alexa Sub Diaphragmatic Abscess Following Laparoscopic Cholecystectomy: an Uncommon Event | Open Access Journals
ISSN: 2155-6148
Journal of Anesthesia & Clinical Research
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Sub Diaphragmatic Abscess Following Laparoscopic Cholecystectomy: an Uncommon Event

Shantanu Vyas*

Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

*Corresponding Author:
Shantanu Vyas
Department of General Surgery
Mahatma Gandhi Medical College and Hospital
Jaipur, Rajasthan, India
Tel: +919214010448
E-mail: [email protected]

Received Date: June 02, 2014; Accepted Date: June 21, 2014; Published Date: June 24, 2014

Citation: Vyas S (2014) Sub Diaphragmatic Abscess Following Laparoscopic Cholecystectomy: an Uncommon Event. J Anesth Clin Res 5:413. doi: 10.4172/2155-6148.1000413

Copyright: © 2014 Vyas S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Anesthesia & Clinical Research

Abstract

In the current era of minimally invasive surgery, Laparoscopic Cholecystectomy has become the gold standard for the surgical management of symptomatic gallstones. However, with the increase in the number of laparoscopic operations performed, there has also been a noticeable increase in the number of complications specific to these procedures. Known complications of laparoscopic Cholecystectomy include bowel and vascular injury, injury of the bile duct and complications of retained stones, in less than 5% procedures performed. Spillage of bile and stones in the abdominal cavity has been reported in 15%-40% of procedures performed, but these are believed to be innocuous. We report a patient who suffered a thoraco abdominal complication in form of right sub diaphragmatic abscess, may be due to bile spillage, three weeks after initial operation.

Keywords

Sub diaphragmatic abscess; Laparoscopic cholecystectomy

Introduction

In the current era of minimally invasive surgery, Laparoscopic Cholecystectomy has become the gold standard for the surgical management of symptomatic gallstones. However, with the increase in the number of laparoscopic operations performed, there has also been a noticeable increase in the number of complications specific to these procedures. Known complications of laparoscopic Cholecystectomy include bowel and vascular injury, injury of the bile duct and complications of retained stones, in less than 5% procedures performed. Spillage of bile and stones in the abdominal cavity has been reported in 15%-40% of procedures performed [1], but these are believed to be innocuous. We report a patient who suffered a thoraco abdominal complication in form of right sub diaphragmatic abscess, may be due to bile spillage, three weeks after initial operation. This is worth reporting because authors have seen only single instance of sub diaphragmatic abscess in an experience of more than 700 lapcholecystectomies.

Case Report

A 25 year old female presented to primary care physician with 3 days history of pain right hypochondrium and right lower chest, coughing and fever (range 100°F-10°F), approximately three weeks after laparoscopic Cholecystectomy. X-ray chest done shows air fluid level under Right. Sub diaphragm with Right Basal lung signs. Sonography revealed Right sub diaphragmatic abscess, with Right. Pleural effusion HRCT thorax also confirmed Right sub diaphragmatic abscess, USG guided Right. Sub diaphragmatic abscess drainage done twice on 18/07/2013 and 22/07/2013, but abscess could not be completely resolved, hence drainage under GA done on 26/07/2013. Detailed investigation revealed TLC 11.16×103, Hb-9 gm/dl, ESR-80 mm in Ist hr, CRP +ve, Pleural fluid culture sterile, pus culture-pseudomonas aeruginosa grow pleural fluid ADA-127 u/l, Pleural fluid -sugar 57 mg/dl, Protein 3.8 gm/dl, LDH -434 u/l. No AFB seen in Pus or pleural fluid. Patient discharged on 31/07/13. Patient at 6 month follow up when last seen was perfectly well.

Discussion

Since its inception in 1987, laparoscopic Cholecystectomy has largely replaced the open approach for treatment of Cholecystitis and Cholelithiasis. The benefits of laparoscopic surgery are well described and include greatly reduced postoperative hospital stay and surgical pain. Nevertheless, rare but serious complications such as vascular and common bile duct injuries occur twice as often with laparoscopic approach versus an open procedure [2]. A more frequent undesired event is accidental spillage of gall stones occurring is 6% to 16% of the cases, in recent large retrospective analysis [3,4]. Although the bile is easily sucked after irrigation in such cases, removal of gallstones from within the abdominal cavity can prove more challenging.

Various authors have reported postoperative complications in 0.08% to 2.5% of all patients undergoing laparoscopic Cholecystectomy having unretrieved gall stones [5-7].

A review of the literature published in 2002 revealed 127 case reports describing spillage of gall stones since 1963, of which 44% involved intra peritoneal abscess, 18% abdominal wall abscess, 12% thoracic abscess, 10% retroperitoneal abscess, 3% pelvic abscess and 3% pericolic abscess [8].

Thus overall thoracic complications of unretrieved gall stones are rare, but do represent significant morbidity in the affected patient. In our patient there was no spillage of gall stones, still our patient had developed sub diaphragmatic abscess, probably it would have been spilled bile which was not sucked completely, so a need to do proper peritoneal toileting is mandatory especially in difficult cases.

There is insufficient evidence to support conversion of a laparoscopic procedure to a laparotomy based solely on the spillage of bile, or even the leaving of multiple stones intraperitoneally after the procedure. It is good practice to attempt to remove all debris spilt intra operatively during laparoscopic Cholecystectomy, but this does not necessitate conversion to a laparotomy in most cases. It is also important for the surgeon to be mindful of delayed complications in patients presenting with vague symptoms after a laparoscopic Cholecystectomy.

Percutaneous drainage of a sub diaphragmatic abscess is an accepted method of treatment today. Percutaneous drainage offers lower invasiveness and cost and has equal efficacy in drainage [9]. However, we feel that once sub diaphragmatic collection develops than drainage under general anesthesia should be considered initially to avoid morbidity in such cases. In our case USG guided aspiration was done twice, but with unsatisfactory result, so we have to resort to drainage under general anesthesia. Further location of these abscesses is such that hinders satisfactory USG guided aspiration.

Conclusion

During lap Cholecystectomy, bile may spill into the abdominal cavity for a variety of reasons. Every attempt should be made to minimize the spillage, irrigate the abdomen to dilute the spilled bile prior to sucking and retrieve the dropped stones if any.

Inspite of all attempts, it is important for the surgeon to be aware that unsucked bile, on rare occasion, may result in complication after the initial operation. Our patient presented 3 weeks after lap Cholecystectomy as a Right sub diaphragmatic abscess and treated successfully by external drainage. Hence emphasis should be made to minimize the bile spillage, irrigate the abdomen to dilute the spilled bile and suck the dropped bile.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Recommended Conferences

Article Usage

  • Total views: 11860
  • [From(publication date):
    June-2014 - Oct 20, 2017]
  • Breakdown by view type
  • HTML page views : 8077
  • PDF downloads :3783
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords