We report the case of a 92-year-old woman with a history of hypertension and temporal arteritis, treated with lisinopril and prednisone, who came to the emergency department for fever and pain in the right hypochondrium.
He had mild pain to severe pain in the right hypochondrium.
Abdominal computed tomography showed a calcified hydatid cyst and a focal lesion of 6 cm in hepatic segment V with air-fluid level compatible with liver abscess.
This lesion was in close contact with the hepatic angle of the colon.
The Interventional Radiology Department placed a percutaneous drainage aspirating purulent content and introducing contrast into the cavity.
No communication was observed with the bile duct, although there was a passage of contrast to the hepatic flexure of the colon.
After the radiological puncture the initial clinical symptoms persisted, with growth in the cultures of liquid extracted from the collection of Eschericia coli and Streptococcus constellatus.
The fistulous tract was observed in the objectification studies, with an orifice located about 7-8 mm in the hepatic angle, about 60 cm from the anal margin, through which it was observed that
The drainage bag was immediately filled with air in the area.
No diverticula were seen.
Once the express consent was obtained, a Padlock ClipTM endoscopic clip was prepared (Aos Medical, Kingston, NH, United States) Propus®1mm gastric sequestration OQ model (11mm).
After locating the lesion, the surrounding mucosa was inserted into the plastic cap by aspiration.
Subsequently, the metallic endoclip was coated by applying a gentle pressure to the handle designed for it.
The metallic ring closed the colonic defect, leaving in the area a pseudopolyp formed by the mucosa fixed in its sinus.
We opened the external drainage without passing gas to the pouch that had radiological drainage.
Complete closure of the fistulous tract was observed in a subsequent CT scan.
The patient was asymptomatic, without drainage output, and was discharged after completing a course of antibiotic therapy seven days after the procedure.
