Absceso hepático roto. (Spanish)

Rupture of liver abscess. (English)

Introduction: liver abscess is a collection of pus surrounded by a fibrous capsule, of high morbidity and mortality rates in the world. It has an incidence of approximately 20 per 100,000 inhabitants and a mortality of 5 % to 30 %. Objective: to present a case of rupture of liver abscess in the abdominal cavity associated with cholelithiasis. Case report: a 65-year-old female patient was admitted to the emergency general surgery department after a month of pain in the right hypochondriac region accompanied by copious vomiting and asthenia. Physical examination revealed jaundice, tachycardia, tachypnea, intense pain in the right hypochondriac region with defense and peritoneal reaction (positive Murphy's score). It was decided to take the patient to the operating room, finding ruptured liver abscess associated with vesicular lithiasis and fibrinopurulent peritonitis, a sample was taken for culture, a thorough neck cholecystectomy was performed, washing of the abdominal cavity and hepatic craters. Subhepatic drainage was left. Evolution was satisfactory. Conclusions: peritoneal lavage, cholecystectomy and broad spectrum antibiotic therapy is an effective therapeutic alternative in patients with ruptured pyogenic liver abscess with cholelithiasis. [ABSTRACT FROM AUTHOR]

Introducción: el absceso hepático es una colección de pus rodeada por una cápsula fibrosa, de alta morbilidad y mortalidad en el mundo. Tiene una incidencia aproximada de 20 por cada 100 000 habitantes y una mortalidad de un 5 % a un 30 %. Objetivo: presentar un caso de absceso hepático roto en cavidad abdominal asociado a colelitiasis. Caso clínico: paciente femenina de 65 años de edad recibida en los servicios de urgencia de cirugía general luego de haber sufrido hacía un mes dolor en hipocondrio derecho acompañado de vómitos copiosos y astenia. Al examen físico se constató íctero, taquicardia, taquipnea, dolor intenso en hipocondrio derecho con defensa y reacción peritoneal (punto de Murphy positivo). Se decide llevar al salón de operaciones, se encontraron abscesos hepáticos rotos asociado a litiasis vesicular y peritonitis fibrinopurulenta, se toma muestra para cultivo, se realiza colecistectomía de cuello a fondo, lavado de la cavidad abdominal y de los cráteres hepáticos. Se deja drenaje subhepático. La evolución fue satisfactoria. Conclusiones: el lavado peritoneal, la colecistectomía y antibioticoterapia de amplio espectro son una alternativa terapéutica efectiva en pacientes afectos de absceso hepático piógeno roto con colelitiasis. [ABSTRACT FROM AUTHOR]

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