KẾT QUẢ PHẪU THUẬT NỘI SOI CẮT LÁCH, THÂN ĐUÔI TỤY ĐIỀU TRỊ APXE LÁCH THÂN ĐUÔI TỤY DO VI KHUẨN WHITMORE (BỆNH MELIOIDOSIS)

Abstract

Study aim: 1. Case report of  the clinic and paraclinic manifestations of left pancreaticspleenic abscess due to Burkholderia pseudomalei contamination. 2. Result of laparoscopic left panceaticospleenectomy with lavage and drainage of left pancreatico spleenic abscess. Patient and method: Retrospective study (case report).  Result: + Male, farmer, age of 45 year old, address Kỳ Phong commune, Kỳ Anh Distric, Hà Tĩnh Province. + Admission in  K hospital due to fever and abdominal pain. + Examination revealed no specific symptoms excepted infection and raise of  white cell (21.100 G/L). + Abdominal ultrasound revealed some small spleenic cyst (16mm in diameter). + Abdominal CTScan detected some small spleenic tumors (24 mm in diameter) with out intra abdominal fluid. + Pre operative biopsy (ultrasound guided): Necroses of spleenic parenchyma. The preoperative diagnosis was lymphomalin with spleenic manifestation and laparoscopic spleenectomy would be  planned to perform. Peroperation we found one pancreaticospleenic abscess about 5-3 cm in diameter with pus (the lesions concentrated in the body, tail of pancreas and rate). Pus was sent for culture and left laparoscopic pancreaticospeenectomy with lavage and drainage was  performed. Patient had fever the  2 nd day and  third day post operation with 38,5⁰ degree. The result of pus cultured  positive with bacteria Burkholderia Pseudomalei on the 5nd day post operation. The antibiotic therapy was Meronem 1g/each 8h during 14 days. Anastomopathological result:  Pancreatico spleenic necroses and abscess. The patient discharged on the 19nd day post operation. and had  oral antibiotic  drug therapy (Amoxiciline-Clavunilic during 3 months post hospitalization). Conclusion: We concluded that we should think over the melioidosis diseases that had organ manifestations in ìnfectious patient who come from epidemiologic area.Lavage and drainge the pancreaticospleenic abscess should be performed early laparoscopically or ultrasound guided drainage combined with IV antibiotic therapy 10-14 days by antibiotic map or by Imipenem (93,2% susceptibility, Meronem 96,3%, ceftazidime 93,3%, Amoxicilin-a. Clavunlanic 88,4%, TMP-SMX 82,2%)