scholarly journals Dropped Gallstones Causing a Perihepatic Abscess and Empyema

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
J. R. Robinson ◽  
J. K. Wright ◽  
S. K. Geevarghese
Keyword(s):  
Computed Tomography ◽  
Laparoscopic Cholecystectomy ◽  
Fluid Collection ◽  
Surgical Operation ◽  
Initial Operation ◽  
Iatrogenic Perforation ◽  
Abdominal Exploration ◽  
Night Sweats ◽  
Fluid Collections ◽  
Gallstone Spillage

Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy is a well-known occurrence; however, the consequences of spillage of gallstones in the peritoneum and particularly intrathoracic complications are less defined. We describe the delayed development of a perihepatic abscess and empyema in a patient five years following laparoscopic cholecystectomy secondary to dropped gallstones. A 53-year-old man with medical history significant for a laparoscopic cholecystectomy five years prior to acute cholecystitis presented with purulent cough, hemoptysis, night sweats, and right-upper quadrant (RUQ) pain. Computed tomography (CT) scan revealed 5.4 cm right-sided subpulmonic and 5.9 cm perihepatic fluid collections with an 8 mm focal radiopaque density within the perihepatic fluid collection. Open intra-abdominal exploration resulted in retrieval of a 1 cm intraperitoneal gallstone. Laparoscopic cholecystectomy is a common surgical operation during which gallstone spillage can occur, causing both intra-abdominal and intrathoracic complications, presenting even years after surgery. This necessitates an attempt to retrieve all free intra-abdominal gallstones during the initial operation.

Diagnostic Accuracy of Intra-abdominal Fluid Collection Characterization in the Era of Multidetector Computed Tomography

2012 ◽  
Vol 78 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Brian C. Allen ◽  
Huiman Barnhart ◽  
Mustafa Bashir ◽  
Christopher Nieman ◽  
Steven Breault ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Ct ◽  
Imaging Finding ◽  
Fluid Collection ◽  
Ct Guided ◽  
High Attenuation ◽  
Institutional Review ◽  
Imaging Characteristics ◽  
Fluid Collections ◽  
Ct Density

The purpose of this study was to test the hypothesis that with improved technology, the presence of abscess in a postoperative fluid collection may be prospectively made. This is an Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective review of computed tomography (CT)-guided intra-abdominal fluid collection drainages. The diagnostic CT scans of 95 consecutive patients performed on 16- and 64-multidetector CT (MDCT) were reviewed by four readers with varying abdominal imaging expertise. Readers were asked to determine fluid content, to document whether infection was present, and to rate reader confidence for infection. A fifth radiologist reviewed the collections for imaging characteristics. The gold standard for presence of infection was microbiological Gram stain and culture. The logistic regression model showed that both fluid collections containing gas or high attenuation fluid (average CT density 20 or greater Hounsfield units) are significant predictors of infection ( P = 0.001). The average sensitivity over the four readers for determining presence of infection was 83.4 per cent and specificity was 39.3 per cent. Even in the era of MDCT, the ability to predict whether or not a fluid collection is infected or not, based on imaging findings alone, is limited. Presence of gas is a strong indicator of infection, but no imaging finding is characteristic of a sterile fluid collection.

scholarly journals Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259701
Author(s):  
Koki Maeda ◽  
Naohisa Kuriyama ◽  
Yuki Nakagawa ◽  
Takahiro Ito ◽  
Aoi Hayasaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
Intervention Group ◽  
Postoperative Pancreatic Fistula ◽  
Optimal Management ◽  
Duration Of Hospitalization ◽  
Pancreatic Fistulas ◽  
Fluid Collections

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

scholarly journals Volumetric Computed Tomography Angiography in the Evaluation of Mediastinal Fluid Collections following Congenital Cardiac Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Arno A. W. Roest ◽  
Joost Roelofs ◽  
Mark G. Hazekamp ◽  
Marry E. B. Rijlaarsdam ◽  
Jacob Geleijns ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Case Report ◽  
Radiation Dose ◽  
Essential Role ◽  
Fluid Collection ◽  
Congenital Cardiac Surgery ◽  
Imaging Tool ◽  
Fluid Collections ◽  
Accurate Imaging

We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report. Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management. Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

scholarly journals A case of chronic cough due to sarcoidosis

2021 ◽  
pp. 201010582110190
Author(s):  
Qin Jian Low ◽  
Mohd Nadzri Bin Misni ◽  
Seng Wee Cheo ◽  
Khai Lip Ng ◽  
Noorul Afidza Muhammad
Keyword(s):  
Computed Tomography ◽  
Chronic Cough ◽  
Pulmonary Sarcoidosis ◽  
Granulomatous Disease ◽  
Unknown Aetiology ◽  
Caseous Necrosis ◽  
Night Sweats ◽  
Histopathological Lesion ◽  
Treatment Of Sarcoidosis ◽  
Steroid Sparing

Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown aetiology that often affects the lungs. Diagnosis and treatment of sarcoidosis can be strenuous. Patients may be asymptomatic or experience cough, dyspnoea, fatigue, unintentional weight loss or night sweats. Computed tomography is valuable in the diagnosis of sarcoidosis. The typical histopathological lesion of sarcoidosis is granuloma without caseous necrosis in the involved organs. As tuberculosis is endemic in our region, clinicians should not forget this great mimicker. The cornerstone of treatment of sarcoidosis is corticosteroids but newer agents such as steroid-sparing agents and biological agents are available. We report a case of pulmonary sarcoidosis presenting with chronic cough.

863 Peri-Implant Fluid Collection in Breast Reconstruction and Aesthetic Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Karagiannidis ◽  
E Mallidis
Keyword(s):  
Reconstructive Surgery ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Fluid Collection ◽  
Aesthetic Surgery ◽  
Large Cell ◽  
Inclusion Criteria ◽  
Electronic Data Collection ◽  
Fluid Collections ◽  
Mean Time

Abstract Introduction Peri-implant fluid more than 6 months from surgery is a known complication of breast surgery.Differential diagnosis includes infection, inflammation,implant rupture and haematoma.Other than infection raised no concern until the identification of Breast Implant Associated Anaplastic Large Cell Lymphoma(BIA-ALCL). Method Retrospective electronic data collection for women 18 years or older who met the following inclusion criteria:(a)oncoplastic and/or cosmetic reconstructive surgery with placement of implant(b)peri-implant fluid collection after 6-36 months. Results In total,17 women with implants with a mean age of 56 years were included in the study.The mean time between reconstructive surgery and the peri-implant fluid collection was 23 months.The median peri-implant fluid collection size was 143 ml.14 of the 17 peri-implant fluid collections were benign.12 of 14 had polyurethane-coated textured implants.4 of the 17 were BIA-ALCL. Conclusions The current literature suggests that late peri-implant seromas arise from friction as the implant moves within the cavity and that this friction is increased with textured rather than smooth implants.In our unit 12/14 of the benign collections appeared in reconstructions with polyurethane implants.Furthermore,BIA-ALCL should always be considered in this situation and aspirate should be sent for cytology.Is this change in polyurethane implants a new entity?

scholarly journals Management of a pseudo-aneurysm in the hepatic artery after a laparoscopic cholecystectomy

2016 ◽  
Vol 98 (7) ◽  
pp. 456-460 ◽  
Author(s):  
MP Senthilkumar ◽  
N Battula ◽  
MTPR Perera ◽  
R Marudanayagam ◽  
J Isaac ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Laparoscopic Cholecystectomy ◽  
Hepatic Artery ◽  
Computed Tomography Angiography ◽  
Rare Complication ◽  
Artery Pseudoaneurysm ◽  
Pseudo Aneurysm ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction Symptomatic hepatic-artery pseudoaneurysm (HAP) after bile-duct injury (BDI) is a rare complication with a varied (but clinically urgent) presentation. Methods A prospectively maintained database of all patients with BDI at laparoscopic cholecystectomy (LC) referred to a tertiary specialist hepatobiliary centre between 1992 and 2011 was searched systematically to identify patients with a symptomatic HAP. Care and outcome of these patients was studied. Results Eight (6 men) of 236 patients with BDI (3.4%) with a median age of 65 (range: 54?6) years presented with symptomatic HAP. Median time of presentation of the HAP from the index LC was 31 (range: 13?16) days. Bleeding was the dominant presentation in 7 patients. One patient presented late (>2 years) with abdominal pain alone. Computed tomography angiography was the most useful investigation. Angioembolisation was successful in 7 patients. One patient died, and another patient developed liver infarction. Three patients (38%) developed biliary strictures after embolisation. Seven patients are alive and well at a median follow-up of 66 months. Conclusions Presentation of HAP is often delayed. A high index of suspicion is necessary for the diagnosis. Computed tomography angiography is the first-line investigation and selective angioembolisation can yield successful outcomes.

Value of Spectral Detector Computed Tomography to differentiate Infected from Noninfected Thoracoabominal Fluid Collections

2021 ◽  
pp. 110037
Author(s):  
Robert Peter Reimer ◽  
Roman Johannes Gertz ◽  
Lenhard Pennig ◽  
Jörn Henze ◽  
Erkan Celik ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Fluid Collections
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