Intra-abdominal Actinomycosis 11 Years After Spilled Gallstones at the Time of Laparoscopic Cholecystectomy
Department of Internal Medicine, Beth Israel Medical Center, New York, New York, USA.Surgical laparoscopy, endoscopy & percutaneous techniques (Impact Factor: 1.14). 01/2008; 17(6):542-4. DOI: 10.1097/SLE.0b013e3181469069
A 72-year-old woman with a remote surgical history of a laparoscopic cholecystectomy (LC) complicated by gallstone spillage presented with fever, 3 weeks of nausea and anorexia, and increasing right upper quadrant abdominal pain. After the LC performed 11 years before symptom presentation, the patient was found to have a fluid collection in the right upper quadrant. The patient was asymptomatic at the time, and had no symptoms while being monitored with sequential scans over the next 5 years. At presentation, computed tomography scans revealed a subhepatic, lobulated fluid collection and a radioopacity, consistent with a gallstone, at the inferior aspect of the fluid collection. Subsequent percutaneous drainage of the fluid collection yielded pus that eventually grew Actinomyces israelii. Intravenous clindamycin therapy was initiated, and with further drainage, the abscess resolved. Intra-abdominal abscess formation can present as a delayed complication dropped stones during LC, but these cases usually present within a few years of the procedure. In this case, however, an intra-abdominal abscess formed 11 years after the LC. This extended duration from surgical manipulation to symptom onset is likely secondary to the indolent nature of the infecting organism, A. israelii.
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ABSTRACT: A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented.Southern medical journal 06/2009; 102(7):725-7. DOI:10.1097/SMJ.0b013e3181abddc5 · 0.93 Impact Factor
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ABSTRACT: Objective: The purpose of this article is to describe the diagnostic pitfalls caused by dropped gallstones left in situ after laparoscopic cholecystectomy. Conclusion: Dropped gallstones may rarely become symptomatic, causing recurrent abscesses. Diagnosis is challenging due to unusual clinical presentations, myriad locations, and radiologically occult calculi. Even asymptomatic dropped gallstones may cause diagnostic confusion by masquerading as intraperitoneal neoplastic deposits. Radiologists should be aware of techniques for identifying and retrieving dropped gallstones and be wary of their complications and imitations in patients who have undergone laparoscopic cholecystectomy.American Journal of Roentgenology 06/2013; 200(6):1244-1253. DOI:10.2214/AJR.12.9430 · 2.73 Impact Factor
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