ĐIỀU TRỊ PHẪU THUẬT VIÊM PHÚC MẠC DO VỠ Ổ APXE CƠ THÀNH BỤNG NGUYÊN PHÁT VÀO Ổ BỤNG

Abstract

Aims of study: 1 Evaluation of  clinic and paraclinic features of rare patient having diffuse peritonitis due to primary anterior abdominal wall abscess perforated into abdominal cavity. 2 Literature rewiew. Patient and method: Retrospective study. Results: Male patients aged of 59 year old. Medical history: Alcohol abused, undergone appendectomy >20 year (Macburney), tongue cancer (at stage IV) treated by chemo-radiation therapy. Admission for abdominal pain for 10 days and got fever 37,8-38,5 degrees Celsius for 2 days. On physical examination he was conscious. There was swelling in upper right quadrant abdomen, measuring around 10-8 cm, irregular marging, adherent to abdominal muscles with redness. There was  collateral circulation and diffuse abdominal  tenderness. Abdominal ultrasound revealed fluid collection located in upper right anterior abdominal wall, measuring 69-19mm with a hole communicated with abdominal cavity. There were free intra abdominal fluid and supra hepatic fluid about 16mm. Laboratory studies: White blood  cell count (WBC) of 25,34 G/L. Albuminemie 20,3 mmol/L; creatinin at 221mmol/L. Blood ure nitrogen at 15,9 mmol/L; AST 53,5U/L; ALT 43,7mmol/L. Preoperative cytology showed necrotic  tissues with WBC, no epithelial components. Peritonitis diffuse due to primary anterior abdominal wall abscess (PAAWA) was diagnosed and emmergency operation performed. Intraoparative findings: diffuse peritonitis with pus and the abscess cavity  located intra abdominal anterior muscles (right upper anterior muscles) perforated to abdominal cavity with 3cm hole. Lavage and drainage were performed and 6 drains were placed (2 drains placed  supra hepatic, 2  other drains placed in the  inferior hepatic area and 2  placed in the  sac of douglas). Antibiotic therapy: Meronem 3 g/24h and levofloxacin 1g/24h were given during 14 days. Discharge  postoperative 14 days. Conclusion: We concluded that primary anterior abdominal abscess is very rare diseases. Immunosupression, diabetes mellitus, liver cirrhosis with abdominal collateral circulation could relate to infection (risk factors).The diagnosis should base on clinical manifestation, ultrasound or CTscaner, and cytology. Treatment should consist of  surgical incision, drainage and laparotomy for lavage and drainage (abscess cavity communicated with abdominal cavity) in combination with  antibiotic therapy