膿胸で発症した腹腔鏡下胆嚢摘出術後の落下胆石による横隔膜下膿ようの１例

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  • A CASE OF SUBPHRENIC ABSCESS DUE TO LOST GALLSTONE AFTER LAPAROSCOPIC CHOLECYSTECTOMY PRESENTED WITH PYOTHORAX

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A 68-year-old man complaining of fever and cough was referred to the department of internal medicine in our hospital for close examination because chest plain X-ray film showed right thoracic pleural effusion at another hospital in January 1997. There was a previous history of undergoing a laparoscopic cholecystectomy elsewhere in 1993. After admission to the hospital, the pleural effusion was exudative, and a culture of the effusion yielded E. coli. Further exploration was conducted for pyothorax of unknown origin, and CT, magnetic resonance imaging, abdominal ultrasonography showed a cystic tumor shadow in the extrahepatic diaphragm. With a diagnosis of acute pyothorax and diaphragmatic tumor, administration of antibiotics was started and surgery for pyothorax was performed. At surgery, we performed a thoracotomy-aided scarification of empyema cavity with Two Windows Method. After the surgery irrigation was carried out and the subdiaphragmatic tumor removed after inflammatory reaction subsided. The lesion was presented in the subphrenic space, and was an abscess surrounded by hypertrophied cicatrical tissue, including a calcium bilirubin calculus.<br>We sometimes encounter cases of subphrenic abscess caused by lost stone at laparoscopic cholecystectomy in the literature, however, rarely see such cases presented with pyothorax as this case. This paper reports the case together with some bibliographical comments.

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