Transphrenic fistulization of a subphrenic abscess to lung parenchyma.
A 53-year-old woman was admitted with respiratory distress. For several years, she had chronic alcoholic pancreatitis with ductal stones that were treated with a stent and with shockwave lithotripsy. Both treatments were unsuccessful, and the pancreatitis was complicated with an infected pseudocyst. The pancreatic head had to be resected, which was complicated with recurrent subphrenic abscesses. She then was admitted with respiratory distress and initially diagnosed with pneumonia of the right lower lobe. Further investigations showed supradiaphragmatic and subdiaphragmatic air-fluid levels. In both collections Streptococcus milleri was cultured, and subsequently the patient was diagnosed with a fistula connecting the subdiaphragmatic abscess with pulmonary tissue. This was treated with intravenous amoxicillin/clavulanate and drainage of the subdiaphragmatic collection. She did not develop a pulmonary empyema, because multiple adhesions, which were due to recurrent abscesses after pancreatic surgery, prevented breakthrough into the pleural cavity.
Romijn
Sander
S
Department of Surgery, Amphia Hospital, Breda, Netherlands. sanderromijn@chello.nl
Sturm
Maarten
M
van der Schelling
Georges
G
D000900:Anti-Bacterial Agents; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002908:Chronic Disease; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis / Q000601:surgery; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013369:Subphrenic Abscess / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents