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Infeção de quisto hepático simples : caso clínico
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Os quistos hepáticos simples são lesões benignas comuns, com uma prevalência entre os 2,5% e 18%, geralmente assintomáticas. O desenvolvimento de complicações como hemorragia, rutura ou infeção é raro.
O presente caso clínico descreve o caso de uma mulher de 80 anos, que se apresentou com um quadro de febre, obnubilação e dor no hipocôndrio direito. O diagnóstico de quisto hepático infetado foi realizado através da ecografia abdominal e tomografia computorizada. A abordagem cirúrgica consistiu na fenestração por laparotomia, tendo-se constatado a presença de uma fístula biliar. No pós-operatório, observou-se a saída de liquído biliar pelo dreno que necessitou de colangiopancreatografia retrógada endoscópica (CPRE) com colocação de stent. A cultura do líquido intraquístico revelou a presença de Escherichia coli e o exame anatomo-patológico excluiu presença de displasia.
Importa salientar que devido à baixa incidência de quistos hepáticos simples sintomáticos com indicação para tratamento, não está definida uma abordagem terapêutica uniforme, existindo múltiplas opções terapêuticas. A terapêutica combinada com agentes antimicrobianos e aspiração percutânea tem surgido como a opção terapêutica de escolha no tratamento destes quistos de modo a aumentar a sua eficácia.
Simple hepatic cysts are common benign lesions, with a prevalence between 2.5% and 18%, usually asymptomatic. The development of complications such as hemorrhage, rupture or infection is rare. This case report describes the case of a 80 year old woman who presented with fever, nausea and pain in the right hypochondrium. The diagnosis of infected hepatic cyst was performed through abdominal ultrasonography and computerized tomography. The surgical approach consisted of laparotomy fenestration, and a biliary fistula was present. In the postoperative period, biliary fluid was withdrawn through the drain that required endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. Intracellular fluid culture revealed the presence of Escherichia coli and the anatomopathological examination excluded presence of dysplasia. It should be noted that due to the low incidence of symptomatic simple hepatic cysts with indication for treatment, a uniform therapeutic approach is not defined and there are multiple therapeutic options. Combination therapy with antimicrobial agents and percutaneous aspiration has emerged as the therapeutic option of choice in the treatment of these cysts in order to increase their efficacy.
Simple hepatic cysts are common benign lesions, with a prevalence between 2.5% and 18%, usually asymptomatic. The development of complications such as hemorrhage, rupture or infection is rare. This case report describes the case of a 80 year old woman who presented with fever, nausea and pain in the right hypochondrium. The diagnosis of infected hepatic cyst was performed through abdominal ultrasonography and computerized tomography. The surgical approach consisted of laparotomy fenestration, and a biliary fistula was present. In the postoperative period, biliary fluid was withdrawn through the drain that required endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. Intracellular fluid culture revealed the presence of Escherichia coli and the anatomopathological examination excluded presence of dysplasia. It should be noted that due to the low incidence of symptomatic simple hepatic cysts with indication for treatment, a uniform therapeutic approach is not defined and there are multiple therapeutic options. Combination therapy with antimicrobial agents and percutaneous aspiration has emerged as the therapeutic option of choice in the treatment of these cysts in order to increase their efficacy.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Infeção Quisto hepático simples Fenestração