A 46-year-old female patient, morbidly obese with body mass index (BMI) 44, with a history of insulin resistance, hepatic dyslipidaemia, cholecystectomy, previous failed laparoscopic gastro-peritoneal banding, was admitted.
No other complications were described after the end of the intervention.
During the immediate postoperative period, the patient was reoperated for hypovolemic shock in the context of hemoperitoneum secondary to hepatic tearing and venous bleeding of splenic hilium; both were successfully repaired with unclosed drainage and uncovered, respectively.
Prophylactic cefitriaxone and metronidazole were prescribed and suspended at 5 days due to sudden eosinoflia (2,500/mm3) and marked thrombocytosis, which increased in 24 hours from 750,000 platelets/mm on average.
One week after surgery, the patient developed systemic inflammatory response syndrome (SIRS) with elevated acute phase reactants (HSV, CRP, procalcitonin and leukocytosis mean of 20,000/mm3) and fever.
It was empirically treated with sodium piperacillin/tazobac-tam sodium plus vancomycin and fuconazole completing 7 days. control gastrogastrogram was not performed.
A CT scan of the chest and abdomen with contrast showed bilateral pleural effusion greater than left and absence of contrast in splenic vessels but present spleen.
Two weeks after surgery the clinical and laboratory parameters described persisted, adding significant sialorrhea, left phantom pain and po-lipnea.
A CT scan showed persistent effusion, disappearance of the spleen, and replacement by a large intra-abdominal collection of 16 x 18 cm with density of fat air, multiple bubbles in the stomach and presence of gastrintestinal obstruction.
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Percutaneous Pig 10F was installed extra plus 400 ml of paste content confirming Streptococcus Streptococcus Streptococcus Streptococcus pneumoniae infection and indicating antibiotic treatment with parenteral drainage daily 10 days ago.
After 25 days of treatment a favorable response was observed (remission of symptoms, resumption of oral feeding, disappearance of pleural effusion and intra-abdominal collection) with gastrosplenic closure in good communication conditions, given high control trogram.
