Presentation
Patient presented with symptoms of continuous high grade fever and pain abdomen following surgery for perforation of 1st part of duodenum.
Patient Data
There are multiple, ill-defined, areas of multi-loculated air with mild fluid collection noted in the mesentery, right para-colic gutter and anterior para-renal space which is also extending towards posterior para-renal space from its inferior aspect. There's slight breech over the right Gerota's fascia with minimal fluid collection and few air foci noted within the anterior peri-renal space. Medially it is compressing right psoas muscle. Post contrast study shows peripheral marginal enhancement of these multi-loculated areas.
There is also mild wall thickening noted at the region of 1st part of duodenum. There is diffuse, mild thickening of the wall of ascending colon and proximal transverse colon with surrounding fat strandings likely reactive changes.
There is a small defect noted on the subcutaneous tissue of anterior abdominal wall suggesting recent post-operative change with open wound.
There are two, ill-defined, small, wedge shaped areas of hypodensity noted in the midpole of right kidney on venous phase which shows striated pattern on delayed phase probably acute pyelonephritic changes.
Appendix is not visualized (previous h/o removal of appendix).
Per-rectal contrast administration revealed there was no bowel perforation.
Visualized chest shows moderate pleural effusion on the right side.
Case Discussion
Abdominal laparotomy revealed extensive soft tissue necrosis with mild fluid collection. Culture of the pathological specimen obtained on surgical debridement yielded the growth of E.coli after culture.
All the imaging appearances and culture finding suggests the diagnosis of intra-abdominal abscess with necrotizing soft tissue infection.
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