Jacobs Journal of Clinical Case Reports

Pericardial Effusion Resulting from A Left Subphrenic Abscess, In A Paediatric Patient with Peritonitis

*Jose María Gómez Luque
Department Of Case Reports, Spain

*Corresponding Author:
Jose María Gómez Luque
Department Of Case Reports, Spain
Email:pepegomezluque@gmail.com

Published on: 2018-11-20

Abstract

Complicated intra-abdominal infection is a major health problem due to its high incidence and mortality. Despite advances in surgical techniques, the provision of support measures and the availability of potent antibiotics. Furthermore, it usually requires considerable diagnostic and therapeutic resources, at great cost to the health system. The appearance of non-infectious pericardial effusion secondary to a Subphrenic abscess, in a patient with peritonitis, is a complication that is rarely reported but very indicative of this pathology. In our case, transudate pericardial effusion associated with clinical-analytical worsening led us to suspect the presence of a left sub-diaphragmatic intra-abdominal accumulation. This was confirmed by CT scans and was completely resolved by drainage of the fluid. It is important to note that the presence of a non-infectious pericardial effusion may be related to a left sub-diaphragmatic infection in patients subjected to surgical intervention for complicated acute appendicitis and whose subsequent recovery is unsatisfactory. This rare complication can provoke high mortality if not correctly diagnosed and treated.

Keywords

Subphrenic Abscesos; Acute peritonitis; Pericardial Efusión

Introduction

Complicated Intra-Abdominal Infection (IAI) is an infectious process that either affects the wall of the hollow viscera or progresses beyond its limits, reaching the peritoneal compartment. IAI is a major health problem due to its high incidence and mortality. Despite advances in surgical techniques, the provision of support measures and the availability of potent antibiotics, the mortality of IAI when septic shock develops is still around 40%. Furthermore, it usually involves a prolonged stay in the ICU and subsequently in a general ward, and requires considerable diagnostic and therapeutic resources, at great cost to the health system. The main types of IAI are peritonitis (primary, secondary and tertiary) and intra-abdominal abscesses, which can affect solid tissues or intraperitoneal organs. An intraperitoneal abscess is defined as a clearly-bounded area of purulent secretion, isolated from the rest of the peritoneal cavity by inflammatory adhesions, bowel loops and the mesentery, the greater omentum or other abdominal viscera. Among the various types of abdominal abscess, subphrenic ones are infrequent and sometimes unnoticed. Nevertheless, their mortality ranges from 11 to 31%, and so diagnosis is of vital importance for appropriate treatment to be provided. Percutaneous drainage guided by ultrasound or CT is currently the treatment of choice, together with empirical antibiotic therapy [1].