A 30-year-old woman with no personal history of interest was admitted to our service with the diagnosis of obstructive jaundice secondary to possible colitis.
Blood tests showed bilirubin of 4.6 mg/dl, AST 406 IU/l, ALT 512 IU/l, amylase 50 IU/l.
Abdominal ultrasound: colitis.
Biliary tract not affected
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic method for cholelithiasis.
After the test, the patient began with epigastric pain and HCD radiating to the shoulder and nauseous sensation.
On examination, the patient is agitated, hypotensive, tachypnea with intense pain in HCD with important voluntary defense that hinders examination.
Analytical: bilirubin 1.6 mg/dl, AST 101 IU/l, ALT 311 IU/l, amylase 71 IU/l, hemoglobin 11.6 g/dl, leukocytes 8,800 μ/l.
Right non-allvic TAC: collection of 4.7 x 10 x 11 cm with a denser area inside (probably clots and adjacent gas bubbles, suggesting infection)
Extrahepatic bile duct aerobilia.
No free fluid or pneumoperitoneum.
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Due to the poor clinical status of the patient, who does not respond to any analgesic regimen and CT findings suggesting an abscess adjacent to the liver with signs of bleeding and infection, and without ruling out duodenal perforation, surgical intervention was decided.
Surgery shows a hematoma arising in the right hepatic lobe 10 cm and bubbles inside.
Intraoperative cholangiography showed no alteration in the bile duct, cholecystectomy and abscess evacuation, leaving drainage in the right subphrenic space.
The patient is transferred to the plant and broad-spectrum antibiotic treatment is established.
Fluid culture: E. coli.
Sterile blood cultures
As a result of an episode of anemization, it is necessary to transfuse four concentrates of ignition.
Serial ultrasound and scanners were performed in which persistence of hematoma was observed, so it was decided to place a pigtail.
The evolution is satisfactory and she is discharged after 4 weeks of admission.
