Empyema Necessitatis: A Case of Pleural Empyema Fistulized to the Abdominal Skin/Empyema Necessitatis: Karin Derisine Fistulize Olan Bir Plevral Ampiyem Olgusu

• Published in: KLIMIK dergisi Vol. 32; no. 1; p. 102
• Main Authors: Gucsav, Mutlu Onur, Canbaz, Mustafa, Deniz, Sami, Alizoroglu, Dursun, Erbaycu, Ahmet Emin, Atay, Tuba, Yazgan, Serkan
• Format: Journal Article
• Language: English
• Published: AVES 01-04-2019
• Subjects: Antibiotics; Empyema; Erythema; Medical research; Morbidity; Mortality; Pleural effusion; Skin
• ISSN: 1301-143X
• DOI: 10.5152/kd.2019.23

Empyema necessitatis is pleural empyema fistulized out of the thorax including subcutaneous tissues. Although it is a rare complication, delayed diagnosis may cause significant morbidity and mortality. A 43-year-old male was admitted to the clinic with a complaint of fever and expectoration of foul-smelling sputum, and a pleural effusion was detected. Fluid was sampled by thoracentesis, and it was concordant with empyema. As the bacteriological culture was positive for Streptococcus intermedius, a combination of two antibiotics was initiated, and a tube thoracostomy was placed. Upon observing protuberance, erythema, temperature rise and fluctuation under skin on the right lower abdominal quadrant, it was drained surgically. Empyema necessitatis was diagnosed since the drained fluid had the same nature with the pleural fluid. Improvement of clinical, radiological and laboratory findings were obtained after antibiotic therapy. Key Words: Empyema necessitatis, Streptococcus intermedius, empyema, fistulization. Empyema necessitatis, plevral ampiyemin deri alti dokular da dahil olmak uzere toraks disina fistulize olmasidir. Nadir bir komplikasyon olmakla birlikte tanida gecikme, onemli morbidite ve mortalite nedeni olabilmektedir. 43 yasindaki erkek hasta, ates ve kokulu balgam cikarma sikayetiyle basvurmus ve plevral efuzyon saptanmistir. Sivi torasentezle orneklenmis, ampiyemle uyumlu oldugu gorulmustur. Bakteriyolojik kulturde Streptococcus intermedius uremesi olmasi uzerine ikili kombine antibiyotik tedavisi ve tup torakostomisi uygulanmistir. Karin sag alt kadran lateralinde deri altinda sislik, kizariklik, sicaklik artisi ve fluktuasyon saptanmasinin ardindan, cerrahi drenaj uygulanmistir. Bu bolgeden plevral siviyla ayni vasifta sivi gelmesi uzerine empyema necessitatis teshisi konulmustur. Hastanin klinik, radyolojik ve laboratuvar bulgulari, antibiyotik tedavisiyle iyilesmistir. Anahtar Sozcukler: Empyema necessitatis, Streptococcus intermedius, ampiyem, fistulizasyon.