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J Glob Infect Dis. 2019 Jan-Mar;11(1):47-49. doi: 10.4103/jgid.jgid_9_18.

Recurrence of Citrobacter koseri-associated Intra-abdominal Infection 2 Years after Spilled Gallstones during Laparoscopic Cholecystectomy.

Author information

1
Department of Internal Medicine, Stony Brook University Hospital, New York, USA.
2
Department of Pathology, Veteran's Affairs Medical Center, New York, USA.
3
Department of Infectious Diseases, Stony Brook University, School of Medicine, Stony Brook, New York, USA.
4
Veterans Affairs Medical Center, Northport, New York, USA.

Abstract

Spilled gallstones during laparoscopic cholecystectomy (LC) are common. Lost gallstones can lead to complications such as intra-abdominal abscesses, which can occur days, months, or even years after the procedure. Citrobacter koseri belongs to the family of Enterobacteriaceae. It is a low-virulence pathogen; however, it is linked to infections of the urinary tract and abdomen. We report the case of a 70-year-old diabetic male who presented with C. koseri- associated subhepatic abscess. Two years prior, he had emphysematous cholecystitis and liver abscess caused by C. koseri. During his LC, gallstones were spilled in the abdominal cavity and every effort was made to retrieve them. However, 2 years later, an aspiration of the subhepatic abscess revealed cholesterol fragments. We hypothesize that dislodged cholesterol gallstones and bile, contaminated with C. koseri, were the culprits for the appearance of the subhepatic abscess with the same organism 2 years after the LC.

KEYWORDS:

Citrobacter koseri; intra-abdominal infection; liver abscess; spilled gallstones

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