“Absceso hepático y esplénico secundario a apendicitis aguda”

Abstract

We present the case of a male patient of 15 years of age, with a surgical history of grade II appendicitis resolved 1 month ago on the day of admission, go to the emergency service, presenting abdominal pain of 7 days of evolution, add boost non-quantifiable thermal, cough that does not mobilize secretions, chills, went to a private doctor 4 days ago who prescribes antipyretic treatment and discharge with medication, improvement picture however 2 days ago it presents thermal rise not quantified, yellow skin, upper abdominal pain so they go to this health house. Physical examination at admission: TA: 91/49; FC: 120; FR: 28; SO2: 92%, temperature 36.8 ° C; General Appearance: Algico, jaundiced, conscious, oriented patient, Glasgow scale15 / 15. Mouth: dry oral mucosa; skin: icteric dye; heart: hyperphonic noises, no murmurs; lungs: diminished vesicular murmur in right lung base; abdomen: soft, depressible, painful on palpation, positive blumberg, liver palpation 2 cm under the costal margin; lower extremities: multiple petechiae, patient is operated on the following day approaching an exploratory laparotomy evidencing yellow inflammatory fluid approximately 600cc in suprahepatic and perihepatic space and 300 cc in perisplenic space, placing drainages; due to the septic and hemodynamic condition, patient enters the Intensive Care Unit, 17 days after admission, hepatic abscess is seen in segment VI on Computed Tomography, performing percutaneous drainage; on the second day after drainage, new abscess is evidenced in segment VII of 14cc , total of 6 percutaneous drainages, plus abscess culture reports Pseudomonas aeruginosa, presents complications of a subconjunctival hemorrhage, hypoacusis due to possible drug ototoxicity, patient is transferred to the surgery service where it ends with antibiotic scheme, presenting favorable clinical evolution is discharged to the month 4 days and control with treating doctor in outpatient clinic.