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Uwe Will and Viliam Masaryk, Department of Internal Medicine III (Gastroenterology, Hepatology, and General Internal Medicine), SRH Wald-Klinikum Gera

Sequenzen:

Video sequence 1

Gallbladder perforation, with stone “emptying” into the abdominal cavity, is a potential complication during cholecystectomy. Later complications may develop, particularly abscess formation. A subphrenic abscess on the left hepatic lobe, with a diameter of 5 cm, was noted on abdominal ultrasonography. Ultrasound-guided percutaneous pigtail drainage of the abscess was carried out using a freehand technique. The abscess regressed with antibiotic treatment and regular rinsing, and the patient was discharged after removal of the drain. The finding was considered to represent a late abscess following prior necrotic cholecystitis.

Video sequence 2

A recurrent abscess developed 2 months later. Ultrasound-guided percutaneous pigtail drainage was repeated. In the process, incorrect positioning of the drain occurred, with the drain tip located in the left hepatic lobe. Following contrast administration to check the drain’s position, enhancement was noted in the left hepatic vein. The abscess was then drained via a second drain, which dislocated spontaneously after 4 days. The drain incorrectly located in the left hepatic lobe was removed later.

Video sequence 3

A recurrent abscess developed 2 months later. Ultrasound-guided percutaneous pigtail drainage was repeated. In the process, incorrect positioning of the drain occurred, with the drain tip located in the left hepatic lobe. Following contrast administration to check the drain’s position, enhancement was noted in the left hepatic vein. The abscess was then drained via a second drain, which dislocated spontaneously after 4 days. The drain incorrectly located in the left hepatic lobe was removed later.

Video sequence 4

The patient then became free of symptoms, with gradual stabilization of his general condition and a decline in the inflammatory parameters. The prostheses were removed endoscopically 2 months later. No further abnormalities have been observed in the meantime, over a period of more than 6 months.

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