Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report

BACKGROUNDPyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.CASE SUMMARYThis report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient''s general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory. CONCLUSIONPLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.     

Sarcomatoid intrahepatic cholangiocarcinoma mimicking liver abscess: A case report

Sarcomatoid intrahepatic cholangiocarcinoma(SICC)is an extremely rare and highly invasive malignant tumor of the liver.To our knowledge,the imaging findings of sarcomatous cholangiocarcinoma have been rarely reported;and radiological features of this tumor mimicking liver abscess have not yet been reported.CASE SUMMARY We present a case of SICC mimicking liver abscess.The patient,a 43-year-old male,complained of repeated upper right abdominal discomfort and intermittent distension over a period of one month.Radiology examination revealed a huge focal lesion in the right liver.The lesion was hypointense on computed tomography with honeycomb enhancement surrounded by enhanced peripheral areas.It showed a hypo-signal on non-contrast T1-weighted images and a hypersignal on non-contrast T2-weighted images.Radiologists diagnosed the lesion as an atypical liver abscess.The patient underwent a hepatectomy.After surgery,he survived another 2.5 mo before passing away.A search of PubMed and Google revealed 43 non-repeated cases of SICC reported in 20 published studies.The following is a short review in order to improve the diagnostic and therapeutic skills in cases of SICC.CONCLUSION This report presents the clinical and radiological features of SICC and imaging features which showed hypovascularity and progressive enhancement.SICC can present as a multilocular cyst on radiological images and it is necessary to distinguish this lesion from an atypical abscess.Simple surgical treatment is not the best treatment option for this disease.     

侵肺戴阿李斯特菌致菌血症1例

戴阿李斯特菌属(Dialister sp.)是厌氧或微需氧革兰阴性细小球杆菌,含有5个人源性菌种:侵肺戴阿李斯特菌(D. pneumosintes)[1]、浑浊戴阿李斯特菌(D.invisus)[2]、微嗜氧戴阿李斯特菌(D. micraerophilus)、产丙酸戴阿李斯特菌(D.propionicifaciens)...     

A case report of pyogenic liver abscess caused by hypervirulent Klebsiella pneumoniae diagnosed by metagenomic next-generation sequencing

A 56-year-old woman with a history of diabetes mellitus presented with high fever but no abdominal pain. An abdominal computed tomography scan showed a large liver abscess. Hypervirulent, string test-positive, rmpA/ampA2-, and iutA-positive Klebsiella pneumoniae was rapidly identified from drainage fluid of the liver abscess using metagenomic next-generation sequencing (mNGS). After intravenous antibiotic therapy and drainage of the abscess, the patient’s condition resolved. This case report highlights the value of mNGS in rapidly and accurately identifying a pathogenic microorganism, which helps reduce the incidence of antimicrobial resistance and enables the targeted use of antibiotics.     

Gastric heterotopia of colon found cancer workup in liver abscess: A case report

BACKGROUNDRecently reported cases of pyogenic liver abscess associated with colonic cancer in the absence of underlying disease, have included a small number of cases of gastric heterotopia (GHT). GHT is a congenital anomaly composed of ectopic gastric mucosa and can occur anywhere in the gastrointestinal tract but is more frequently encountered in the cervical esophagus. However, it is rarely observed in colon. Furthermore, most reported cases of GHT of the colon involved the rectum, and GHT involving the colon proximal to the rectum is rare. CASE SUMMARYAn 83-year-old male patient presented with fever and a diagnosis of pyogenic liver abscess. Colonoscopy was performed for colon cancer workup and revealed a 1.0 cm sized polyp at the transverse colon. The polyp was removed by endoscopic mucosal resection by monopolar electrocauterization using a snare. Pathological examination revealed GHT. After administering intravenous antibiotics, the patient recovered well.CONCLUSIONGHT in the colon could affect the development of pyogenic liver abscess by enabling hematogenous propagation of Klebsiella pneumoniae through mucosal damage. However, more study is needed due to the lack of cases.     

Spinal epidural abscess caused by non-typhoidal Salmonella: A case report and literature review

Non-typhoidal Salmonellae are Gram negative bacilli commonly causing self-limiting gastroenteritis, representing a public health issue particularly in tropical countries. Further, the epidemiology of invasive infection by non-typhoidal Salmonella species is poorly understood. Herein, we presented a case of an unusual Salmonella enterica subsp. enterica serovar Altona epidural abscess that cause osteomyelitis and psoas abscess in a 52-year-old Japanese man. To ensure adequate antibiotics penetration into the epidural space, the patient was treated with antibiotics in doses similar to those administered for meningitis. We also reviewed the literature on patients who developed non-typhoidal Salmonella epidural abscesses, and we found 10 other previously reported cases. Salmonella Enteritidis was the pathogen most commonly identified, similar to gastroenteritis. More surveillance of non-typhoidal Salmonella serovars, especially in cases of severe infection, and investigation of antibiotic penetration rate into the epidural space are warranted to decide the best treatment course.     

Isolated psoas abscess caused by Mycobacterium tuberculosis: A rare case report

Psoas tuberculosis abscess is very rarely detected primarily without an adjacent vertebral cold abscess. Early diagnosis prevents unnecessary operations and life‐threatening complications.     

肝癌化疗栓塞并发肝脓肿的临床特点及易感因素分析

目的 探讨肝癌患者化疗栓塞(TACE)后并发肝脓肿的临床特点及易感因素.方法 回顾性分析523 例肝癌患者共1167 次TACE 术后并发肝脓肿的发病率、临床表现、治疗转归等临床特点,并分析肝脓肿形成与糖尿病、Child-Pugh B级肝硬化、门静脉阻塞、胆道梗阻及追加颗粒性栓塞剂栓塞等易感因素的关系.结果 8 例患者TACE 术后共发生9 次肝脓肿.肝脓肿并发症的发病率为0.77%(共1167 次操作).肝脓肿临床表现有肝大、肝区疼痛、发热、白细胞增多,发病时间为术后9 ～29 d,平均(18 ±9)d.除1 例患者由于诊断治疗不及时死亡外,余7 例肝脓肿患者经及时诊断和积极经皮肝穿置管引流及抗生素治疗后均痊愈.χ2 检验结果显示,具有胆道阻塞易感因素的患者术后肝脓肿的发生率明显高于控制组(χ2 ＝143.848,P ＜0.001),而糖尿病、门静脉阻塞及追加颗粒性栓塞剂栓塞等易感因素的组间差异无统计学意义(P ＞0.05).结论 肝癌TACE 后肝脓肿并发症具有一定的临床特点,术前胆道梗阻是TACE 并发肝脓肿的易感因素.     

Cervical spine epidural abscess caused by brucellosis: A case report and literature review

We report a rare case of epidural abscess at the cervical 5‐cervical 6 (C5–C6) levels. The patient underwent surgery with complete abscess removal through C6 vertebral body corpectomy. The result of bacteriological culture was Brucella melitensis. Brucellosis must be considered as a possible cause of epidural abscess in patients from endemic area.     

Liver abscess caused by Burkholderia pseudomallei in a young man: A case report and review of literature

Pyogenic liver abscess is a common entity in Indian subcontinent and is mostly caused by gram negative bacteria. Melioidosis is not commonly seen in India and only a few cases are reported. It can give rise to multiple abscesses at different sites including liver. We report a case of isolated liver abscess caused by Burkholderia pseudomallei (B. pseudomallei) in a 29-year-old recently diagnosed diabetic, immunocompetent male. Diagnosis was made by imaging and culture of pus aspirated from the abscess and he was treated with percutaneous pigtail catheter drainage followed by antibiotics (meropenem and trimethoprim-sulphmethoxazole). Melioidosis is an emerging infection in India and has high mortality rate, so early diagnosis and prompt management is warranted which requires clinical vigilance and an intensive microbiological workup. Clinicians should be aware of isolated liver abscess caused by B. pseudomallei in appropriate clinical settings.     

A case of liver abscess co-infected with Desulfovibrio desulfuricans and Escherichia coli and review of the literature

A 73-year-old woman was admitted with consciousness disturbance following a fever. Abdominal computed tomography revealed a large liver abscess with which the presence of Desulfovibrio desulfuricans and Escherichia coli was confirmed by thorough blood and abscess content culture. Empiric meropenem treatment was switched to cefoperazone/sulbactam, followed by ampicillin/sulbactam based on susceptibility testing. Desulfovibrio desulfuricans is a common bacterium that rarely causes liver abscess and may be overlooked during co-infection due to overgrowth of the accompanying bacteria. Clinicians should bear Desulfovibrio desulfuricans in mind and select the appropriate antibiotics according to susceptibility testing when anaerobic bacteria are detected in a liver abscess.     

Primary tuberculous liver abscess. A case report and review of literature

Tuberculous liver abscess (TLA) is an extremely rare condition, even in the country where tuberculosis is an alarming public health problem. Primary TLA, with no evidence of infection elsewhere, is even less common. Herein, we report a case with primary TLA and review the literature.     

Splenic abscess caused by MRSA developing in an infarcted area: case report and literature review

We report a case of a 41-year-old man with a splenic abscess caused by methicillin-resistant Staphylococcus aureus (MRSA). He had been treated with antimicrobials and corticosteroids for interstitial pneumonia caused by Mycoplasma pneumoniae and hemolytic anemia. He developed catheter-related (MRSA) bacteremia during his stay in the ICU and was treated with teicoplanin for 2 weeks. After 4 weeks of outpatient follow-up, he was readmitted to the hospital with fever and pain in the left upper quadrant. A thoracoabdominal CT scan showed subcapsular collection in areas of splenic infarction that had been detected on his first admission. CT-guided percutaneous aspiration resulted in the isolation of MRSA. The patient was treated successfully with teicoplanin for 6 weeks. Our aim in presenting this quite rare case is to highlight the tendency of infarcts that develop as a result of hemolytic attacks during systemic infections to be a focus of infection for nosocomial bacteremia.     

Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

BACKGROUND Loss of graft function after liver transplantation(LT) inevitably requires liver retransplant. Retransplantation of the liver(Re LT) remains controversial because of inferior outcomes compared with the primary orthotopic LT(OLT).Meanwhile, if accompanied by vascular complications such as arterial and portal vein(PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center’s experience in Re LT through a complicated case of ReLT.CASE SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful.Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years.The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.CONCLUSION With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.     

Successful transcatheter arterial antimicrobial and steroid therapy for refractory liver abscess in chronic granulomatous disease: A case report and review of literature

Hepatic abscess in chronic granulomatous disease (CGD) is very refractory and frequently requires multiple surgeries with frequent morbidities. Although surgical interventions are often required, patients are often not able to have surgery for various reasons. We present the case of a 21-year-old man with recurrent hepatic abscess in CGD. We could not provide surgical interventions due to the lack of a fluid cavity and the patient's refusal, and therefore we administered transcatheter arterial antimicrobial and steroid therapy. He did not have any exacerbation for more than 18 months after the final transcatheter treatment. This is the first reported case of successful transcatheter arterial antimicrobial and steroid therapy for refractory hepatic abscess in CGD. Although the patient's burden and medical cost were not inconsequential, this case shows that the transcatheter arterial antimicrobial and steroid therapy may be a treatment option for patients who are not candidates for surgical interventions.