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Intrahepatic abscess secondary to retained stercolith, following laparoscopic appendectomy
Jihad Boularab1, Meryem Zhim1, Chaymae Lahlou1
1Department of Radiology, Mohammed V Military Hospital, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco.
Abstract:
Abscesses of the peritoneal cavity and in particular hepatic abscess due to stercolith retention are a rare complication of appendectomy. Their prevalence is likely to increase as laparoscopic appendectomies become more common. This potentially serious complication can be prevented by following certain technical recommendations. Percutaneous drainage is bound to failure since it leaves the coprolite that causes the recurrence of the abscess, thus when it happens it requires surgical drainage. We report a case of a 40-year-old man, who underwent laparoscopic appendectomy 8 months prior, and presented to the emergency department for acute pain of the right hypochondrium. The radiologic investigations revealed 2 abscesses of the liver and the right iliac fossa containing a central spontaneously hyperdense stercolith. The patient was treated with open surgery removing the stercoliths and draining of the abscesses, with favorable postoperative outcome.
Insights
Stercolith retention after appendectomy can cause rare but serious liver abscesses. Surgical drainage is crucial for effective treatment, unlike percutaneous methods which often lead to recurrence.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Complications
- Infectious Diseases
Background:
- Appendectomy, particularly laparoscopic procedures, is increasingly common.
- Stercolith retention is a rare but serious complication following appendectomy.
- Hepatic and peritoneal abscesses can result from retained stercoliths.
Observation:
- A 40-year-old male presented with right hypochondrium pain 8 months post-laparoscopic appendectomy.
- Radiological imaging revealed two abscesses in the liver and right iliac fossa.
- Both abscesses contained a central, spontaneously hyperdense stercolith.
Findings:
- Percutaneous drainage is often unsuccessful due to the persistent stercolith, leading to recurrence.
- Open surgical drainage with stercolith removal is necessary for definitive treatment.
- The patient experienced a favorable outcome after open surgery.
Implications:
- Adherence to technical recommendations during appendectomy may prevent stercolith-related abscesses.
- Early recognition and appropriate surgical management are vital for treating these rare complications.
- Increased prevalence of laparoscopic appendectomies necessitates awareness of this potential complication.
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