Ann Thorac Surg 2012;93:e163. doi:10.1016/j.athoracsur.2012.01.057
© 2012 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
A Huge Transdiaphragmatic Abscess Detected Postcholecystectomy
Bruno Hochhegger, MD, PhDa,b,
Gláucia Zanetti, MD, PhDb,
Edson Marchiori, MD, PhDb,*
a Pavilhão Pereira Filho, Post graduation Program in Pulmonary Sciences, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
b Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
* Address correspondence to Dr Marchiori, Rua Thomaz Cameron, 438 Valparaiso CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil (Email: edmarchiori{at}gmail.com).
A 51-year-old man presented with fever and right chest pain. He had undergone a laparoscopic cholecystectomy (LC) 30 days previously. Chest computed tomography (Figs 1A,
1B) showed a right subphrenic abscess that extended through the diaphragm to the pleural cavity. Thoracic drainage yielded yellow-green pus in which Enterococcus faecalis was identified. The patient underwent a pleurotomy with drainage, which resolved the abscess. No evidence of gallstone spillage was present.
Complications related to LC are numerous, including gallstone spillage, bile duct injury, hemorrhage, and subhepatic abscess. Other possible complications are thermal injury that may result in bile leakage and late strictures of extrahepatic ducts, postoperative fever, and umbilical hernia at the site of a midline trocar. Reported thoracic complications of LC include abscess (eg, subphrenic, transdiaphragmatic) and empyema. Gallstone spillage is frequently seen in these patients, regardless of the interval since LC. Thoracic complications of LC constitute an uncommon problem deriving from a very common procedure [1–3].
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References
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- Duca S, Bãlã O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2003;5:152-158.[Medline]
- Shea JA, Healey MJ, Berlin JA, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg 1996;224:609-620.[Medline]
- Preciado A, Matthews BD, Scarborough TK, et al. Transdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy J Laparoendosc Adv Surg Tech A 1999;9:517-521.[Medline]
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