Biliyer Askariasis Olgusunda ERCP ve Laparoskopik Kolesistektomi Sonrası Gelişen Karaciğer Apsesi:Olgu Sunumu

Year 2010, Volume: 27 Issue: 4, 172 - 175, 16.02.2011

Bülent Güngör Ayfer Kamalı Polat Oktay Karaköse Ahmet Bektaş Kenan Erzurumlu

Abstract

Karaciğerin piyojenik apseleri genellikle kolanjite sekonder olarak gelişmektedir. Ancak girişimsel kolanjiopankreatografik işlemler ya da karaciğer ve safra yolları cerrahisini takiben de görülebilirler. Burada kolesistokoledokolithiasis ve biliyer askariasisli bir diabetik olguda endoskopik retrograd kolanjiopankreatografi ve sfinkterotomiyi takiben yapılan laparoskopik kolesistektomiden sekiz gün sonra gelişen bir karaciğer apsesi sunulmaktadır. Hasta, ateş, titreme ve lökositoz nedeniyle hastaneye yatırılmıştır. Ultrasonografi ve bilgisayarlı tomografide sağ subdiyafragmatik alana uzanan karaciğer sağ lob yerleşimli bir apse ve sağ plevral efüzyon saptanmıştır. Apse ve plevral efüzyon perkütan drenaj, torasentez ve antibiyotiklerle tedavi edilmiştir. Özellikle bu olgudaki gibi koledokta taş ve askarisin birlikte bulunması gibi komplike durumlarda endoskopik retrograd kolanjiopankreatografiyi takiben yapılacak laparoskopik kolesistektominin ertelenmesinin uygun olabileceğini düşünüyoruz.


The pyogenic liver abscess usually develops secondary to the cholangitis. It may also be seen following invasive cholangiopancreatographic procedures or surgery of the liver and biliary tract. We here report a liver abscess developed eight days after laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography and sphincterotomy in a diabetic patient with cholecystocholedocholithiasis and biliary ascariasis. The patient was admitted to the hospital with fever, chills and leukocytosis. Ultrasonography and computerized tomography revealed a right lobe liver abscess extending to the right subdiaphragmatic space and right pleural effusion. The abscess and pleural effusion were treated by percutaneaous drainage, thoracentesis and antibiotics. The laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatographic procedures, especially in complicated situations like in this case with stones and ascaris in common bile duct, may be delayed.

Keywords

-

References

• Akyar, G., 1997. Abscess formation due to dropped gallstone after laparoscopic cholecystectomy. Eur. J. Radiol. 25, 242-245.
• Bhandarkar, D.S., 2004. Intrahepatic subcapsular hematoma complicating laparoscopic cholecystectomy. Surg. Endosc.18, 868- 870.
• Bhati, C.S., 2006. A Tale of Three Spilled Gall Stones: One Liver Mass and Two Abscesses. Dig. Surg., 23, 198-200.
• Cervantes, J., 1994. Intrahepatic subcapsular biloma. A rare complication of laparoscopic cholecystectomy. Surg. Endosc.8, 208- 210.
• Geller, D.A., 2010. Infections of the Liver, Liver. Schwarz’s Principles of Surgery, 9th Ed.,1115-1117.
• Horton, M., Florence, M.G., 1998. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am. J. Surg.175, 375-379.
• Iannitti, D.A., 2006. Subphrenic and pleural abscess due to spilled gallstones. JSLS. 10, 101-104.
• Kaplan, G.G., 2004. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin. Gastroen- terol. Hepatol. 2, 1032-1038.
• Lam, Y.H., 1999. ERCP and pyogenic liver abscess. Gastrointest. Endosc.50, 340-344.
• Mallery, J.S., 2003. Standards of Practice Committee American Society for Gastrointestinal Endoscopy. Complications of ERCP. Gastrointest. Endosc. 57, 633-638.
• Manukyan, M.N., 2005. Retained abdominal gallstones during laparoscopic cholecystectomy. Am. J. Surg. 189, 450-452.
• Obara, K., 1998. A case with subcapsular hematoma of the liver following laparoscopic cholecystectomy. Nippon Ika Daigaku Zasshi. 65, 478-480.
• Rice, D.C., 1997. Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J. Gastrointest. Surg. 1, 85-91.
• Shetty, G.S., 2005. Subcapsular hematoma of the liver after laparoscopic cholecystectomy. J. Laparoendosc. Adv. Surg. Tech. 15, 48-50.
• Thannisch, G., 1957. Multiple hepatic abscesses due to Ascaris lumbricoides; case report. J. Pediatr. 53, 602-607.
• Vuilleumier, H., Halkic, N., 2003. Ruptured subcapsular hematoma after laparoscopic cholecystectomy attributed to ketorolac- induced coagulopathy. Surg. Endosc. 17, 659.