Spontaneous cholecystocutaneous fistula: an uncommon complication of acute cholecystitis

2020 ◽  
Vol 13 (12) ◽  
pp. e238063
Author(s):  
Philipp Kasper ◽  
Julia Kaminiorz ◽  
Christoph Schramm ◽  
Tobias Goeser
Keyword(s):  
Rare Complication ◽  
Gallstone Disease ◽  
Acalculous Cholecystitis ◽  
Abdominal Ultrasound ◽  
Gallbladder Perforation ◽  
Ct Guided ◽  
Acute Calculous Cholecystitis ◽  
Hypochondriac Region ◽  
Pericholecystic Abscess ◽  
The Right

A 78-year-old man presented to the hospital with acute right upper quadrant pain, fever and nausea. A focused abdominal ultrasound and abdominal CT scan were performed demonstrating an acute calculous cholecystitis with gallbladder perforation. Although a CT-guided cholecystostomy was performed and a pericholecystic abscess was relieved promptly, the patient developed a cholecystocutaneous fistula in the right hypochondriac region. A cholecystocutaneous fistula is an extremely rare complication that may occur in patients with acute calculous or acalculous cholecystitis, chronic gallstone disease, gallbladder carcinoma or prior hepatobiliary surgery.

Hepatic brucelloma: a rare complication of a common zoonotic disease

2020 ◽  
Vol 13 (12) ◽  
pp. e237076
Author(s):  
George Vatidis ◽  
Eirini I Rigopoulou ◽  
Konstantinos Tepetes ◽  
George N Dalekos
Keyword(s):  
Rare Complication ◽  
Surgical Excision ◽  
Coombs Test ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Ct Guided ◽  
Rare Manifestation ◽  
Bone Marrow Cultures ◽  
History Of ◽  
The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

Complicated EBV infection in a healthy child

2021 ◽  
Vol 14 (3) ◽  
pp. e241099
Author(s):  
Hugo Teles ◽  
Teresa Brito ◽  
Joana Cachão ◽  
Susana Parente
Keyword(s):  
Healthy Child ◽  
Acalculous Cholecystitis ◽  
Abdominal Ultrasound ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Acute Acalculous Cholecystitis ◽  
Cervical Lymph Nodes ◽  
Barr Virus ◽  
Ebv Infection ◽  
The Right

The Epstein-Barr virus (EBV) is highly prevalent throughout the population. Although in most cases, the infection has a good prognosis, it can cause severe complications. We report a case of a healthy child with a primary EBV infection that evolved with two rare complications. She first presented in the emergency room with fever and sore throat, and was diagnosed with tonsillitis and medicated with antibiotic. She returned 7 days later for fatigue, vomiting and abdominal pain. The examination revealed tonsillitis, swollen cervical lymph nodes and pain in the right hypochondrium. An abdominal ultrasound was performed, compatible with acute acalculous cholecystitis. She was admitted in the paediatric nursery and medicated with intravenous antibiotics. The EBV serology revealed primary infection. Two days later, she developed cardiogenic shock and had to be transferred to an intensive care unit under mechanical ventilation and inotropics. She was discharged 12 days later, keeping a moderate left ventricular dysfunction.

scholarly journals Hepatic Adenoma - A Case Report

2016 ◽  
pp. 59-62
Author(s):  
Tareq M Bhuiyan ◽  
Indrajit Kumar Datta ◽  
Md Mohsin Kabir ◽  
Md Nazmul Haque ◽  
Md Golam Azam ◽  
...  
Keyword(s):  
Oral Contraceptive Pill ◽  
Abdominal Ultrasound ◽  
Malignant Cell ◽  
Needle Aspiration ◽  
Posterior Aspect ◽  
Ct Guided ◽  
Right Lobe ◽  
Alpha Feto Protein ◽  
Needle Aspiration Cytology ◽  
The Right

We report the case of a 32-year-old female who presented to us with incidental findings of a space occupying lesion (SOL) in liver on abdominal ultrasound (USG). She was taking oral contraceptive pill for last 9 years. Clinical examination was unremarkable and liver investigation revealed mildly raised Serum alanine aminotrasferase (ALT). Dyslipidemia was also present. Computed tomography (CT) identified a 2.5 cm lesion in the right lobe of liver at posterior aspect which was isodense. Alpha-feto protein was normal. CT guided Fine Needle Aspiration Cytology (FNAC) showed adequate cellular material containing organized reactive hepatocytes in the background of blood. No granuloma or malignant cell was seen. Findings were suggestive of hepatic adenoma.Birdem Med J 2015; 5(1) Supplement: 59-62

scholarly journals Gallbladder perforation with liver abscess; laparoscopic cholecystectomy converted to open: a case report

2021 ◽  
Vol 9 (12) ◽  
pp. 3685
Author(s):  
Edgar Salvador Salas Ochoa ◽  
Maria Eugenia Dominguez Gutierrez ◽  
Alfredo Lopez Rocha ◽  
Edilia Naraleth Arce Sanchez ◽  
Karla Itzel Altamirano Moreno ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Liver Abscess ◽  
Rare Complication ◽  
Gallbladder Disease ◽  
Laparoscopic Approach ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Gallbladder Perforation ◽  
Public Care

Gallbladder disease affects more than 20 million people in the United States. Acute cholecystitis is a clinic entity characterized by the inflammation of the vesicular wall that is usually manipulated by abdominal pain, right hypochondrial sensitivity and fever. The technique of choice for the diagnosis of cholecystitis is abdominal ultrasound; gallbladder perforation is a rare complication of acute cholecystitis (2%-11%). The presence of perivesicular abscesses is infrequent, its prevalence varies between 2.1% and 19.5%. Clinical record was reviewed of a 73 years old woman who attended a second level public care unit, with a clinical picture of acute chronic lithiasis cholecystitis, who underwent surgery consisting of open converted laparoscopic cholecystectomy with a finding of vesicular perforation with liver abscess, it was initiated with laparoscopic approach, it was not possible to identify anatomical structures, so it was decided to convert to open surgery. Cholecystectomy and abdominal lavage are usually sufficient in the treatment of gallbladder perforation.

scholarly journals Presacral abscess as a rare complication of sacral nerve stimulator implantation

2017 ◽  
Vol 99 (3) ◽  
pp. e1-e4 ◽  
Author(s):  
A Gumber ◽  
S Ayyar ◽  
H Varia ◽  
S Pettit
Keyword(s):  
Rare Complication ◽  
Symptomatic Relief ◽  
Nerve Stimulator ◽  
Pelvic Brim ◽  
Ct Guided ◽  
Sacral Nerve ◽  
Presacral Abscess ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Invasive Techniques

A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

scholarly journals Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Grigoris Chatzimavroudis ◽  
Stefanos Atmatzidis ◽  
Basilis Papaziogas ◽  
Ioannis Galanis ◽  
Ioannis Koutelidakis ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Symptoms ◽  
Gallstone Disease ◽  
Abscess Formation ◽  
Gallbladder Perforation ◽  
Retroperitoneal Abscess ◽  
Ct Guided ◽  
Good General Condition ◽  
Gallstone Spillage ◽  
Unusual Case Report

One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient’s decision to refuse abscess’s surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

scholarly journals Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Preeti R. John ◽  
Amelia M. Pasley
Keyword(s):  
Abdominal Pain ◽  
Acute Cholecystitis ◽  
Fallopian Tube ◽  
Bladder Wall ◽  
Age Groups ◽  
Lower Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Acute Calculous Cholecystitis ◽  
Upper Abdominal ◽  
The Right

Introduction.Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case.Methods.We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed.Results.Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure.Conclusions.In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis.

scholarly journals Iliopsoas Abscess as the First Clinical Manifestation of Crohn’s Disease - A Rare Case Report and Literature Review

2019 ◽  
pp. 1-3
Author(s):  
Cristiano Alpendre ◽  
Abdul Waheed ◽  
Cristiano Alpendre ◽  
Kai Huang ◽  
Nikita Sijapati ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Rare Complication ◽  
Right Hemicolectomy ◽  
Rare Presentation ◽  
Ct Guided ◽  
Iliopsoas Abscess ◽  
Rare Case Report ◽  
Duodenocolic Fistula ◽  
The Right

Objective: Iliopsoas abscess is a rare complication of fistulizing Crohn’s disease, which is difficult to diagnose and manage. We report this case to alert clinicians to the diagnosis and management of this unusual association. Case presentation: A 31-year-old male who presented with right groin pain, and hip pain due to an iliopsoas abscess. He was found to have iliopsoas fistula and underlying Crohn’s disease. The right iliopsoas abscess was managed with CT guided percutaneous drainage and pigtail catheter placement and intravenous antibiotics. The patient was started on mesalamine and prednisone. A month later, the patient became symptomatic again and a duodenocolic fistula was found. A laparoscopic extended right hemicolectomy with both fistulas takes-down, end ileostomy and mucus fistula were performed. Pathology revealed chronic active Crohn’s ileocolitis. His ileostomy was reversed three months later. The patient recovered uneventfully and was doing well after six-month follow-up. Conclusions: Iliopsoas abscess can be a rare presentation of Crohn’s disease. Evaluation with CT imaging, and initial management with drainage and antibiotics are recommended. Surgical intervention should be considered early for impending arthritis.

P-BN30 Retroperitoneal biloma: a case report of spontaneous retroperitoneal bike leak and collection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Robert Bickerton ◽  
Amy Godden ◽  
Georgios Bointas ◽  
Marize Bakhet ◽  
George Bingham ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Bile Leak ◽  
Liver Function Tests ◽  
Interesting Case ◽  
Gallbladder Perforation ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Cbd Stone

Abstract Background Retroperitoneal biloma is a rare complication of gallstone disease. Only a handful of cases have been reported in the literature with various mechanisms postulated.  Here, we report a case of spontaneous retroperitoneal biloma arising from gallbladder perforation. Methods An 87-year-old female patient presented with right upper quadrant pain in the context of known gallstone disease. Inflammatory markers and liver function tests were deranged. Cross sectional imaging found acute cholecystitis and a gallbadder neck perforation with an impacted 2cm proximal common bile duct (CBD) stone.   A cholecystostomy was placed and she improved clinically. However, inflammatory markers remained high, and a subsequent computed tomography (CT) found a large collection in the retroperitoneum.   Results The retroperitoneal collection measured 14cm x 7cm, and there had been evidence on prior CT scans of retroperitoneal inflammation. It was urgently drained under ultrasound guidance and found to contain bilious content.  Subsequent endoscopic retrograde cholangiopancreatography (ERCP) was unable to retrieve the CBD stone, but left stents either side of the stone. The patient clinically and biochemically improved. She was discharged and had an elective ERCP, which successfully retrieved the stone, with a plan for urgent elective laparoscopic cholecystectomy.  Conclusions Here, we report an interesting case of retroperitoneal biloma successfully managed with ultrasound-guided drainage. Perforation of the distal CBD can result in retroperitoneal bile leak, but the proximal CBD stone in this case would have likely prevented passage of bile. A more likely cause is adhesion of the gallbladder neck to the posterior parietal peritoneum due to chronic inflammation, with subsequent perforation and release of bile into the retroperitoneum. This has previously been described in the literature. Regardless of mechanism, knowledge of the potential for this rare complication is important for anticipating and appropriately managing complications of gallbladder perforation. 

scholarly journals Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication

2016 ◽  
Vol 98 (6) ◽  
pp. e88-e91 ◽  
Author(s):  
T Hussain ◽  
M Adams ◽  
M Ahmed ◽  
N Arshad ◽  
M Solkar
Keyword(s):  
Rare Complication ◽  
Gallstone Disease ◽  
Case Series ◽  
Gallbladder Perforation ◽  
Imaging Studies ◽  
Liver Abscesses ◽  
Surgical Options ◽  
Patient Series ◽  
Atypical Presentations

A spontaneous (non-traumatic) gallbladder perforation with gallstone disease is not common. Concomitant development of a liver abscess is a very rare complication observed in such cases. A few cases of intrahepatic gallbladder perforations with chronic liver abscesses have been described. However, a patient series summarising classical and atypical presentations, relevant imaging studies, and the role of surgical and non-surgical options are lacking. We report a short case series on this rare complication of intrahepatic gallbladder perforations and share our experience of management of this condition.

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