RESUMEN
Primary peritonitis is rare; the bacteria involved are mainly, by order of frequency: Escherichia coli, Streptococcus pneumoniae, and the other streptococci. Extraintestinal sites of minor salmonellosis are exceptional, although they are constantly progressing, especially since the spread of the HIV-induced epidemic. We report one case of primary Salmonella brandenburg peritonitis, whose mechanism could not be explained, in a non-immunodepressive female patient.
Asunto(s)
Peritonitis/etiología , Infecciones por Salmonella , Femenino , Humanos , Persona de Mediana Edad , Peritonitis/inmunología , Peritonitis/microbiología , Infecciones por Salmonella/inmunologíaRESUMEN
Anterior incision does not afford a direct approach to lesions located in the posterior part of the liver, or to right subphrenic and retrohepatic abcesses, and may contaminate the peritoneal cavity in suppurative collections. Posterior incision is a more direct approach. It can be extrapleural and extraperitoneal, or transpleural with exclusion of the pleura when resecting a lower rib; a posterior thoraco-phreno-laparotomy gives a wider exposure. When the pleural cavity has been opened it should be drained and excluded before dealing with the subphrenic lesion. Such an incision is advocated in posterior abscesses of the liver, in those located under the diaphragm or posterior to the liver, as well as in posterior hydatic and biliary cysts. Scannography helps to locate exactly the cavity and makes sure that there is no other cyst or collection. Endoscopic cholangiography supplies valuable information concerning the bile ducts in case of hydatic cyst.
Asunto(s)
Hígado/cirugía , Diafragma , Equinococosis Hepática/cirugía , Femenino , Humanos , Laparotomía , Absceso Hepático/cirugía , Masculino , Métodos , Peritoneo , Pleura , TóraxRESUMEN
We have collected 62 cases of post-operative subphrenic abscess. Two thirds of these patients were sent to us by another unit for post-operative complications. Subphrenic asbcess is still very dangerous as the mortality is still 38%. They occurred after a gastro-duodenal operation (26 times), spleno-pancreatic operation (21 times), intestinal operation (15 times), hepato-bilary operation (11 times) appendicectomy (twice). They were situated usually on the right, but 11 patients had a double subphrenic abscess and 14 an associated submesocolic abscess. Gram negative bacteria were usually the cause. These abscesses often started early. They occurred in 80% of cases in patients operated under the antibiotic cover. Chest X-ray was the best method of detection, but experience is necessary to read them. The abscesses were drained by the abdominal route in order to verify th whole peritoneal cavity. 22 patients died. 11 from septicemia. 21 out of 22 had a digestive fistula. Among the factors in prognosis, the most obvious were age, type of operation, the notion of reoperation, multiple abscess, and finally the delay in starting treatment.