Favourable outcome of multiple pyogenic liver abscesses with conservative treatment

We describe a patient with multiple pyogenic liver abscesses treated only with antibiotics with a favourable outcome. This conservative treatment may be an option in some patients with multiple pyogenic liver abscesses.     

Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin

OBJECTIVES: Pyogenic liver abscesses remain an important and life-threatening clinical problem but their causes and management have changed over the last two decades. The aim of this study was to assess the feasibility and the impact of an endoscopic approach in the management of liver abscesses with suspected biliary origin. METHODS: We reviewed the records of 16 patients suffering from pyogenic liver abscess, who underwent endoscopic retrograde cholangiopancreatography (ERCP) in the setting of biliary diseases between January 1995 and December 2004. Nine patients had an underlying neoplastic disease; 13 had a history of biliary endoscopic maneuvers. When the collections were communicating with the biliary tree, an endoscopic drainage of the abscess was performed either by sphincterotomy, dilation, insertion of a nasobiliary catheter, or stenting. In noncommunicating liver abscesses associated with bile duct abnormalities, biliary decompression was obtained by insertion or replacement of biliary stents. RESULTS: Fourteen patients had liver abscesses communicating with the biliary system and underwent an endoscopic drainage of the cavity. Ten of these patients had an exclusive endoscopic drainage of the abscess, while four cases required additional percutaneous drainage. The two noncommunicating abscesses were associated with previous insertion of biliary stents; these were cured percutaneously after endoscopic stent replacement. Among the 16 patients, 13 had a rapid resolution of symptoms (81%). CONCLUSION: This initial clinical experience suggests that ERCP can demonstrate communications between the biliary tract and liver abscesses, and that an internal drainage of the cavity is feasible and safe.     

Hepatobronchial fistula with percutaneous pyogenic abscess drainage of the liver

Percutaneous abscess drainage has been successfully used in the treatment of hepatic abscesses. We present a case of a posttraumatic pyogenic liver abscess treated by CT-guided percutaneous catheter drainage with an unusual complication of a hepatobronchial fistula. Patient management and the subtle roentgenographic features of this case are presented. Early signs of hepatobronchial fistula including paroxysms of coughing and a peculiar metallic taste during the performance of an abscessogram are reported.     

超声引导下经皮穿刺抽吸冲洗术治疗化脓性肝脓肿临床研究

目的 研究超声引导下经皮穿刺抽脓治疗化脓性肝脓肿（PLA）患者的疗效。方法 2014年6月～2016年6月收治PLA患者60例,30例接受穿刺抽脓,另30例接受置管排脓。观察临床治疗效果。结果 在60例PLA患者脓液中,培养发现细菌阳性34例（56.7%）,获得致病菌43株,其中变形杆菌1株（2.3%）,肺炎克雷伯杆菌29株（67.4%）,表皮葡萄球菌1株（2.3%）,大肠埃希菌5株（11.6%）,粪肠球菌2株（4.7%）,金黄色葡萄球菌5株（11.6%）;在23例血培养患者,发现与脓液相同细菌阳性6例（26.1%）;穿刺抽脓和置管排脓患者脓腔消失时间分别为[（9.18±1.84）d和（12.57±1.67）d,P＜0.05],体温恢复正常分别为[（2.18±0.52）d和（2.24±0.59）d,P＞0.05],住院日分别为[（12.84±1.97）d和（12.04±1.78）d,P＞0.05],医疗费用分别为[（13982±1604）元和（16007±1657）元,P＞0.05]。结论 两种抽脓方法治疗PLA患者疗效显著,操作简单易行,风险小,且术后基本无并发症发生。     

Hepatic abscesses and fungemia from Torulopsis glabrata. Successful treatment with percutaneous drainage and amphotericin B

A 39-year-old man with severe diabetes mellitus, chronic pancreatic insufficiency, intrapancreatic choledochal stricture, and secondary biliary cirrhosis developed postsurgical fungemia and large hepatic abscesses due to Torulopsis glabrata. These were treated successfully with a combination of amphotericin B and percutaneous drainage of the liver abscesses. We believe this is the first reported case of such infection due to this normally saprophytic agent.     

Pylephlebitis and pyogenic liver abscesses: a complication of hemorrhoidal banding.

Hemorrhoidal banding is a well-established and safe outpatient procedure. Septic complications of hemorrhoidal banding are rare but can be fatal. The first case of pylephlebitis (septic portal vein thrombosis) and pyogenic liver abscess following hemorrhoidal banding in a 49-year-old man with diabetes is reported in the present study. Risk factors, management and the role of prophylaxis in immunocompromised patients are discussed. Caution against hemorrhoidal banding in immunosuppressed patients, including patients with diabetes, is warranted.     

A case of multiple lung abscesses successfully treated with computed tomography guided percutaneous thoracic drainage]

A 48-year-old woman who had abused alcohol admitted to our hospital because of fever and chest pain. Laboratory data presented inflammation and liver dysfunction. Chest X-ray films revealed multiple mass lesions with air fluid levels. We diagnosed multiple lung abscesses and started treatment with antibiotics. However, her fever did not improve and mass lesions increased. On day 6 of hospitalization, three drainage tubes were inserted percutaneously into the mass lesions under computed tomography (CT) guidance, and alpha-hemolytic streptococcus, peptostreptococcus sp. and neutrophils were isolated from the drainage fluid. Abcesses and inflammation were improved by administration of the antibiotics selected according to the result of fluid culture. Because all multiple abcesses were located near the pleura, we successfully treated them with simultaneous percutaneus thoracic drainage.     

Percutaneous and surgical treatment of pyogenic liver abscesses: Observation over a 21-year period in 148 patients

BACKGROUND: Percutaneous drainage of pyogenic liver abscess has become first-line treatment. In the past surgical drainage was preferred in some centres. AIM: The aim of this retrospective study was to assess the effectiveness of percutaneous treatments and surgical drainage, in terms of treatment success, hospital stay and costs. PATIENTS: Data of 148 patients (90 males; 58 females; mean age, 61 yrs; range, 30-86 yrs) were retrospectively analysed. METHODS: Patients' outcomes, including the length of hospital stay, procedure-related complications, treatment failure and death, were recorded. Multiple logistic regression model was used for statistical analysis. RESULTS: One hundred and four patients (83 with solitary and 21 with multiple abscesses) were treated percutaneously, either by needle aspiration (91 patients) or catheter drainage (13 patients) depending on the abscess's size, and 44 patients (30 with solitary and 14 with multiple abscesses) were treated surgically. There was no statistically significant difference in patients' demographics or abscess characteristics between groups. Hospital stay was longer, and costs were higher in patients treated surgically (p<0.001). There was statistically significant difference in morbidity rate between groups (p<0.001). No death occurred in both groups. CONCLUSIONS: Percutaneous and surgical treatment of pyogenic liver abscesses are both effective, nevertheless percutaneous drainage carries lower morbidity and is cheaper.     

Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter

BACKGROUND: It is universally recognized that the most frequent cause of hepatic abscess is biliary disease. The aim of this study was to determine the efficacy of endoscopic drainage and local antibiotic lavage via nasobiliary catheter in the treatment of liver abscesses of biliary origin. METHOD: From January 1994 to December 1995, twenty-two cases of pyogenic liver abscess were treated. Diagnosis was established with ultrasound, computed tomography, endoscopic retrograde cholangiography, and laboratory tests. All patients were assigned prospectively to endoscopic or other non-surgical forms of therapy, depending on the etiology of the pyogenic process. Patients in whom this treatment failed underwent surgical drainage. Twenty patients had hepatic abscesses of biliary origin. In this subgroup, a nasobiliary catheter was placed into the biliary tree for continuous antibiotic lavage (infusion technique: 1 to 1.5 mL/min for 8 to 10 days) after endoscopic sphincterotomy. Two patients had hepatic abscesses of hematogenous and amebic origin, respectively. They were treated only with the appropriate systemic antibiotics. RESULTS: Nineteen patients of the biliary subgroup (95%) and the two patients with non-biliary disease (100%) had complete resolution of the abscesses. "Salvage" surgical drainage was required in only one patient (4.5%). There was no treatment related mortality. CONCLUSION: Endoscopic sphincterotomy and local antibiotic lavage via an endoscopically placed nasobiliary catheter is a safe and effective treatment for biliary liver abscesses. It should be considered as first-line treatment in this subgroup of patients with liver abscesses. Percutaneous or surgical drainage modalities should be reserved for patients in whom endoscopic treatment fails.     

A case of phlegmonous gastritis with multiple liver and splenic abscesses

A 63-year-old woman was admitted with high fever. Laboratory tests showed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal ultrasonography and computed tomography revealed multiple liver and splenic tumors. We diagnosed phlegmonous gastritis with multiple liver and splenic abscesses based on a discharge of pus from the gastric ulcer on biopsy obtained during esophagogastroduodenoscopy. She showed remission after spontaneous drainage and treatment with antibiotics. A search of the literature yielded no other cases of phlegmonous gastritis with multiple liver and splenic abscesses, and we therefore report this case.     

Aortic insufficiency associated with interventricular communication. Natural history, angiographic diagnosis and surgical approach

Clinical, electrocardiographic, radiological, hemodynamic and angiocardiographic data of 12 patients with ventricular septal defect (VSD) associated to aortic regurgitation (AR) have been analyzed. The trend of evolution of the AR has been evaluated and angiographic criteria to make a correct diagnosis have been pointed out. Nine patients have been followed up for a mean of 3.8 years. The severity of AR seemed to increase only in three cases: this demonstrates that AR associated to VSD is not always a progressive disease. The usefulness of various radiological views in evidencing the anatomy of both VSD and aortic valve has been discussed and findings of left ventriculogram and aortogram are detailedly described. The site of VSD and the type of lesion of the aortic valve may be crucial for indicating surgical intervention and its type. Indication for surgery is briefly discussed. Surgical technics are shortly summarized.     

Splenic abscess: sonographic diagnosis and percutaneous drainage or aspiration.

During a recent 5-year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound (US) examination. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. The latter four patients had developed splenic microabscesses with a diameter of less than 1.5 cm. The larger abscesses showed an irregular wall, weak or no internal echoes, ovoid or round in shape, and accompanied by mild to moderate distal acoustic enhancement. Wedge-shaped abscesses were typically noted in patients with infectious endocarditis and septic embolism. US-guided percutaneous drainage was done in five patients (abscesses greater than 4 cm). Simple aspiration in conjunction with antibiotic administration was done for seven smaller abscesses (diameter less than 3.5 cm) in five patients. A second drainage, either for a dislodged catheter or a recurrent abscess, was performed in two cases. All patients had uneventful clinical course following this therapeutic approach.     

超声引导下经皮肝穿刺抽脓法和置管引流法治疗艾滋病并发肝脓肿患者临床效果分析

目的 分析艾滋病(AIDS)并发肝脓肿患者临床特点并观察在超声引导下介入治疗的效果.方法 2013年6月～2019年12月我院诊治的74例肝脓肿患者,其中39例有AIDS基础病,均在内科治疗的基础上采用超声引导下经皮肝穿刺抽脓法(PA)和置管引流法(PCD)治疗.结果 两组患者主要临床表现为发热,AIDS患者出现腹痛或...