ABSTRACT
Laparoscopic cholecystectomy is the treatment of choice in symptomatic cholelithiasis. Despite its many advantages over the conventional laparotomic approach, accidental perforation of the gallbladder with spilled stones and bile leakage is frequent during this procedure. Complications from missed gallstones are uncommon, although they can sometimes lead to severe consequences. Great effort must be made to achieve laparoscopic retrieval of all the gallstones missed into the peritoneal cavity and conversion to an open procedure should be used only in selected cases. We report a case of subhepatic abscess as a late complication of a missed gallstone during a previous laparoscopic cholecystectomy.
Subject(s)
Abdominal Abscess/etiology , Cholecystectomy, Laparoscopic/adverse effects , Foreign-Body Migration/complications , Foreign-Body Migration/surgery , Gallstones/complications , Gallstones/surgery , Abdominal Abscess/diagnostic imaging , Abdominal Abscess/surgery , Foreign-Body Migration/diagnosis , Gallstones/diagnosis , Humans , Intraoperative Complications , Laparotomy , Liver/diagnostic imaging , Liver/microbiology , Liver/pathology , Male , Middle Aged , Peritoneal Cavity/diagnostic imaging , Peritoneal Cavity/pathology , Peritoneal Cavity/surgery , Postoperative Period , Time Factors , Tomography, X-Ray ComputedABSTRACT
Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.
Subject(s)
Actinomycosis/microbiology , Liver Abscess/microbiology , Actinomycosis/diagnostic imaging , Actinomycosis/drug therapy , Actinomycosis/pathology , Aged , Anti-Bacterial Agents/therapeutic use , Biopsy, Needle , Diagnosis, Differential , Humans , Liver/diagnostic imaging , Liver/microbiology , Liver/pathology , Liver Abscess/diagnostic imaging , Liver Abscess/drug therapy , Liver Abscess/pathology , Male , Penicillin G/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Lymphangiomatosis is a rare syndrome that can affect different organs, although simultaneous splenic and adrenal involvement is exceptional. We report the case of a young female with a symptomatic massive splenomegaly and no-nhypersecreating bilateral adrenal masses incidentally discovered that represented a diagnostic challenge. The management of adrenal incidentalomas is controversial, as the presence of large sized bilateral masses are highly indicative of malignancy. Despite the different diagnostic techniques available, it is sometimes impossible to reach an accurate preoperative diagnosis. Elective splenectomy and left adrenalectomy were performed, preserving the functioning of the right adrenal gland, radiologically similar to the left one, to prevent the development of definitive adrenal insufficiency. Postoperative evolution has been favourable without initial increase of the size of the right adrenal lesion. However, the persistence of this mass obligated long-term follow-up and shall assist us in better understanding the behavior of this bening lesion.
Subject(s)
Adrenal Gland Neoplasms/pathology , Lymphangioma/pathology , Spleen/pathology , Splenic Neoplasms/pathology , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Adult , Female , Humans , Lymphangioma/diagnostic imaging , Lymphangioma/surgery , Spleen/diagnostic imaging , Spleen/surgery , Splenectomy/methods , Splenic Neoplasms/diagnostic imaging , Splenic Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We present a case of a brucellar liver abscess in a 25-year-old male that was successfully treated by surgery and comment on this unusual form of brucellosis. We detail the complementary exams and how the diagnosis was achieved. We also review the 23 cases reported in the world literature, commenting on them from an etiological, clinical, diagnostic and therapeutic point of view in its two aspects: medical and surgical.