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PubMed2001

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.

Empyema, Pleural↗

PubMed1979

Recent concepts in the treatment of hepatic trauma: facts and fallacies.

Experience with 85 consecutive patients treated at Bellevue Hospital for hepatic trauma over the past two years has established the importance of several principles of management. Simple liver injuries can be treated by superficial suture and drainage. Using this approach in 57 patients there were no deaths and no postoperative abscesses. Among 28 other patients with complex liver injuries, the first six patients (Group 1) were treated by lobectomy alone (1 patient), lobectomy and intracaval shunt (3 patients), hepatic artery ligation (1 patient), and left lateral segmentectomy (1 patient). Only one of the six survived. In the next 22 consecutive patients managed by the Pringle maneuver combined with finger fracture technique of the hepatic parenchyma and a viable omental pack there was only one death (4.5%). An intracaval shunt was used successfully once in this group, in a patient with a lacerated middle hepatic vein. Only one patient developed a postoperative subphrenic abscess (4.5%), and no patients required reoperation for bleeding. Eighty-two per cent of these 22 patients safely tolerated inflow occlusion of greater than 20 minutes with steroid protection. Hepatic artery ligation is superfluous in the majority of liver injuries. In complex injuries involving lobar branches of the portal vein, the retrohepatic cava or hepatic veins hepatic artery ligation is probably ineffective. Hepatic resection is rarely required and carries a prohibitive mortality. The finger fracture technique provides a direct approach to the source of heniorrhage and is probably the procedure of choice.

Adult↗

PubMed1985

Complications requiring operative intervention after gastric bariatric surgery.

In a series of 565 morbidly obese patients having one of five gastric bariatric procedures done at North Carolina Memorial Hospital between May 1975 and December 1982, 55 patients had 58 complications requiring reoperation. These complications included a leak from the stomach or anastomosis, stomal obstruction, and subphrenic abscess. Weight loss after vertical banded gastroplasty appears to be comparable to that following gastric bypass with Roux-en-Y gastrojejunostomy. The complication rate of vertical banded gastroplasty is the lowest of the gastric obstructive operations we have done.

Bile Reflux↗

PubMed1986

Difficulty in diagnosing complications of Caroli's disease.

Congenital cystic dilatation of the biliary tree (Caroli's disease) is a rare condition that usually presents with ascending cholangitis. This report demonstrates the difficulty of recognizing other complications of Caroli's disease antemortem. A 35-year-old man developed a subphrenic abscess and malignant transformation of the biliary tree; both were clinically undetected. Episodes of pain, pyrexia, or weight loss should be assessed carefully and the complications of Caroli's disease considered before attributing such symptoms to recurrent cholangitis.

Adenoma, Bile Duct↗

PubMedDate not supplied

[Cholecystectomy using celioscopy: analysis of 368 operations].

The management of calculous disease of the biliary tract has undergone significant changes during the past decade. Yet, the only radical method of treatment remains cholecystectomy. The surgical option has been improved by the development of laparoscopic cholecystectomy. From February 1990 to February 1991, we performed 368 laparoscopic cholecystectomies, with no mortality and a morbidity rate of 3.8%. There were 283 women and 85 men, with a mean age of 56.2 years (range 18 to 92 years). Two patients were asymptomatic but presented with a growing gallbladder polyp. All the other patients were symptomatic: biliary colic (63.8%), dyspepsia (18.6%), or acute cholecystitis (17.6%); 36 patients had an history of stone migration to the main biliary tract. Mean operating time was 58.3 minutes (22 to 180 minutes) and mean postoperative stay was 3.4 days. There were four systemic complications and 10 local technically related complications: two have been controlled by a laparoscopic approach (one hemorrhage and one biliary leak), one by laparotomy (bile duct injury). The other 7 local complications resolved spontaneously (4 biliary fistulas) or by percutaneous punction (3 subphrenic abscesses). Twenty-six patients (7%) required conversion to open cholecystectomy because of technical difficulties with the dissection or main biliary tract stones. We conclude that laparoscopic cholecystectomy is a safe and effective procedure.

Adolescent↗

PubMed1986

Spontaneous thrombolysis of a large caval thrombus after insertion of an inferior vena cava filter: diagnosis and follow-up by ultrasound.

In the ultrasonic evaluation of a patient with a right-sided subphrenic abscess, coincidentally, a large inferior vena cava thrombus was found and subsequently proved by cavography. Considering the clinical condition of the patient, abdominal surgery was not performed, and instead a percutaneously inserted caval filter was successfully placed above the thrombus. The patient received oral anticoagulant therapy and after 6 weeks, ultrasound demonstrated complete thrombolysis.

Filtration↗

PubMed1980

Post-splenectomy: true mass and pseudomass ultrasound diagnosis.

Ultrasound plays a major role in the evaluation of mass lesions in the postoperative period. Diagnostic pitfalls may occur in post-splenectomy cases when stomach and bowel loops settle into the splenic fossa and simulate mass lesions. While true masses such as subphrenic abscess, pancreatitis and pancreatic pseudocyst are essentially unchanging in appearance or location when scanned in varying patient positions, pseudomasses of stomach or bowel loops often do change, Awareness of possible post-splenectomy pseudomass is important in order to avoid confusing the gastrointestinal tract with a pathological condition.

Adult↗

PubMed2004

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.

Cholecystectomy, Laparoscopic↗

PubMed1975

[Diagnosis and therapy of liver actinomycosis].

A 47-year-old man who had undergone gastrectomy for duodenal ulcer required repeated hospitalization due to recurrent fistulas in the region of the laparotomy scar and increased cholestasis and cachexia. An intrahepatic and subphrenic abscess was diagnosed clinically and by liver scan and confirmed by laparotomy. The histologic findings revealed actinomycosis. Through early surgical drainage and administration of 20 million units penicillin G daily it proved possible to discharge the patient completely cured after 2 months. The pathogenesis of liver actinomycosis is discussed.

Actinomycosis↗

PubMed1997

[Use of collagen and gentamycin in the treatment of chronic soft tissue lesions].

The authors describe two case-histories where Garamycin-schwamm was used in the treatment of a chronic fistula and cavities in the subphrenium resulting from treatment of a subphrenic abscess, and in the pelvis minor as a result of a fistula which developed after establishment of an ileoanal intestinal pouch. They confirm the experience of authors abroad with the treatment of chronic cavities in soft tissues as a result of operations, which so far had to be treated by other methods.

Adult↗

PubMed1985

[Clinical evaluation of cefminox in surgery].

Cefminox (CMNX, MT-141) was administered to 7 cases with postoperative infections including subphrenic abscess and wound abscess, and the clinical effect was good in 2 cases, fair in 2, poor in 2 and unknown in 1. A daily dose was 2 g in 7 cases. The maximum total dose and duration were 22 g and 11 days respectively. Side effect which was observed during the test period was 1 case of drug eruption. No abnormal laboratory findings related to this drug were noted.

Adult↗

PubMed1984

An unusual presentation of carcinoma of the colon in a child. A case report.

A patient with carcinoma of the large bowel who presented with a subphrenic abscess is reported. This case emphasizes two important facts relating to colonic cancer in childhood: (i) premalignant disease of the large bowel is no prerequisite for the development of colonic cancer; and (ii) in childhood this disease is characterized by a fulminating course and high mortality. In about 50% of cases the tumour is of the signet ring or mucin-producing type, which explains the grave prognosis.

Adenocarcinoma↗

PubMed1985

Dual radionuclide subtraction imaging of the spleen.

Dual radionuclide subtraction imaging of the spleen using 67Ga citrate and 99mTc is useful in further delineating lesions that are identified on either a routine radiogallium survey or on a conventional sulfur colloid liver-spleen image. Better anatomic localization of left subphrenic abscesses may be obtained. Differentiation of tumors and abscesses from less serious lesions such as cysts, infarcts, and hematomas is possible. We have found this technique to be generally applicable to any organ that can be selectively imaged using a technetium radiopharmaceutical, including the liver, bones, and kidneys. In addition, we are currently evaluating thallium-pertechnetate subtraction imaging in the evaluation of parathyroid adenomata.

Aged↗

PubMed1999

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.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

[Esophageal and gastric fistulas following surgery of the esophagogastric junction].

Seven cases of oesophageal and gastric fistulae after hiatal hernia surgery are reported: 4 fistulae occurred after an abdominal anti-reflux repair; 3 after an intrathoracic Nissen repair. The clinical symptomatology of these complications highly influences their therapeutical strategy. The fistulae with only an abdominal manifestation (subphrenic abscess or peritonitis) are opposed to those with mediastinal or pleural symptoms. The different modalities of treatment and their results are analysed. The authors prefer in case of a fistula with abdominal manifestation a directed fistulization associated with enteral alimentation; in case of a fistulae with thoracic manifestation an oesophageal exclusion with delayed restoration of G.I. tract continuity is indicated.

Adult↗

PubMed2002

Mini-access for retroperitoneal laparoscopy.

The purpose of this study was to establish the feasibility of primary mini-access to the retroperitoneal space to perform certain retroperitoneoscopic procedures in which an enlarged port is not required for extraction of the specimen. Mini-laparoscopy or needlescopic laparoscopy has been performed in the past via the transperitoneal route, but this has not yet been reported for a retroperitoneoscopic procedure. Through a 5-mm primary access and 3- or 5-mm secondary ports, retroperitoneoscopic surgery was performed in seven adults for ureterolithotomy, renal biopsy, simple nephrectomy, nephropexy, cyst decortication, or drainage of a subphrenic abscess. The access technique used was a mini-version of a previously described percutaneous access technique with some modifications. The retroperitoneoscopic procedure was successful in all seven patients, and no complications developed. The operative time, blood loss, analgesic intake, and length of hospital stay were comparable with those of a standard retroperitoneoscopic procedure. However, the cosmetic results were better. Mini-retroperitoneoscopy is feasible and is a better alternative for patients in whom the whole procedure can be performed through 5-mm or smaller ports.

Feasibility Studies↗

PubMed1979

Management of surgical gastrointestinal complications in renal transplant recipients.

Gastrointestinal (GI) complications developed in 19 (7.2%) of 265 patients after renal transplantation, and 3 (16%) patients died. Complications included colon perforations, colonic bleeding, small-bowel infarction, pancreatitis, subphrenic abscess, and upper GI tract bleeding. Ulcers located in the second portion of the duodenum developed in six patients; four of them required operation for massive hemorrhage, which occurred during or immediately after the administration of high-dose methylprednisolone for rejection. However, the association of methylprednisolone and colon perforation was not clear from this report. Early diagnosis and prompt operation for surgical-type GI complications in transplant recipients contribute to a low mortality.

Adult↗

PubMed2004

[Multiple complications after renal transplantation].

This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable.

Adult↗