6A8E REP0RT

60P0 w|Th 6P6
Riski 0ohartua, widiRahardjo, Luhur 3oeroso
0|v|s|on of |nfect|on and 0|v|s|on of P|eura
0epartment of Pu|mono|ogy and Resp|ratory Hed|c|ne
8choo| of Hed|c|ne Un|vers|tas 8umatera Utara, Adam Ha||k Cenera| hosp|ta|
Hedan

Abstract
F|slu|a lorral|or oelWeer lre ororcr| ard per|lorea| cav|ly |s exlrere|y rare. lr prev|ous reporls, l|slu|a rave
occurred secordary lo lroraco-aodor|ra| lraura, suoprrer|c aoscess, supporl|ve o|||ary lracl ooslrucl|or,
ra||grarcy ard |alroger|ca||y lrrougr procedures sucr as o|||ary surgery or perculareuso|||ary dra|rage. Tre
d|recl|or ol l|slu|a lorral|or ras a|Ways oeer lrougrl lo oe lror lre per|lorea| cav|ly lo lre ororcr| : lrere are ro
reporls ol a l|slu|a W|lr a ororcr|a| or|g|r. Tr|s case reporl preserls a pal|erl Wro preserled W|lr seps|s ard a
ororcroper|lorea| l|slu|a ard preuroper|loreur secordary lo |urg aoscess.
ey words : 8ronchoperitoneal fistula, Lung abscess, Pneumoperitoneum

|NTR00U6T|0N
rorcroper|lorea| l|slu|a ras rare|y oeer reporled.
1-ê
Tre rajor|ly ol reporled cases rave |rvo|ved suoprrer|c
|rlecl|or resu|l|rg |r d|aprragral|c ruplure ard lre lorral|or ol a ororcroper|lorea| or ororcroo|||ary l|slu|a.
lr lre pal|erl preserled |r lr|s case reporl, lre ororcroper|lorea| l|slu|a c|ear|y or|g|raled lror a |urg aoscess. Tre
d|agros|s, lrealrerl ard poss|o|e recrar|srs ol ororcroper|lorea| l|slu|a lorral|or are d|scussed.

6A8E REP0RT
A 39 year o|d rar preserled W|lr 3rorlress ol orealr (30, cr|||s, lever ard aodor|ra| lu||ress. le le|l srorlress
ol orealr lor 1 rorlrs ard a|so lever.
v|la| s|grs sroWed a|erl, ! : 120/80 rrlg, !u|se : 98 l|res/r|rule, Resp|ralory rale : 22 l|res/r|rule,
Terperalure : 38.ê
0
C.
!rys|ca| exar|ral|or sroWed reduced cresl Wa|| expars|or or lre r|grl |oWer zore, |rcreased ol lrer|lus or lre
r|grl |oWer zore ard reduced cresl expars|or or lre r|grl rer|lrorax, percuss|or : 0u||ress or lre r|grl |oWer zore,
rorcr|a| or lre r|grl |oWer zore ard ves|cu|ar or lre |ell rer|lrorax ard lre r|grl upper ard r|d |urg zore,
red|ur Crac||es (|ale or par - |rsp|ralory crac||es or lre r|grl |oWer |urg zore.
Laooralory l|rd|rgs : lo : 13 g/d|, wC : 1ê x 10
9
/L, Arler|a| o|ood gases : pl : Z.1ê, !a02 : Z5 rrlg, !aC02 : 30
rrlg, : -2, 3a02 : 90º.

Cresl x - ray ard aodor|ra| CT scar sroWed severe preuroper|loreur lror lre r|grl suoprrer|c space lo lre
r|grl per|-repal|c space ard o||alera| corso||dal|or ol lre |oWer |urg l|e|ds, espec|a||y |r lre r|grl |oWer |ooe (F|g.1.
Tre pal|erl rad a 10-year r|slory ol rero|r add|cl|or. xp|oralory |aparolory Was perlorred |rred|ale|y lor
prooao|e aodor|ra| ro||oW orgar perloral|or W|lr seps|s. 0ur|rg surgery, luro|d l|u|d |r lre per|lorea| cav|ly ard a
pers|slerl a|r |ea| lror a ro|e |r lre r|grl rer|-d|aprragr Was ooserved; ro||oW orgar perloral|or Was rol |derl|l|ed.
A r|grl posl-|alera| lroracolory Was allerpled oul la||ed oecause ol severe rypox|a ard urslao|e v|la| s|grs
secordary lo seps|s.
3evere suoculareous erprysera ard a|r |ea| lror lre per|lorea| dra|r Was rol poslopral|ve|y. lrlraoperal|ve|y,
corso||dal|or or lre r|grl |oWer |urg W|lr severe adres|or lo lre dore ol lre r|grl d|aprragr Was roled. A ruplured
aoscess |r lre r|grl |oWer |urg W|lr a ororcroper|lorea| l|slu|a caus|rg pers|slerl a|r |ea| |rlo lre per|lorea| cav|ly
Was |derl|l|ed. Tre resu|l|rg d|aprragral|c ro|e Was aooul 1.5 cr |r d|areler (F|g.2. !reuro|ys|s, decorl|cal|or,
deor|dererl, c|osure ol lre d|aprragral|c perloral|or ard p|acererl ol lrree cresl luoes lor dra|rage Were
perlorred. Cu|lure ol aoscess corlerls sroWed r|eos|e||apneumon|ae ard Esoner|on|a oo||. Arl|o|ol|cs Were
prescr|oed, ard lre pal|erl recovered ureverllu||y.








F|gure 1. !reoperal|ve rad|o|og|c l|rd|rgs (a palcry corso||dal|or ol lre |oWer zores ol oolr |urgs ard e|eval|or ol
lre r|grl rer|d|agragr W|lr suoprrer|c a|r co||ecl|or (Wr|le arroW. (o Corso||dal|or W|lr a|r ororcrogrars over ol
lre |oWer zores ol oolr |urgs ard a res|dua| aoscess cav|ly aller exlerra| dra|rage v|a lre l|slu|a (o|ac| arroW over
lre r|grl |oWer |ooe. (c !reuroper|loreur W|lr loca| gaseous co||ecl|or (Wr|le arroW lror lre r|grl per|-repal|c
space.









F|gure 2 lrlraoperal|ve|y, a d|apgraral|c ro|e (o|ac| arroW reasur|rg aooul 1.5 cr |r d|areler Was roled

0|86U88|0N
F|slu|as oelWeer lre ororcr| ard per|olorea| space are rare, ard a|| reporled l|slu|as rave apperearl|y lorred |r
cepra|ad d|recl|or lror lre suoprrer|c space lo lre |urg parercryra.
1-ê
No pr|rary suppural|ve|rlralrorac|c
process ras oeer rerl|ored. lr lre pal|erl preserled, pus ard a|r Were seer l|oW|rg lror lre ruplured |urg aoscess
lo lre per|lorea| cav|ly, Wr||e ro s|gr|l|carl aodor|ra| aororra||ly Was |derl|l|ed dur|rg lre exp|oralory |aparolory.
A|lrougr cu|lure resu|ls sroWed r. pneumon|ae ard E. oo||, Wr|cr are corror |r lre gaslro|rlesl|ra| lracl, a |urg
aoscess |s sl||| |||e|y lo oe lre or|g|ra| |rlecl|ous source (F|g.2. Tre |urg aoscess resu|led |r |rl|arral|or ol
surrourd|rg |urg l|ssue lo||oWed oy a r||d p|eura| ellus|or ard adres|or oelWeer lre
|urg l|ssue ard lre r|grl rer|-d|aprragr. Aller lre |urg aoscess greW ard ruplured, lre l|slu|a lorred. ll |s |roWr
Wry ororcroper|lorea| l|slu|a lorral|or |s cepr|ad |r rosl cases ard sore rave poslu|aled a corlr|oul|or lo l|slu|a
lorral|or lror verous relurr.
Tre pal|erl's red|ca| r|slory Was rolao|e lor a|coro||sr ard rero|r add|cl|or lor approx|rale|y 10 years. lrrure
corpror|se |s assoc|aled W|lr a|coro||sr. 0ouv|er reporled lral a|coro| car depress lre |rrure sysler oy
|rpa|r|rg resp|ralory sysler delerces ard decreas|rg resp|ralory lurcl|or.
Z
As resu|l, lre |rc|derce
ororcropu|rorary d|seases ray oe r|grer lrar |r ror-a|coro||c persors, espec|a||y lral corpror|sed |rrure
lurcl|or corlr|ouled lo lre lu|r|rarl |rlecl|or |r lr|s case.
lr corc|us|or, ororcroper|lorea| l|slu|as exlrere|y rare ; suoprrer|c aoscess ard o|||ary lracl proo|ers are lre rosl
corror reporled ael|o|og|es.
1-5
Trealrerl |rc|udes deor|dererl ol ororcropu|rorary l|ssue, repa|r ol
d|aprragral|c perloral|ors, dra|rage ol lre suoprrer|c |rlecled space ard adequale arl|o|ol|cs.

REFEREN6E8
1. 3loc|oerger 3V, Jr, Kes|er KA, roder|c| L3, loWard TJ. rorcrop|eura| l|slu|a secordary lo crror|c
K|eos|e||apreuror|aesuprrer|c aoscess. Arr. Trorac. 3urg.1999;ê8: 1058-ê0
2. oyd 0!. rorcroo|||ary ard ororcrop|eura l|slu|as. Arr Trorac. 3urg. 19ZZ;21 : 181 - Z
3. loarra - !erez C. Trorac|c corp||cal|ors ol areo|c aoscess ol lre ||ver : reporl ol 501 cases. Cresl 1981 ; Z9 : êZ2
- Z
1. ||l|rger Tv, 0|drar KT, Looe T, arror 3, layder CK. 3ucceslu|perculareus dra|rage ol pyoger|c ||ver aoscess
corp||caled oy ororcrop|eura| l|slu|a. 3oulr Ved.J. 198Z ; 80: 90Z - 9

5. 3lar| !. rorcroerler|cd|su|ae |r |yrprora. AJR Ar.J.Roerlgero|1981 ; 13ê : ê15 - Z

ê. 3avage !J, 0orovar wN, K||gore TL, Co|oororcr|a| l|slu|a |r pal|erl W|lr carc|rora ol lre co|or. 3oulr Ved. J.
1982 ; Z5 : 21ê - Z
Z. 0ouv|er JJ, vergerel J, Taylard A, Freour !. A|coro| ard lre |urg. Aralor|ca| ard lucl|ora| corsequerces. Arra|es
de Vedec|re lrlerre 1985 ; 13ê : êêZ - Z0
8. Krurpe !, Curr|s|ey JV, L||||rglor 0A, A|coro| ard lre resp|ralory lracl (rev|eW. Ved. C||r. Norlr Ar. 1981;ê8 :
201 - 19

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