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A 65-yr-old diabetic woman had air in the bile ducts after a choledochoduodenostomy. Following a liver needle biopsy (LNB) she developed a subphrenic abscess with an air-fluid level. Presence of air in the bile ducts in a diabetic patient is a predisposing factor for infection and a contraindication for LNB.
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Non Hodgkin's lymphoma revealed by hepatic manifestations is extremely rare. We describe here a 82-year old male patient who presented with a right subphrenic abscess and a solitary liver tumour that was shown to be a centrocytic lymphoma. Furthermore, asymptomatic cryptogenic liver cirrhosis was diagnosed. This previously unreported form of clinical presentation of a non Hodgkin's lymphoma as well as the association with liver cirrhosis are discussed in the context of the recent literature.
Gallstones lost into the peritoneal cavity rarely cause symptoms. This case report describes the development of a subphrenic abscess 1 year after laparoscopic cholecystectomy due to lost gallstones, and it's management by the adaptation of routine urological minimally invasive techniques.
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Traumatic diaphragmatic hernias can be difficult to diagnose because of their varied clinical and radiologic signs and because patients may not present with symptoms for months to years following the injury. We report a case of a delayed presentation of a traumatic diaphragmatic rupture through which a portion of the stomach herniated and simulated a large subphrenic abscess.
A false-positive radiocolloid liver image can occur in various disease processes from extrinsic structures adjacent to the liver. A patient whose radiocolloid liver imaging showed an apparent photopenic area in the liver is presented; the abdominal CT demonstrated a low-density lesion located anterior to the liver, and at surgery the lesion was confirmed to be a right anterior subphrenic abscess.
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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.
Although laparoscopic cholecystectomy has become a safe and effective alternative for open cholecystectomy as treatment of symptomatic cholelithiasis, it may be followed by different complications. Two cases are presented with unusual complications after laparoscopic cholecystectomy. One patient was readmitted 11 days after laparoscopic cholecystectomy with severe upper abdominal pain and a false aneurysm of a branch of the right hepatic artery. The other patient developed a recurrent subphrenic abscess 10 months after the initial operation, which eventually was shown to be caused by a lost gallstone. Although these are rare complications of laparoscopic cholecystectomy, they should be recognized as potential causes of recurrent abdominal pain, even months after the procedure.
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A 54-year-old female, who had been mediated for simple type schizophrenia for the past eleven years, was hospitalized with left lumbar discomfort or pain. After admission, the following abnormalities were apparent serologically; leucocytosis of 15700/mm, erythrocyte sedimentation rate of 147 mm/h, hyper alpha 2-globulinemia (675 ng/dl of haptoglobulin). Urine cultures were negative. Left renal simple cyst with infection was evaluated by intravenous urography, ultrasonogram, computed tomographic (CT) scan., and renal angiogram. In addition, left subphrenic abscess behind the spleen, which had to be penetrated through retroperitoneum, could be diagnosed. So, in our case, cystic wall resection (unroofing) and/or conservatively percutaneous cystotomy for pus drainage were all not indicated instead of radical operation for abscess removal completely. CT scan is mostly available to make differential diagnosis whether the infectious renal cyst influence to the neighbouring organs beyond the renal capsule, or not. Here, we discussed the pathogenesis on the infection of solitary renal cyst, and some problems reported in the literature.
Abdominal pregnancy appears once in 3000 pregnancies. It usually terminates with abortion and urgent surgery. Thanks to ultrasonography and computed tomography the diagnosis is possible before surgery. Most frequently the diagnosis has been established during emergency laparotomy. Gynaecologists are not in agreement whether removal of placenta is mandatory or not, as it may include removal of parts or entire organs or may be followed with serious bleeding difficult to control. We present a 21-year old woman in whom during an urgent laparotomy performed for abdominal pregnancy placenta inserted in the spleen was left in situ. Postoperatively the patient developed subphrenic abscess which could not be solved without reoperation during which both the placenta and the spleen were removed. Ten years after surgery she is symptom-free.
Abdominal abscesses located in the left upper quadrant may occur in two major anatomic locations, the subphrenic space or the lesser sac. The left coronary or triangular ligament extending from the dorsal aspect of the liver to the diaphragm separates the subphrenic space from the lesser sac. As the ligament usually extends posteriorly, the anterior subphrenic space extends under the dome of the diaphragm, occupying the most superior part of the left upper quadrant. Both the lesser sac and the left anterior subphrenic space extend to the right of midline. The left anterior subphrenic compartment is bounded on the right by the falciform ligament while the lesser sac extends to the right coronary ligament and foramen of Winslow. Therefore, abscesses either in the left anterior subphrenic compartment or lesser sac may extend across the midline into the right upper quadrant. Left anterior subphrenic abscesses will be immediately subdiaphragmatic while lesser sac abscesses extending to the right of midline will not usually extend up to the diaphragm. Six cases are presented demonstrating midline air-fluid levels and soft-tissue masses in the immediate subdiaphragmatic area, characteristic signs of anterior left subphrenic abscesses.
The authors describe the slow development of an abscess in the left subphrenic space in a patient with acute myeloid leukaemia. The patient suffered several months before the diagnosis was established from pain in the left subcostal region and was on account of this pain examined repeatedly by clinical methods and sonography. During the last sonographic examination in this area a hypoechogenic formation was detected. The diagnosis was than established more accurately by computer tomography by visualization of the abscess cavity. The case-history and relatively thick wall of the cavity suggested a long-term process. The abscess cavity was evacuated surgically, however, the patient suffered a relapse later and died from septicaemia. In the discussion the authors analyze the problem of development of metastatic abscesses in leukopenic patients, early diagnosis and treatment.
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