Abstract
Pyogenic liver abscess (PLA) complicated by inferior vena caval (IVC) thrombosis is rare but life-threatening. We experienced a case of PLA complicated by an IVC thrombus close to the right atrium after pancreatoduodenectomy. A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years prior, and no recurrence was noted on follow-up. He was admitted to our hospital owing to fever and general fatigue. PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated. His general condition gradually improved, but a thrombus in the middle hepatic vein and IVC was noted on follow-up computed tomography on hospital day 8. Although anticoagulant therapy using heparin was started, the thrombus size increase and extended to the right atrium. Considering the risk of pulmonary embolism, we planned a surgical intervention with a cardiovascular surgeon to remove the thrombus. During surgery, we made an incision in the right atrium and removed the thrombus using extracorporeal circulation. After removal, we dissected the middle hepatic vein using an automated suturing device to prevent the thrombus from extending into the IVC. The patient was discharged 10 weeks after surgery. Eighteen months post-intervention, there was no recurrence of either PLA or thrombi. Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.
Highlights
With increasingly effective diagnostic tools and treatment modalities available, the prognosis of patients with pyogenic liver abscess (PLA) has improved
PLA can be accompanied by a number of complications, such as abscess rupture and metastatic central nervous system infections [3, 4], inferior vena caval (IVC) thrombosis is rare
A number of complications have been reported in cases of PLA, such as abscess rupture and metastatic central nervous system infections [3, 4], but vascular complications such as IVC thrombosis are rare
Summary
With increasingly effective diagnostic tools and treatment modalities available, the prognosis of patients with pyogenic liver abscess (PLA) has improved. Case details A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years earlier and did not experience recurrence on follow-up He was admitted to our hospital owing to fever and general fatigue. His vital signs on admission were as follows: consciousness, alert; heart rate, 69 beats/ min; blood pressure, 77/48 mmHg; respiratory rate, 15 breaths/min; peripheral capillary oxygen saturation, 95 % on room air; and body temperature, 36.5 °C. A contrast CT scan on hospital day 8 revealed a thrombus in the middle hepatic vein (Fig. 2). We made an incision in the right atrium and removed the thrombus through the orifice of the middle hepatic vein. 18 months after the surgery, the patient experienced no recurrence of either the liver abscess or thrombus
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