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+A 73-year-old male patient with a history of brucellosis, hyperuricaemia and hypercholesterolaemia was admitted to our department for scheduled surgery for benign prostatic hyperplasia. In the diagnostic study, a rectal examination revealed a prostate with adenomatous characteristics, very enlarged (G III/IV). A retropubic adenomectomy was performed according to the T. Millin technique, enucleating a large adenoma weighing 170 grams. Six days later, the catheter was removed, the patient resumed comfortable urination and was discharged.
+Eleven days after the operation, and barely four days after discharge, the patient was readmitted to our department for abdominal pain (hypogastric), pain in the right testicle and thigh root on the same side, and a non-specific general malaise in the last 24 hours. A small amount of sero-purulent liquid drained from the orifice where the adenomectomy drainage was performed. The surgical wound was minimally impacted. He was admitted to the urology department with a diagnosis of surgical wound infection and empirical antibiotic treatment was started.
+The general and urological examination was within normal limits. Orchiepididymitis was ruled out. Laboratory tests showed a marked decrease in red blood count, but no leukocytosis. The patient is treated symptomatically but does not improve. The pain in the pubic area is accentuated, so bone scintigraphy is performed, which reports the finding of pathological hypercaptation of the radiotracer in the upper third of both pubis in relation to possible pubic osteopathy, as the only data of interest. The patient continues without improvement, the treatments (based on empirical antibiotherapy and analgesia) fail to reduce the pain, which is now located in the root of the thigh, and the general deterioration is accentuated. The patient presented severe anaemia, elevated ESR, fibrinogen and CRP. Examination of the thigh was unremarkable, with non-specific pain on pressure on the inner thigh. The pain was attributed to neurological involvement, as the examination was normal, and the pain also extended to the inguinal area and right testicle.
+With the diagnosis of a suspected pelvic abscess (the septic picture seemed unquestionable to us) in relation to the surgical history, an abdominal CT scan was requested. This showed absolute normality of the abdominal organs... but cuts made below the symphysis pubis at the level of the right thigh revealed a large abscess in the area of the adductor muscles. In view of this finding, the traumatology department was called in and noted that the inner aspect of the right thigh was now slightly reddened, swollen, painful on palpation but without clear fluctuation. The coxofemoral joint was free. Seven days after admission and as a matter of urgency, surgery was performed: a wide longitudinal incision was made on the inner side of the proximal third of the thigh and by means of blunt digital dissection, a deep penetration was made through the abductor musculature until a large purulent collection was reached, which was directed proximally towards the pubis. An abundance of foul-smelling pus is obtained (samples are taken for microbiological examination). After washing the cavity with abundant saline and oxygenated water, the surgical wound is partially closed and Penrose drains are left in place. Examination of the surgical wound of the adenomectomy and the area where the drain had been at the present time were absolutely normal and no cavities or collections were identified. Drains were placed and the operation was concluded. The patient required intensive care, transfusion of blood products, a long period of hospitalisation, meticulous local dressings, etc. The patient made a slow but excellent progress towards complete recovery. All subsequent controls (analytical, radiological, ultrasound...) corroborate the good evolution. The microbiology department informs us that the following results were obtained in the cultures taken: pure culture of seropurulent fluid from the adenomectomy wound: coagulase-negative Staphylococcus (without being able to specify the species). Culture of pus obtained during the operation to drain the thigh abscess: two strains of coagulase-negative Staphylococcus (identified as Staphylococcus epidermidis and Streptococcus alpha haemolyticus).
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