Delayed Presentation of Actinomycotic Intra-Abdominal Abscess Following Laparoscopic Cholecystectomy Complicated by Empyema: Dropped Gallstone to Blame?
Bibliographic record
Abstract
Laparoscopic cholecystectomy (LC) has universally become the gold standard for symptomatic gallstone disease. However, there are two specific complications more frequent in LC compared to open cholecystectomy, i.e. injury to the common bile duct and complications from dropped gallstones. Although asymptomatic in majority of cases, adverse events are reported in between 0.08% and 0.3% of these cases. The complications due to dropped stones include abscesses around liver, spleen, diaphragm, retroperitoneum and port sites, broncholithiasis, empyema, peritonitis leading to septicemia, intestinal obstruction, thrombosis of middle colic vein, colocutaneous fistula, and bladder obstruction. Abscesses are the most common infective complications and have been reported to occur from 3.3 months to 10 years. In most cases, E. coli have been identified in abscesses and in cause of septicemia and peritonitis. There are case reports of Klebsiella , Strep. bovis and Samonella being the contaminants after dropped stones. However, actinomycosis as source of infection has rarely been described. We describe a case of an elderly patient who presented with symptoms of shortness of breath and shoulder pain, 2.5 years after cholecystectomy, in whom actinomyces species were cultured from abdominal abscesses. Only few case reports, to our knowledge, have identified actinomyces species as an etiologic agent. We also briefly describe the management of such stones. Clin Infect Immun. 2018;3(1):20-23 doi: https://doi.org/10.14740/cii74e
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".