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Wednesday, 22 November 2017

CASE 462: LIVER ABSCESS POST ENDOSCOPIC CHOLECYSTECTOMY, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man 67 y o, emergency operation by acute necrosis of  gallbladder by stone one week ago, still pain at  Murphy area. WBC = 12k with neutro 90%,  CRP= 100ng/mL.
Abdomen ultrasound detected one mass # 5 cm  at the bed of gallbladder. Mass has got fluid content  and  white structures inside with very strong  shadowing and air in formatting an abscess.
No dilatation of the biliary system.
US 1: subhepatic abscess  with strong shadowing in abscess.


US  2: umbrella sign of  the shadowing.


US 3:  elatoscan  shows  this structure is very hard.



MSCT:   CT 1:  abscess with  air and fluid filling at the bed of gall bladder which had been  removed of GB.



              CT 2:  crossed-section view of this abscess:  inhomogenous structure  and air



              CT 3:   frontal view of the abscess.

   
Radiologist reported  textilloma in suspection.


Laparoendoscopy detected an abscess in liver at the bed of gallbladder necrosis and no textilloma.

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