy with hematological diseases; ruptured spleen; incidental splenectomy).

Hemorrhage↗
PubMed1992

[Diseases of the diaphragmatic area. Difficulties of the radiological diagnosis].

Following a reminder of anatomy, the semiology of standard radiology and modern imaging methods is described. The authors then deal with the phrenic-supraphrenic thoracic pathologies (air and liquid effusions, neighbourhood atelectasis, etc.) and with the phrenic-infraphrenic pathologies (transdiaphragmatic hernias, hepatic pathology, subphrenic abscess and pleural effusions). In each of these chapters, the often complex elements of standard radiology and modern imaging methods are detailed.

Diaphragm↗
PubMed1990

Indications for placement of drains in the splenic fossa.

Drainage of the splenic fossa has for years remained a controversial issue. A large potential space exists in the left hypochondrium following splenectomy. Proponents of the use of drainage maintain that drainage is safe, efficacious in removal of blood, serum, and pancreatic enzymes, and carries little, if any, risk of subsequent infectious morbidity. Critics of the use of drainage cite the heretofore reported high incidence of subphrenic abscess formation in those patients in whom drains are placed as the reason for abandoning routine or therapeutic drainage of the splenic fossa.

Drainage↗
PubMedDate not supplied

Halitosis: a delayed complication of splenectomy.

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.

Halitosis↗
PubMed1981

The "elephant man" of Cambridge. a case report of neurofibromatosis.

The case is presented of a 65-year-old man with neurofibromatosis manifesting facial and skeletal features resembling those of the "elephant man" described by Sir Frederick Treves. Autopsy revealed not only a pheochromocytoma (a common accompaniment of neurofibromatosis), but an enlarged infarcted spleen and a subphrenic abscess. These findings have not been described previously in a patient with neurofibromatosis.

Adolescent↗
PubMed1982

The radiology of gastroplasty for morbid obesity.

From experience with 101 patients, the radiologic features of gastroplasty for the surgical treatment of morbid obesity are described. Prompt recognition of surgical complications requires familiarity with expected postoperative appearances. Early complications are: (a) gastric leak with subphrenic abscess, (b) stomal edema and (c) staple dehiscence. Failure to continue to lose weight after surgery results from stretching of the pouch and/or stoma, or delayed staple disruption, due to persistent over-eating.

Edema↗
PubMed1976

[Unusual complication of pancreatitis as seen in angiographic picture (author's transl)].

Selective angiography of pancreas is useful not only to diagnosis of early inflammatory changes but also it is an important exploratory method of pathological processes in later period. By this method it is possible to discover important pathological changes on passing by arteries which can end fataly. In our case the arteriography of pancreas was performed to make clear a subphrenic abscess and at the same time there were discovered inflammatory lesions of splenic artery accompanied by a creation of some pseudoaneurysmas in pancreatic tissue. Their evolution was followed four times by arteriography.

Adult↗
PubMed2004

Rapid onset Chilaiditi's sign on top of fulminant hepatic failure.

Fulminant hepatic failure is a medical emergency. When this condition declared itself irreversible, a timely liver transplantation is the only effective treatment. A 34-year-old Chinese with fulminant hepatic failure was evaluated as a potential liver transplantation candidate. On the erect chest radiograph, Chilaiditi's sign has developed over a very short period of a week due to rapid shrinkage of the liver. Awareness of Chilaiditi's sign facilitated distinguishing the condition of free gas under the diaphragm due to bowel perforation and subphrenic abscess by gas forming micro-organisms. Rapidity of onset of this sign parallels the deterioration of liver function and reflects the urgency of condition.

Adult↗