Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Case Report

Volume 16, Number 3, June 2023, pages 184-191

Does Liver Resection Remain a Viable Option in Patients With Pyogenic Liver Abscess? A Single-Center Experience

Figures

Figure 1.
Figure 1. Coronal CT of abdomen and pelvis on presentation with IV contrast showing a 7 × 5 cm fluid density with gas pockets in segment VII peripherally (blue arrow) associated with moderate ascites and multiple gas pockets in the right subhepatic region (red arrows). CT: computed tomography.
Figure 2.
Figure 2. CT of abdomen 9 days after abscess drainage showing a percutaneous drain in segment VII (encircled). CT: computed tomography.
Figure 3.
Figure 3. A follow-up CT of abdomen and pelvis (3 months after discharge) showing enlarged cirrhotic liver without definite evidence of a focal liver lesion (green encircled). CT: computed tomography.
Figure 4.
Figure 4. CT of abdomen and pelvis (2 months prior to presentation) showing multiple different sized cystic lesions, many of them with ring enhancement seen scattered in both lobes of the liver, with the largest measuring about 10 cm and located in segment VII (blue arrow). CT: computed tomography.
Figure 5.
Figure 5. CT of abdomen and pelvis with IV contrast 2 months prior showing numerous cystic lesions (blue arrows) scattered in both lobes of the liver, with the largest measuring 12 × 10 cm compressing segment VII (red arrow). CT: computed tomography.
Figure 6.
Figure 6. CT of abdomen and pelvis (on admission) showing abscess recurrence in segment VII (encircled). CT: computed tomography.
Figure 7.
Figure 7. CT scan of abdomen and pelvis showing a large liver abscess in segment VII measuring 5 × 6.1 cm (encircled) and segment VI measuring 8.7 × 8 cm (not shown). CT: computed tomography.
Figure 8.
Figure 8. (a, b) Laparotomy findings of extensive grade V liver injury of segments V, VII, and VIII (green arrows) with diaphragmatic perforation.
Figure 9.
Figure 9. CT scan of abdomen and pelvis showing a massive fluid collection in the right pleural space (red arrows) herniated through the anterior mediastinum into the left side and displaced mediastinum (encircled), collapsed right lung, and large liver heamtoma (blue arrow). CT: computed tomography.
Figure 10.
Figure 10. (a, b) CT scan of chest and abdomen showing the periphral enhancement of the pleural fluid collection (encircled) indicating empyema, multiple right-sided fluid loculations and partial right lung collapse noted with atelectasis. Right heaptic lobe shows large fluid collection with multiple air pockets (red arrow). CT: computed tomography.

Table

Table 1. Demographic and Clinical Profiles of the Four Cases
 
CharacteristicCase 1Case 2Case 3Case 4
CRP: C-reactive protein; CT: computed tomography; HCC: hepatocellular carcinoma; RUQ: right upper quadrant.
Age (years)75484422
GenderMaleFemaleMaleMale
Past medical historyAtrial fibrillation, chronic hepatitis B, liver cirrhosis, and HCCInflammatory cecal mass and recurrent multiple liver abscessesNoneNone
Cirrhosis (Child-Pugh score)Yes (10)NoNoNo
History of chronic hepatitisHepatitis BNoNoNo
Previous history of liver abscessNoneYesNoNo
PresentationFever, epigastric pain, abdominal distention, anorexia, jaundiceFever, epigastric pain, abdominal distentionFever, chills, right upper abdominal pain and shortness of breathShortness of breath, right-sided chest pain and RUQ abdominal pain
Initial CRP (mg/L)249240201250
Alkaline phosphatase7046186332
Albumin3.12.82.93.7
Aspirate culture (intraoperative cultures)Enterococcus faecium (E. coli)No growthNo growthPseudomonas aeruginosa
Blood culturesNegativeNegativeNegativeNegative
Source of the abscessUnknownTraumatic (shrapnel injury after explosion)
Liver abscess site and locationSegment VII, measuring (7 × 5 cm)Segment VII, multiple abscesses largest (11.6 × 10.4 cm)Segment VII (5 × 6.1 cm) cm and segment VI (8.7 × 8 cm)Lateral aspect of the right hepatic lobe, approximately 11 × 10 × 7 cm
Percutaneous drain trial (modality, number)Yes (CT-guided aspiration, once)Yes (CT-guided drainage, twice)NoYes (ultrasound-guided drainage, once)
Surgical modalityOpen drainage with resection of segment VIICholecystectomy with resection of segment VII and most of segment VICholecystectomy with resection of segment VII and segment VIRight hepatectomy
A follow-up modality and timingCT of abdomen and pelvis 3 months laterUltrasound 3 weeks laterUltrasound after 1 weekUltrasound 3 weeks
Follow-up conditionImprovedImprovedImprovedImproved
Follow-up CRP (mg/dL)3914614786