M/ 65 with sepsis 3 days post op

Submitted by Dr Tang Kam Shing on 4 Nov 2009, ICU, Tuen Mun Hospital
M/ 65 enjoying good past health was admitted for septic shock and abdominal pain.  Emergency laparotomy was done, showing perforation due to suspected diverticulitis.  Post-op day 3, he became dyspnoeic and agitated.  CXR showed right sided hazziness.  Bedside USG was done to look for pleural effusion but the following was found.

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CT abdomen was done, showing a large subhepatic collection.  USG guided aspiration was done, showing blood stained serous fluid only.  He subsequently improved with changing antibiotic to Tazocin and Fluconazole.