Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.     

A recurrent case of amebic liver abscess seventeen years after the first occurrence

A 49-year-old male who had been diagnosed as having amebic liver abscess when he was 32-year-old was admitted to our hospital with fever and watery diarrhea. Ultrasonography and CT examination demonstrated a solitary abscess in the right lobe of the liver. Cysts of Entamoeba histolytica were detected in the stool and an aspiration of the liver abscess looked like anchovy paste. Serum amebic antibody by the IFA method was positive and the case was diagnosed as amebic liver abscess. The patient was treated with metronidazole, and percutaneous transhepatic abscess drainage was performed. The liver abscess decreased remarkably in size and serum amebic antibody was negative after the treatment. Recurrence of amebic liver abscess is rare and we report this case with some literature.     

A case report of a lung abscess as a rare complication of a pyogenic liver abscess

Rationale:A hepatobronchial fistula and lung abscess following a pyogenic liver abscess is a rare entity and it is not easy to diagnose this condition based on the symptoms and chest radiography.Patient concerns:An 81-year-old man presented with productive cough and dyspnea.Diagnosis:Chest radiography indicated increased opacities in the right lower lung field with an air-fluid level suggestive of pneumonia complicated by a lung abscess. Chest and abdominal computed tomography revealed an abscess in the right lower lung field that bordered an abscess at segment 7 of the liver. Tubography confirmed a fistula between the liver and lung abscesses.Interventions:Due to communication between 2 abscesses, transhepatic approach was done instead of transpleural approach to avoid complications.Outcomes:A liver abscess complicated by a lung abscess was resolved following percutaneous transhepatic drainage of the liver abscess and antibiotic administration.Lessons:Though uncommon, the lack of suspicion of sub-diaphragmatic liver abscess often lead to a delay in diagnosis and proper treatment. Our case implies the importance of computed tomography in early diagnosis of liver abscess in case of lung abscess in the right lower lung field.     

Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark

BACKGROUND: Patients with liver cirrhosis are at increased risk of serious bacterial infections carrying a high case fatality rate. Case reports have suggested an association between liver cirrhosis and pyogenic liver abscess. AIMS: To estimate the risk and case fatality rate of pyogenic liver abscess in Danish patients with liver cirrhosis compared with the background population. METHODS: Identification of all patients with liver cirrhosis and pyogenic liver abscess over a 17 year period in the National Registry of Patients. Information on death was obtained from the Danish Central Person Registry. RESULTS: We identified 22 764 patients with liver cirrhosis and 665 patients with pyogenic liver abscess, of whom 21 were cirrhotics and 644 were non-cirrhotics. The crude incidence rate of liver abscess in cirrhotics was 23.3 (95% CI 14.4-35.6) per 100 000 person years. The age adjusted risk of liver abscess was increased 15-fold in patients with cirrhosis compared with the background population. The 30 day case fatality rates in patients with liver abscess and cirrhosis were 38.5% (13.9-68.4) in alcoholic cirrhosis and 62.5% (24.5-91.5) in non-alcoholic cirrhosis compared with 26.9% (23.5-30.5) in liver abscess patients from the background population. After adjustment for sex, age, and comorbidity, the relative risk of death was increased more than fourfold in alcoholic cirrhosis and non-alcoholic cirrhosis compared with the background population. CONCLUSIONS: Liver cirrhosis is a strong risk factor for pyogenic liver abscess associated with a poor prognosis.     

Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome.

BACKGROUND: Klebsiella pneumoniae-associated liver abscesses have distinct clinical and epidemiologic features. METHODS: We report the unusual case of an American patient with a K. pneumoniae-associated liver abscess and septic spread to other organs. We additionally present a comprehensive review of K. pneumoniae-associated liver abscess syndromes in adults. RESULTS: We identified three distinct K. pneumoniae liver abscess syndromes: the polymicrobial liver abscess, the monomicrobial cryptogenic noninvasive liver abscess, and the monomicrobial cryptogenic invasive K. pneumoniae-associated liver abscess (CIKPLA) syndromes, with distinct clinical, epidemiologic and outcome features. CIKPLA syndrome typically affects diabetic patients, mainly in Southeast Asia, and is complicated by septic spread to other organs. CONCLUSIONS: The community-acquired, monomicrobial, K. pneumoniae-associated liver abscess syndromes that typically occur in the USA are mainly noninvasive and affect Asian or Hispanic persons. However, this report provides an alert that CIKPLA syndrome can occur in North America, and physicians need to be aware of it.     

Amebic liver abscess rupturing into the lesser omentum space

A case of an amebic abscess localized in the lesser omentum is reported. There was no sign of a liver abscess in the imaging examination or the operative findings. However, it is likely that the amebic infection occurred after a liver abscess ruptured into the abdominal cavity. Early diagnosis and therapy are required when an abscess of unknown origin borders the liver, given the possibility of amebic abscess.     

Liver abscess: a rare but an important complication that must be considered in Crohn's disease

Liver abscess is a quite rare complication in Crohn's disease. Early diagnosis and differentiation of pyogenic abscess from amoebic abscess are as important as the choosing of proper treatment in the management of liver abscess. Herein, 28-year-old man with Crohn's disease developing liver abscess is presented. He was treated with surgical drainage.     

Salmonellosis with liver abscess mimicking hepatocellular carcinoma in a diabetic and cirrhotic patient: a case report and review of the literature.

Salmonellosis with liver abscess in a cirrhotic liver is extremely rare. We report the first case of Salmonellosis with septic shock and liver abscess in a diabetic and cirrhotic patient. The image studies of liver initially favored hepatocellular carcinoma. But no definite focus of sepsis was found. After close follow-up of the liver space-occupied lesion, ultrasound examination revealed the features of liver abscesses at space-occupied lesion later. Ultrasound-guided liver aspiration proved abscess. The clinical and radiological responses were good after antibiotics treatment.     

Pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma

Background

Pyogenic liver abscess and hepatocellular carcinoma are common in Taiwan. We investigated the frequency of, risk factors for, and prognosis of pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma over a 12-year period in Taiwan.

Methods

We extracted 32,454 patients with pyogenic liver abscess from a nationwide health registry in Taiwan during the period 1997-2008. The frequency of and risk factors for pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma were determined. The prognosis of these patients was compared with patients with hepatocellular carcinoma but without liver abscess.

Results

A total of 698 (2.15%) patients presented with liver abscess as the initial manifestation of underlying hepatocellular carcinoma during the 12-year period. Liver cirrhosis, hepatitis B virus infection, hepatitis C virus infection, and age ≥65 years were independent risk factors for liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Furthermore, these patients had a lower 2-year survival rate than patients with hepatocellular carcinoma but without liver abscess (30% vs 37%; P = .004).

Conclusions

The prognosis of patients who presented with pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma was poor. Physicians should not ignore the possibility of underlying hepatocellular carcinoma in patients with risk factors for the disease in regions with a high prevalence of both pyogenic liver abscess and hepatocellular carcinoma.     

用聚合酶链反应检测血清标本诊断阿米巴肝脓肿的价值

用聚合酶链反应（ Ｐ Ｃ Ｒ）检测阿米巴肝脓肿患者血清标本中的溶组织内阿米巴 ３０ ０００ 蛋白基因,结果４２ 例患者中有３５ 例呈阳性反应,阳性率为８３．３％ ,低于脓标本 Ｐ Ｃ Ｒ阳性率（１００％ ）（ Ｐ＜ ０．０１）。３ 例细菌性肝脓肿、１ 例肝癌及１０ 例其它部位脓肿患者的血清和脓对照标本 Ｐ Ｃ Ｒ均呈阴性反应。对 Ｐ Ｃ Ｒ检测血标本诊断阿米巴肝脓肿的价值进行了讨论。     

A case of Salmonella liver abscess]

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.     

Liver abscess in Crohn's disease. Report of four cases and review of the literature

Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed. The incidence of liver abscess in patients with Crohn's disease (114-297 per 100,000) appears to be higher than that of liver abscess in the general population (8-16 per 100,000). Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed. In comparison to patients with liver abscess in the general population, patients with Crohn's disease and liver abscess are considerably younger, are more likely to have multiple rather than solitary abscesses, and usually have a predisposing intraabdominal focus of infection, rather than a biliary one. Streptococci, especially Streptococcus milleri, are the most frequent cause of liver abscess in patients with Crohn's disease. Liver scanning should be performed routinely in patients with Crohn's disease in whom a febrile illness cannot be completely explained by bowel disease, or in whom fever does not respond to drainage of intraabdominal abscesses.     

Blunt Trauma and Liver Abscess

Three cases of pyogenic liver abscess following blunt trauma to the torso are described. The association between blunt trauma with liver contusion and the development of bacterial pyogenic liver abscess is explored. Reported series of liver abscess are reviewed. It is suggested that physicians look for the development of liver abscess in patients who have had major blunt trauma to the torso. Physicians should also inquire about blunt trauma in patients with documented pyogenic liver abscesses.     

Ultrasonographic features of amoebic abscess: Study in 59 patients

Sonographic examination was carried out in 59 patients with a clinical diagnosis of amoebic liver abscess during the previous 4 years (January 1982 to December 1985). The amoebic liver abscess was located in the right lobe in 45 patients, in the left lobe in eight patients, and in both lobes in six patients. The ultrasonic diagnosis was confirmed in the majority of patients by the indirect haemaglutination test (titres 1:512 or greater) coupled with excellent response to metronidazole, or by ultrasonic-guided percutaneous aspiration producing anchovy sauce pus.
The sonographic patterns of the abscess were evaluated. All patients had well-defined hypoechoic lesions near the surface, which demonstrated fine homogeneous low-level echoes throughout at a normal and a high-gain setting, without a peripheral echo-free halo. The configuration of the abscess was round, oval or lobulated. The walls were irregular in 53 patients, and showed a slight distal sonic enhancement. This ultrasonic feature is suggestive of amoebic liver abscess. The specific ultrasonographic features of amoebic liver abscess, combined with a feature of pleural effusion, pericardial effusion, or an abdominal abscess, were suggestive of the complications of liver abscess found in 19 patients.
It is concluded that ultrasonography is a valuable aid in the diagnosis of amoebic liver abscess. It is of value not only for detection, but also for determination of the site, depth, size, and location of the complicating rupture of the abscess.     

Liver Abscess in Children: A 10-year Single Centre Experience

Background/Aim:

Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries.

Materials and Methods:

The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients’ records retrospectively.

Results:

There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscesswere immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later ttaken for open drainage, with an overall mortality rate of 5.5%. Conclusion: The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.     

Isolated liver tuberculosis abscess in a patient without immunodeficiency: A case report

Although hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare. It is usually associated with foci of infection either in the lung and/or gastrointestinal tract or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. We report on a 28 year old man who developed an isolated tuberculous liver abscess not associated with lung involvement. Ultrasonography and computed tomography of the abdomen showed the abscess lesions in the liver but the diagnosis of tuberculosis was confirmed by histological examination of the wall of the abscess after surgical drainage. Although tuberculous liver abscess is very rare, it should be included in the differential diagnosis of abscess and unknown hepatic mass lesions.     

Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients

Septic metastatic endophthalmitis from Klebsiella pneumoniae liver abscess, first reported in seven cases treated at the Veterans General Hospital, Taipei, Taiwan, between 1981 and 1985, was seen in six similar cases at the same hospital in the subsequent 2 years. We conducted a retrospective search for factors that might be associated with these complications of pyogenic liver abscess. A total of 23 cases with septic metastatic lesions from pyogenic liver abscess were found between 1981 and 1987, and 164 cases of pyogenic liver abscess without septic metastatic lesions were identified as a comparison group. Klebsiella pneumoniae liver abscess, bacteremia, and the underlying diabetes mellitus were significantly more common in the study group than in the comparison group. Of the 23 patients with septic metastatic lesions, there were 14 cases (60.8%) of endophthalmitis or uveitis, 10 cases (43.4%) of pulmonary abscess and/or emboli, six cases (26.0%) of brain abscess and/or purulent meningitis, five cases (21.7%) of bacteriuria and/or prostate abscess, two cases (8.6%) of osteomyelitis and/or pyogenic arthritis, and one case (4.3%) of psoas abscess.     

Salmonella Paratyphi A liver abscess—Secondary infection of an amoebic liver abscess?

Liver abscess is a rare complication of both enteric fever and non-enteric salmonella infection. We present an unusual case of Salmonella Paratyphi A liver abscess, where secondary bacterial infection of an amoebic liver abscess was suspected.     

Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae

Klebsiella pneumoniae (KP) is the most common cause of pyogenic liver abscess in eastern Asia. KP liver abscess commonly presents as a single large abscess with a predominantly solid consistency. It is sometimes unsuitable for percutaneous catheter drainage because of the poorly liquefied contents. Antibiotic therapy alone may raise a probability of treatment failure and occurrence of complications such as abscess rupture. Hepatic or portal venous thrombosis, hematogenous spread, and spontaneous rupture also occur frequently. We report a case of KP liver abscess with a typical solid appearance, complicated by disseminated intravascular coagulation, spontaneous rupture, and pyogenic spondylitis.