Adult ; Drainage ; Female ; Humans ; Hysterectomy, Vaginal ; adverse effects ; Laparoscopy ; adverse effects ; Radiography ; Subphrenic Abscess ; diagnostic imaging ; etiology ; therapy ; Ultrasonography

Pyogenic liver abscesses are rare in children. In pediatric patients, altered host defences seem to play an important role. However, pyogenic liver abscess also occurs in healthy children. We experienced a case of pyogenic liver abscess in a healthy immunocompetent 10-year-old-girl. The patient presented two distinct abscesses: one subphrenic and the other intrahepatic. The intrahepatic abscess resolved with percutaneous drainage and 3 weeks of parenteral antibiotic therapy but the subphrenic abscess which could not be drained needed prolonged parenteral antibiotic therapy in addition to oral antibiotic therapy. We performed follow-up serial CT scan of the abscess cavity to decide on the duration of antibiotic therapy. Here we present this case with a brief review of the literature.
Abscess ; Anti-Bacterial Agents ; Child ; Drainage ; Follow-Up Studies ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic ; Subphrenic Abscess

Asphyxia ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Retropharyngeal Abscess ; complications ; therapy ; Subphrenic Abscess ; complications ; therapy ; Treatment Outcome

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.
Adenocarcinoma/complications/diagnosis/*secondary ; Aged ; English Abstract ; Humans ; Ileal Diseases/diagnosis/*etiology ; Ileal Neoplasms/complications/diagnosis/*secondary ; Intestinal Fistula/diagnosis/*etiology ; Male ; *Neoplasms, Unknown Primary ; Subphrenic Abscess/diagnosis/*etiology

Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.
Empyema ; Female ; Fistula* ; Hernia, Hiatal ; Humans ; Middle Aged ; Postoperative Complications ; Respiratory Insufficiency* ; Subphrenic Abscess

Eighty-four-year old man who had lapalotomy for stomach ulcer perforation 35 years ago was admitted for left lower chest discomfort. Chest X-ray and CT showed a large mass with air fluid level in left lower lung field. The tentative diagnosis was infected bronchogenic cyst. After a thoracotomy, the mass was confirmed as elevated diaphragm and subphrenic abscess with a foreign body, retained surgical gauze. The pus and gauze were located between stomach and diaphragm. His hospital course was smooth and uneventful, he was discharged with good outcome on postoperative day 9.
Bronchogenic Cyst ; Diagnosis ; Diaphragm ; Foreign Bodies ; Lung ; Stomach ; Stomach Ulcer ; Subphrenic Abscess* ; Suppuration ; Thoracotomy ; Thorax

PURPOSE: Postoperative biliary stricture is rare, but can result in a dreadful condition unless it is properly treated. This study was undertaken to assess the clinical features of a postoperative biliary stricture and to evaluate the outcome of reconstructive methods according to the stricture locations and types. METHODS: From 1984 to 2001, 28 cases (M=16, F=12) of postoperative biliary stricture, which resulted from surgical injury and had subsequent reconstructive procedures performed in department of surgery of Seoul National University Hospital, during the period of 1984 to 2001, were retrospectively reviewed. Clinical features such as the symptom, type of surgery causing the stricture, laboratory finding, diagnostic modality, interval between the operation and symptoms and the type of stricture were reviewed and clinical outcomes of the reconstructive procedures were also analyzed. The mean follow-up period was 45.9 months (2~157). RESULTS: The most common symptoms of stricture was jaundice. 57.1% of patients showed symptoms within postoperative 6 months and 64.3% showed symptoms within 1 year. A cholecystectomy was most common surgical procedure that caused a postoperative biliary stricture. Bismuth type I was most common type of stricture (52.2%). Bilioenteric anastomosis (Roux-en Y hepaticojejunostomy) showed most excellent result among the many reconstructive methods. One case of an interventional balloon dilatation has maintained a good condition for 3 years after the procedure. The postoperative complications comprises bile leakage, a subphrenic abscess, an incisional hernia, am intrahepatic duct stone, recurrent pyogenic cholangitis. There were 2 cases of postoperative mortality. CONCLUSION: Roux-en Y hepaticojejunostomy is considered to the procedure of choice for a postoperative biliary stricture. An interventional balloon dilatation is expected to show good result with more cases and adequate indications.
Bile Ducts* ; Bile* ; Bismuth ; Cholangitis ; Cholecystectomy ; Constriction, Pathologic* ; Dilatation ; Follow-Up Studies ; Hernia ; Humans ; Intraoperative Complications ; Jaundice ; Mortality ; Postoperative Complications ; Retrospective Studies ; Seoul ; Subphrenic Abscess

Acute hepatic failure, liver infarction, abscess, intrahepatic biloma, and multiple intrahepatic aneurysms could be complicated after transcatheter arterial embolization (TAE) in a patient with hepatocellular carcinoma. Conservative managements such as nutritional support and control of sepsis for gastrointestinal fistula have been recommended for the last few decades. Histoacryl(R) has been applied to treat gastrointestinal fistula. We report a case of liver abscess after TAE followed by hepatosubphrenic abscess in a patient with hepatocellular carcinoma. The fistula between liver abscess and subphrenic abscess was occluded with Histoacryl(R) injection by ERCP. Endoscopic nasobiliary drainage and percutaneous drainage were performed respectively. Both abscesses were treated, but the patient died of hepatic failure.
Abscess ; Aneurysm ; Carcinoma, Hepatocellular ; Cholangiopancreatography, Endoscopic Retrograde* ; Drainage ; Fistula* ; Humans ; Infarction ; Liver ; Liver Abscess ; Liver Failure ; Liver Failure, Acute ; Nutritional Support ; Sepsis ; Subphrenic Abscess

Gastrobronchial fistula is an extremely rare condition. It is usually associated with trauma, esophagogastric surgery, subphrenic abscess, gastric ulcer, and neoplasm. A case of recurrent gastrobronchial fistula secondary to a benign gastric ulcer 2 and 3 years after Ivor Lewis procedure for treatment of esophageal carcinoma is described. The literature of this subject is reviewed and discussed.
Bronchial Fistula ; Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Postoperative Complications ; Stomach Ulcer ; Subphrenic Abscess

PURPOSE: We assessed the feasibility and efficacy of a laparoscopic approach in surgically managing various conditions of the acute abdomen. METHODS: This report presents preliminary data from our ongoing prospective study. Sixty patients underwent a diagnostic or a therapeutic laparoscopy for acute or subacute abdominal conditions between July 1997 and September 1998. RESULTS: Conditions were classified into trauma (n=8), peritonitis (n=41), and obstruction (n=11). Trauma included 5 blunt (2 small bowel perforations, 1 spleen rupture, 2 mesenteric ruptures) and 3 stab injuries. Peritonitis included 23 duodenal ulcer perforations, 10 acute cholecytitis/empyema, 3 colon perforations, 1 tuberculous peritonitis, 1 ectopic pregnancy, 1 ruptured corpus luteum, 1 appendicitis, and 1 ruptured liver abscess. Obstruction included 5 intussusceptions (4 Children, 1 adult), 2 intestinal adhesions; and 4 congenital hypertropic pyloric stenoses. Among the 54 cases of therapeutic laparoscopy, 9 cases were converted during the procedure (conversion rate: 16.7%). There were 2 intraoperative (bowel perforation) and 4 postoperative (1 subphrenic abscess, 1 incomplete adhesiolysis, 1 port site hernia, 1 port-site seroma) complications. CONCLUSION: Our preliminary data may justify further clinical study to clarify the role of laparoscopy in managing acute or subacute abdominal conditions.
Abdomen, Acute* ; Appendicitis ; Child ; Colon ; Constriction, Pathologic ; Corpus Luteum ; Duodenal Ulcer ; Female ; Hernia ; Humans ; Intussusception ; Laparoscopy* ; Liver Abscess ; Peritonitis ; Peritonitis, Tuberculous ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Rupture ; Spleen ; Subphrenic Abscess