We report the case of a 67-year-old male with a history of coronary revascularization for acute myocardial infarction in 1999, hypertension, type 2 diabetes mellitus, hypercholesterolemia, chronic renal failure and laparoscopic cholecystectomy in January 2000.
In October 2003, the patient was admitted due to a two-week history of pleuritic pain in the right hemithorax, fever, asthenia, anorexia and cough nonspecific.
During the physical examination, a painful, warm mass fluctuating in the right side of the hemithorax was found.
She had leukocytosis (19.480/mm3) with neutrophilia and impaired renal function (creatinine 1.5 mg/dl).
Abdominal ultrasound showed a right substernal collection with a thick wall, 60 x 22 mm in diameter, associated with ipsilateral pleural disease and extending contiguously to the subcutaneous plane.
A hyperechogenic image with posterior acoustic shadowing was detected inside the collection.
Findings were confirmed by chest and abdominal computed tomography.
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The abscess was drained by percutaneous implantation of a 9F pigtail catheter under ultrasound guidance.
Streptococcus pyogenes and Escherichia coli were isolated from the pus culture.
Before receiving the antibiogram, intravenous antibiotic treatment with imipenem was initiated.
The clinical course was favorable, with disappearance of fever, local symptoms, leukocytosis and deterioration of renal function.
She was discharged 15 days after admission.
He was readmitted two weeks later due to recurrence of symptoms and subphrenic collection.
She underwent right subcostal laparotomy, debridement and drainage of the abscess, as well as extraction of the calculus inside.
Postoperative evolution was favorable and the patient was discharged 9 days after surgery.
After two years of follow-up she has not presented recurrence of her disease.
On the surgical sheet of the LC, performed 46 months before, the finding of acute colitis with perivesicular abscess was confirmed.
During the procedure there was an accidental rupture of the gallbladder and the discharge of three stones into the peritoneum, of which only two could be recovered during the operation.
