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A Curious Case of Recurrent Abdominal Wall Infections

An 82-year-old male was transferred for an abdominal CT scan for chronic cutaneous fistulation at the level of the right abdominal wall. Previous CT and ultrasound imaging described recurrent collections in the right abdominal wall, requiring CT guided abscess drainage. The abdominal CT scan reveale...

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Autores principales: Djelassi, Sara, Vandenbroucke, Frederik, Schoneveld, Martijn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ubiquity Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908932/
https://www.ncbi.nlm.nih.gov/pubmed/33665543
http://dx.doi.org/10.5334/jbsr.2387
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author Djelassi, Sara
Vandenbroucke, Frederik
Schoneveld, Martijn
author_facet Djelassi, Sara
Vandenbroucke, Frederik
Schoneveld, Martijn
author_sort Djelassi, Sara
collection PubMed
description An 82-year-old male was transferred for an abdominal CT scan for chronic cutaneous fistulation at the level of the right abdominal wall. Previous CT and ultrasound imaging described recurrent collections in the right abdominal wall, requiring CT guided abscess drainage. The abdominal CT scan revealed an abscess in between the internal oblique and transversus abdominis muscle layers of the right flank, with significant fat stranding and loss of the intermuscular fat planes (Figure 1). Inside this abscess, we notice a spontaneous hyperdense nodular lesion (Hounsfield Units 130), which doesn’t enhance after contrast injection (Figure 1 arrow). Looking back at the previous CT scans we discern the presence of this hyperdense lesion, which tends to migrate over time over a small distance along the abdominal wall (Figure 2 A–D arrow). We can trace this back on the numerous previous scans, with different local tissue reactions over time. The first performed CT 8 years prior reveals a perforated calculous cholecystitis, containing multiple cholecystolithiases with the same density as our previously mentioned hyperdense lesion (Figure 3 arrow). Thus, raising the suspicion of a biliary origin of this corpus alienum. TEACHING POINT: Spilled gallstones during laparoscopy may lead to late abscess.
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spelling pubmed-79089322021-03-03 A Curious Case of Recurrent Abdominal Wall Infections Djelassi, Sara Vandenbroucke, Frederik Schoneveld, Martijn J Belg Soc Radiol Images in Clinical Radiology An 82-year-old male was transferred for an abdominal CT scan for chronic cutaneous fistulation at the level of the right abdominal wall. Previous CT and ultrasound imaging described recurrent collections in the right abdominal wall, requiring CT guided abscess drainage. The abdominal CT scan revealed an abscess in between the internal oblique and transversus abdominis muscle layers of the right flank, with significant fat stranding and loss of the intermuscular fat planes (Figure 1). Inside this abscess, we notice a spontaneous hyperdense nodular lesion (Hounsfield Units 130), which doesn’t enhance after contrast injection (Figure 1 arrow). Looking back at the previous CT scans we discern the presence of this hyperdense lesion, which tends to migrate over time over a small distance along the abdominal wall (Figure 2 A–D arrow). We can trace this back on the numerous previous scans, with different local tissue reactions over time. The first performed CT 8 years prior reveals a perforated calculous cholecystitis, containing multiple cholecystolithiases with the same density as our previously mentioned hyperdense lesion (Figure 3 arrow). Thus, raising the suspicion of a biliary origin of this corpus alienum. TEACHING POINT: Spilled gallstones during laparoscopy may lead to late abscess. Ubiquity Press 2021-02-24 /pmc/articles/PMC7908932/ /pubmed/33665543 http://dx.doi.org/10.5334/jbsr.2387 Text en Copyright: © 2021 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
spellingShingle Images in Clinical Radiology
Djelassi, Sara
Vandenbroucke, Frederik
Schoneveld, Martijn
A Curious Case of Recurrent Abdominal Wall Infections
title A Curious Case of Recurrent Abdominal Wall Infections
title_full A Curious Case of Recurrent Abdominal Wall Infections
title_fullStr A Curious Case of Recurrent Abdominal Wall Infections
title_full_unstemmed A Curious Case of Recurrent Abdominal Wall Infections
title_short A Curious Case of Recurrent Abdominal Wall Infections
title_sort curious case of recurrent abdominal wall infections
topic Images in Clinical Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908932/
https://www.ncbi.nlm.nih.gov/pubmed/33665543
http://dx.doi.org/10.5334/jbsr.2387
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