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

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

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