2017, Number 1
Subhepatic abscess secondary to a retained appendicolith. Case report
Villalobos REJ, Hernández LA, Sainz HJC, Murillo ZA
Full text
Language: Spanish
References: 6
Page: 40-43
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ABSTRACT
Introduction: Appendectomy is one of the most common surgeries in the world. In those cases of perforated appendicitis, the risk of a residual abscess is up to 20%, being a retained appendicolith an uncommon cause of it. A review of the literature on the variability of residual abscesses secondary to retained appendectomies was carried out. Case report: This was an 18-year-old male who presented, 16 days after a laparoscopic appendectomy, right upper quadrant pain, fever, and nausea. A computed tomography scan of the abdomen was performed, which reported a subcapsular hepatic abscess with an appendicolith. It was treated with drainage and laparoscopic lavage. Four trocars, similar to the laparoscopic cholecystectomy approach, were placed. An abscess of approximately 30 mL was found by the coronary ligament in the fifth and sixth hepatic segments; a one-centimeter fecalith was found, which was extracted through the umbilical trocar with an endo-bag; a closed drain was left in the space of Morrison. The patient was covered with metronidazole and ceftriaxone. He had a suitable postoperative evolution. The drainage was removed at 48 hrs. and he was discharged. Conclusions: Appendicolith migration has been reported, causing empyema, pelvic, retroperitoneal, inter-bowel, and hepatic residual abscesses; the most common one is perihepatic. CT scan is considered the most sensitive and specific study to diagnose this entity. Different approaches have been described, such as drainage guided by ultrasound or tomography without the removal of the appendicolith, which carries a high risk of recurrence. Reoperation with a laparoscopic or open approach with appendicolith extraction is the only definitive resolution for these abscesses.REFERENCES