A 73-year-old male patient with a history of brucellosis, hyperuricemia and hypercholesterolemia was admitted to our department for scheduled surgery for benign prostatic hyperplasia.
The diagnostic study showed a rectal examination that showed a prostate with adenomatous characteristics, very increased in size (G III/IV).
A retroperitoneal adenomectomy was performed according to the T. Millin technique, enucleating a large adenoma weighing 170 grams.
After six days, the catheter was removed, the patient resumed my comfortably and was discharged.
Eleven days after the intervention, and only four days after discharge, the patient was readmitted to our service for presenting in the last 24 hours abdominal pain (hypogastric), pain in the right testicle and root of the thigh.
A small amount of sero-purulent liquid drain was drained through the orifice where the adenomectomy was drained.
Minimally packed surgical wound.
She was admitted to urology with the diagnosis of surgical wound infection and empirical antibiotic treatment was established.
The general and urological examination was within normal limits.
Orchiepididymitis was ruled out.
Analytically, a marked decrease in red blood cell count was observed, but leukocytosis was not observed.
The patient is treated symptomatically but does not improve.
Pain in the pubic area is accentuated, so bone scintigraphy is performed, which reports the finding of pathological uptake of the radiotracer in the upper third of both pubis layers in relation to possible osteopathy p
The patient remains unimproved, empirical antibiotic therapy and analgesia treatments fail to reduce the pain that is now located at the root of the thigh, and general deterioration is accentuated.
The patient has severe anemia, elevated ESR, fibrinogen and CRP.
The examination of the thigh is anodyne, with nonspecific pressure pain in its internal face.
The pain is thought to be neurologically affected, since the examination is normal, and the pain also extends through the inguinal area and right testicle.
With the diagnosis of suspected pelvic abscess (septic picture seemed unquestionable) in relation to the surgical history abdominal CT was requested.
This report shows absolute normality of abdominal organs... but cuts made under pubic symphysis at the right thigh reveal a large abscess in the adductor muscle area.
This finding requires collaboration from the traumatology service that acknowledges that the internal face of the right thigh is now slightly reddened, painful to swelling but without a clear fluctuation.
Free hip arthroplasty
Seven days after admission, an emergency surgical intervention is performed. A wide longitudinal incision is performed in the internal face of the proximal third of the thigh. Through dissection, a large roma digitalis collector enters the purulent musculature.
A lot of brown pus was obtained (taken for microbiological study).
After washing the cavity with abundant fluid and cold water, the surgical wound is partially closed and Penrose drains are left.
Examination of the surgical wound of the adenomectomy and the area where the drainage was at present are absolutely normal and no cavities or collection are identified.
Drains are placed and the intervention is concluded.
The patient required intensive care, transfusion of blood products, long hospital stay, thorough local cures etc. The patient has a slow but excellent evolution towards total healing.
All follow-up controls (analytical diagnosis, diagnosis and management).
The microbiology service informs us that in the cultures performed the following results are obtained: in pure culture of seropurulent fluid of the surgical wound of adenomectomy: negative species coagulase concrete.
Two Staphiloco coagulase-negative strains (identified as Staphylococcus epidermis and Streptococcus alpha hemolytic) grow during the surgical procedure of abscess drainage in the thigh.
