Diagnosis Of Liver Abscess Research Articles

Child Liver Abcess: Study of 12 Cases in the Pediatric Ward of the District Hospital of Bamako

Hepatic abscess is a suppurative collection developed in a neoformed hepatic cavity as a result of the invasion and multiplication of micro-organisms. The prognosis depends on early diagnosis and rapid treatment. The aim of the study was to determine the clinical, biological, ultrasound and therapeutic characteristics of liver abscesses in children aged between 1 month and 15 years hospitalised in the Paediatrics Ward of the District Hospital in Commune V, Bamako. This was a retrospective descriptive study which took place from January 2017 to December 2020, i.e. a period of 4 years, and a prospective study from January 2019 to December 2020, including all children aged between 1 and 15 years in whom the diagnosis of liver abscess had been confirmed by liver ultrasound. Out of 2756 children hospitalised during the study period from January 2017 to December 2020, i.e. a période of 4 years, 12 patients were diagnosed with liver abscess, i.e. a frequency of 0.43% or 4 cases/1000 admissions, with a female predominance of 58.3%, i.e. a sex ratio of 0.7. The mean age was 57 ± 34 months, with extremes of 16 and 120 months. The main reason for consultation was abdominal pain associated with fever, accounting for 75% of patients. Pus culture was positive for Staphylococcus Aureus in one patient (8%). Amebic serology was positive in 33% of patients. Ultrasound revealed a predominance of single abscesses located in the right lobe of the liver in 42% of patients. However, 92% of patients were cured, with an average hospital stay of 12 days, ranging from 2 to 19 days. Liver abscesses uncommon in our context, an early diagnosis and management can improve the prognosis.

A Nomogram Based on a Non-Invasive Method to Distinguish Between Gram-Positive and Gram-Negative Bacterial Infections of Liver Abscess.

The diagnosis of liver abscess (LA) caused by Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB) depends on ultrasonography, but it is difficult to distinguish the overlapping features. Valuable ultrasonic (US) features were extracted to distinguish GPB-LA and GNB-LA and establish the relevant prediction model. We retrospectively analyzed seven clinical features, three laboratory indicators and 11 US features of consecutive patients with LA from April 2013 to December 2023. Patients with LA were randomly divided into training group (n=262) and validation group (n=174) according to a ratio of 6:4. Univariate logistic regression and LASSO regression were used to establish prediction models. The performance of the model was evaluated using area under the curve(AUC), calibration curves, and decision curve analysis (DCA), and subsequently validated in the validation group. A total of 436 participants (median age: 55 years; range: 42-68 years; 144 women) were evaluated, including 369 participants withGNB-LA and 67 with GPB-LA, respectively. A total of 11 predictors by LASSO regression analysis, which included gender, age, the liver background, internal gas bubble, echogenic debris, wall thickening, whether the inner wall is worm-eaten, temperature, diabetes mellitus, hepatobiliary surgery and neutrophil(NEUT). The performance of the Nomogram prediction model distinguished between GNB-LA and GPB-LA was 0.80, 95% confidence interval [CI] (0.73-0.87). In the validation group, the AUC of GNB was 0.79, 95% CI (0.69-0.89). A model for predicting the risk of GPB-LA was established to help diagnose pathogenic organism of LA earlier, which could help select sensitive antibiotics before the results of drug-sensitive culture available, thereby shorten the treatment time of patients.

Case report: Diagnosis and resolution of hepatic abscess in a neonate

BACKGROUND: Hepatic abscesses in the neonatal age can be caused by multiple etiologies and their variability in clinical presentation makes their diagnosis difficult. The incidence of infectious liver abscesses is low, however, their mortality is high and their timely diagnosis and early resolution are essential to improve prognosis and life expectancy, since therapeutic management is the cause of prolonged hospitalization due to the administration of long-lasting intravenous antimicrobials. The following is a case report of a neonatal patient with this pathology. CLINICAL REPORT: neonatal patient born by cesarean section, 38 weeks of gestation, male, admitted to the neonatology department due to the need for mechanical ventilation; with umbilical catheters for 72 hours. At 48 hours of life, he presented febrile peaks and elevation of acute phase reactants, later, abdominal distension, feeding intolerance and hepatomegaly, so antibiotic therapy was administered with suspicion of septic ileus. Due to persistent hepatomegaly, an abdominal ultrasound was performed in which cystic images were observed at the hepatic level. EVOLUTION: after the diagnosis of liver abscesses, it was decided to maintain antibiotic therapy with Meropenem and Vancomycin. Due to persistence of the abscesses despite treatment, surgical drainage was required on two occasions, the first at day 30 of life, and the second at 47 days of life. The newborn received, from the onset of symptoms and clinical symptoms, a total of 60 days of Meropenem and 48 days of Vancomycin, with complete resolution of the lesions after 68 days of hospitalization. CONCLUSION: Hepatic abscesses are rare in the neonatal age, of bacterial origin in most cases, related to hematic propagation due to umbilical catheterization. The pathology involves long hospitalizations and long-term antibiotic therapy; however, its prognosis is good with early diagnosis and timely treatment.

A typical multisite invasive infection caused by hvKP: A case report and literature review

Hypervirulent K. pneumoniae (hvKP) is a new variant of K. pneumoniae that can caused metastatic spreading by blood, including Splenic abscess, endogenous endophthalmitis, purulent meningitis. This report described a case of A typical multisite invasive infection caused by hvKP and carry out a historical review of the literature. A 55-year-old man was referred to our hospital due to liver abscess. Diabetes was found during this hospitalization. Because of glycemic was uncontrolled, splenic abscess, endogenous endophthalmitis and purulent meningitis occurred during subsequent treatment. We made s diagnosis of liver abscess and invasive K. pneumoniae liver abscess syndrome through generation sequencing and imaging features. The patient recovered and was subsequently discharged after mechanical ventilation, continuous renal replacement therapy, laparoscopic exploration and various antimicrobials. HvKP are very aggressive and can disseminate to multiple sites, especially in patient who have diabetes, which is a treatment challenge for clinician.

Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Background and study aimsA full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention. Patients and methods11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed. ResultsThe incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes. ConclusionPTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE.

Liver abscess in children - Clinical profile and outcome in a resource-limited setting.

Liver abscess continues to be a major cause of morbidity in developing countries. There is no gold standard for management; it has to be tailor made for each child depending on availability of resources. We aimed to study clinical features, laboratory parameters, treatment, and outcome of children with liver abscess in resource-limited settings. This is a retrospective observational cohort study of children less than 16 years admitted in pediatric ward with diagnosis of liver abscess during 4 years duration (2016-2019). Demographic data, clinical features, laboratory, ultrasonographic (USG) and microbiological findings, management, and outcome were documented. For descriptive analysis, mean ± standard deviation/median with interquartile range, percentages were used and for testing association, Chi-square test and independent t-test were used. P value <0.05 was considered significant. The mean age of children was 8.4 ± 4.4 years (19- 7 male and 11 female). Fever with chills was the most common symptom (19, 100%), followed by right upper quadrant pain (18, 89.5%), vomiting (7, 36.8%), and pleural effusion (6, 31.6%). Of the 19 children, 26.3% (5) were moderately undernourished and 63.2% (12) severely undernourished. Among the laboratory parameters, leukocytosis (16, 84.2%), anemia (19, 100%), and raised C Reactive protein (CRP) (19, 100%) were seen. Liver abscess on USG was solitary in 14 (73.7%), multiple in five (26.3%), in the right lobe in 14 (73.7%), and left in five (26.3%) with average volume of 104.5 ± 79.2 cc. Blood culture was positive in 22.2% (4/19) with growth of Staphylococcus in 10.4% (2), Pseudomonas in 5.2% (1), and Escherichia coli in 5.2% (1). Pus culture was positive in one (1/8, 12.5%) showing Pseudomonas. Half (9/19) of children were managed on only antibiotics and the other half (10/19) were managed by USG-guided aspiration on two to three occasions along with antibiotics successfully with no mortality. High index of suspicion in children with fever, right upper abdomen pain, positive CRP, and anemia should prompt an urgent USG. Liver abscess can be successfully managed by intravenous antibiotics and USG-guided aspiration in larger abscess, with no mortality. However, in case of signs of impending perforation, surgical management should be considered.

CLINICAL, BIOCHEMICAL, AND IMAGE CHARACTERISTICS IN PATIENTS WITH A DIAGNOSIS OF AMEBIC AND BACTERIAL LIVER ABSCESS.

A hepatic abscess (HA) accumulates purulent material in the liver parenchyma and can be of bacterial, parasitic, fungal, or mixed origin. The incidence ranges from 2.3 to 22 per 100,000 people. In Mexico, the annual incidence of amoebic liver abscess is 6.7 per 100,000 population. To determine the clinical, biochemical, and imaging characteristics in patients diagnosed with amoebic and bacterial liver abscess. Research design: Descriptive, cross-sectional/prevalence. We analyzed medical records of patients admitted during 2019 with a diagnosis of liver abscess and who had an amoeba PCR test. The qualitative variables were expressed in frequencies and percentages; the numerical variables were mean and standard deviation. We use X2, Fisher's exact, Student's t, and Mann-Whitney U to compare groups as appropriate. Of a total of 32 patients admitted with a liver abscess in Gastroenterology during 2019, 20 patients treated with drainage and PCR test for amoeba of the abscess fluid were included. Of these, 85%(17) were men with a mean age of 45.35±10.93 years, and 55%(11) were of bacterial etiology. Regarding the characteristics due to their etiology (amoebic vs. bacterial): 30%(6) were presented in segments VII and VIII; [33.3%(2/6) amoebic vs. 66.7%(4/6) bacterial]. According to the number, they were multiple; 28.6%(2/7) amoebic vs 71.4%(5/7) bacterial, unique; 53.8%(7/13) amoebic vs 46.2%(6/13) bacterial, without significant difference (p = 0.37). 60%(12) presented with pleural effusion, and of these, 58.3%(7) were amoebic. 100% were drained, of which 50% were by catheter with a diameter of 14Fr. Regarding the laboratory studies: 80%(16) of those with amoebic etiology had cultures of the abscess fluid without development, the leukocytes were 18.65 ± 6.55mm3 with a range of 16.5 in the amoebians vs. 14.58±6.51mm3 with a range of 17.6 in bacteria, Hb of 12.10±1.93 gr/dl in amoebians vs. 12.18 ± 1.72 gr/dl in bacteria and with procalcitonin of 18.06±12.77 gr/dl in amoebic vs. 19.98±59.76 gr/dl in bacterial. According to the imaging studies: the USG diameter was 10.67±2.78cm in amoebians vs. 10.53±4.91cm in bacteria and with a volume of 375.08±263.95 with a range of 782.0cm3 in amebic vs. 441.80±393.90 with a range of 1362.1cm3 in bacterial. Common etiologic agents for HA are E. histolytica (amoebic), bacterial (pyogenic), Mycobacterium tuberculosis, and various fungi. They tend to affect the younger population, especially men with immunosuppression, diabetes, and alcohol consumption. In developing countries, two-thirds are of amoebic origin and in need of puncture drainage. Our study observed that half had amoebic etiology corroborated by amoeba PCR, the majority unique, and almost all required drainage with diameters greater than 5cm by USG. In the present work, we can show that half of the patients diagnosed with a liver abscess in the Gastroenterology Service are of amoebic origin and have similar characteristics to those described in the international bibliography. The authors declare that there is no conflict of interest.

Role of Pigtail Catheter Drainage Versus Percutaneous Needle Aspiration in the Management of Liver Abscess: A Retrospective Analysis.

IntroductionA liver abscess is an important health concern in tropical countries. Effective management of liver abscesses includes appropriate antibiotics and drainage of the abscess cavity. Percutaneous abscess drainage by pigtail catheterization is now gaining popularity. We analyzed the role of pigtail catheter drainage over percutaneous aspiration in the treatment of liver abscesses.Methods and materialThis was a retrospective analytical study conducted in a tertiary care center in western India. Patients of age ≥ 18 years admitted with the diagnosis of liver abscess were included in this study. To find the effectiveness of different treatment modalities, data were analyzed in three groups: Group A (Conservative treatment), Group B (Percutaneous needle aspiration), and Group C (Pigtail catheter drainage).ResultsA total of 64 patients with a liver abscess were analyzed. There was male predominance (93.75%). Mean abscess volume in Group C (307.9 ± 212.8 ml) was significantly higher when compared to Group A (130.8 ± 72.9 ml, p = 0.03) and Group B (177.2 ± 129.5; p = 0.024). The duration of hospital stay and residual abscess volume at the time of discharge did not show a statistically significant difference between treatment groups. Pigtail catheterization of abscesses with volume >150 ml shortened the hospital stay, whereas it prolonged the hospital stay in patients with abscess volume <150 ml.ConclusionPercutaneous pigtail catheterization would be an operative decision for the management of liver abscess. We concluded that the use of pigtail catheterization of patients with abscess volume > 150 ml improved the clinical outcome.

English

BACKGROUND Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. Diagnosis of liver abscess can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Children have unique set of predisposing causes for liver abscesses. The purpose of this study was to assess the clinical, demographic, and etiological profile of liver abscess in children between 1 month to 12 years of age. METHODS This is a prospective observational study conducted in the Department of Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt. of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi), Delhi from July 2016 to August 2017. All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children aged less than 7 years. Informed assent was taken from children aged more than 7 years, along with written and informed consent from their parents/guardians. Their clinical characteristics, radiological features and laboratory data were analysed. RESULTS Most common age group suffering from liver abscess was 5 - 10 years with male preponderance. Majority of the children belonged to lower socio-economic class and half of them were suffering from malnutrition. Most common clinical presentation of children suffering from liver abscess was fever with pain abdomen and tender hepatomegaly. Majority of the children had leucocytosis, high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Deranged liver function test with coagulopathy was noted in more than half of the children suffering from liver abscess. Commonest bacterial pathogen was methicillin resistant Staphylococcus aureus followed by Salmonella typhi, Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent causing liver abscess in children. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Most cases involve a single lesion on right lobe of the liver. Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the two most common pathogens. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children

Anterior abdominal wall abscess secondary to spontaneous rupture of liver abscess in a resource-limited, rural, surgical setting: A case report

Liver abscess continues to be a major surgical burden in low-and mid-low-income countries like India. Spontaneous rupture into the anterior abdominal wall is an uncommon presentation of pyogenic liver abscess. A 53-year-old diabetic female presented with acute pain in the right, upper quadrant of the abdomen. On examination, she had an anterior abdominal wall abscess with tender hepatomegaly. On further evaluation with ultrasonography and plain computed tomography, a diagnosis of liver abscess in the right lobe with rupture into the anterior abdominal wall was made. She was treated successfully in a tribal secondary care hospital with an ultrasound-guided aspiration followed by surgical drainage under local anesthesia. This case report highlights that a considerable number of patients with liver abscess and its complications can be appropriately managed in resource-limited, rural, surgical centers.

Liver Abscess Caused by Fusobacterium nucleatum: A Case Report

Introduction: Pyogenic liver abscess (PLA) is a serious infectious disease of the liver. Pyogenic liver abscess caused by Fusobacterium nucleatum is extremely rare. Here we report the first case of liver abscess caused by F. nucleatum in China. Case Presentation: The case was a 34-year-old female patient admitted to the hospital due to high fever. The diagnosis of liver abscess was confirmed by imaging studies and liver puncture. We finally confirmed the pathogen as F. nucleatum by next-generation sequencing (NGS). After the targeted anti-infective treatment, the patient recovered and discharged. Conclusions: As a new microbial detection method, NGS can still help in clinical practice. In addition, to improve the positive rate of anaerobic bacteria culture, we should pay attention to avoid contact with air in the process of specimen collection when the pathogenic bacteria are suspected to be anaerobic bacteria.

Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

BackgroundThere is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes.MethodsWe retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period.ResultsAmongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation.ConclusionsALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

Is the Use of Proton Pump Inhibitors a Predisposing Factor for Pyogenic Liver Abscesses?

BackgroundProton pump inhibitors (PPIs) increase gastric pH by reducing acid production. The resulting alkaline milieu in the stomach increases the risk of bacterial translocation. This study aimed to investigate if there is a correlation between PPI use and developing pyogenic liver abscesses.MethodsIn this retrospective case-control analysis, we studied adult patients diagnosed with cryptogenic liver abscess at Northwell hospitals between 2015 and 2019. Adult patients with the diagnosis of liver abscess were included. We excluded patients with history of liver abscess prior to admission, biliary disease, hepatobiliary malignancy, or intra-abdominal infections. A group of randomly selected patients without liver abscess from the same hospitals’ database were enrolled as the control group. A multivariate logistic regression analysis was performed to adjust for potential confounding factors.ResultsWe identified 277 patients diagnosed with first episode of pyogenic liver abscess. Cases were compared to 554 controls. Klebsiella pneumonia was the most common pathogen. PPI use was associated with an increased risk of developing a first episode of pyogenic liver abscess in univariate (odds ratio (OR): 2.36, 95% confidence interval (CI): 1.70 - 3.27), and multivariate analysis (adjusted OR: 2.27, 95% CI: 1.55 - 3.32).ConclusionThis study is the first US population-based analysis to demonstrate that PPI use is associated with increased risk of developing pyogenic liver abscesses. Further prospective studies are needed to shed more light on this association and better evaluate the impact of dose and duration of PPI exposure.

Assessment of outcome and complications of ultrasonography guided pigtail catheter drainage in management of liver abscess

Background: Liver abscess (LA) is defined as an encapsulated collection of suppurative material within the liver parenchyma. Liver abscesses are most commonly due to bacterial, amoebic or mixed infections. Less commonly these may be fungal in origin. Liver abscess are associated with mortality of up to 20% and are categorized into various types based on aetiology, of which amoebic (ALA) and pyogenic (PLA) liver abscess are major types. The objective is to evaluate and assess the response of percutaneous pigtail catheter drainage in treatment of liver abscess and to document the complications of liver abscess (LA).Methods: The study was conducted on patients who were admitted from casualty and outpatient department with a diagnosis of liver abscess (LA). 100 patients of LA were included in the study. They were divided into two groups. Group 1 consists of LA patients without associated complications and Group 2 consists of LA patients with associated complications like rupture, jaundice, IVC compression, persistent or recurrent LA.Results: There were 88% males and 12% were females in the study. 30% patients had complications. Out of them, 14 (46.6%) patients of LA presented with intra-peritoneal rupture. 12 (40%) with jaundice, 2 (6.7%) with rupture into pleural cavity and 2 (6.7%) patients had IVC compression. (70%) had involvement of right lobe while minimum patients (12.9%) had bilateral lobe involvement in group 1 and (10%) had involvement of left lobe of liver in group 2.Conclusions: Pigtail insertion and percutaneous catheter drainage (PCD) of abscesses, peritoneal or pleural cavity are safe procedures. PCD is a good alternative to open surgical drainage.

Poor Outcome and Prolonged Hospital Stay after the Diagnosis of Liver Abscesses in Hospitalized Cancer Patients: A Single Center Experience

Poor Outcome and Prolonged Hospital Stay after the Diagnosis of Liver Abscesses in Hospitalized Cancer Patients: A Single Center Experience

Is There a Difference in Etiology in the Liver Abscesses in South India?: A Clinical and Microbiological Study

Background: Liver abscesses in India are considered to be amoebic in origin. Studies for determining causative organism of liver abscesses in Southern India are limited in number. The present study was conducted to determine the etiology of these abscesses in the Chennai region. Methods: Twenty-three patients with a diagnosis of liver abscess were prospectively studied with full blood profile. Ultrasound-guided pus was aspirated and sent for culture. Amoebic serology was performed. The abscesses were classified as pyogenic, amoebic and indeterminate. Results: Sixteen patients (69.6%) were diagnosed as pyogenic, three (13%) as amoebic and four (17.4%) as indeterminate. Fifteen (5.2%) abscesses were single and 12 (52.3%) affected the right lobe. Escherichia coli (42.85%) and Staphylococcus aureus (35.71%) remained the most common causative organisms grown on pyogenic culture. Conclusion: In this study of a small group of patients from South India, liver abscesses were found to be predominantly single and pyogenic in origin with an equal propensity of gram-positive and gram-negative organisms.

2107 A Case of Crohn’s Disease Complicated With Liver Abscess, Enterohepatic and Enterocutaneous Fistulas

INTRODUCTION: Crohn’s disease (CD) is a chronic inflammatory disease which can affect any part of the gastrointestinal tract. Liver abscesses and fistulas between a solid organ and intestine are rare. Here we present a unique case report of a CD patient who developed liver abscesses complicated by enterohepatic and enterocutaneous fistula. CASE DESCRIPTION/METHODS: 48-year-old male with a longstanding history of CD presented with abdominal pain. A CT of the abdomen revealed multifocal hepatic abscesses (Figure 1). The abscesses were initially percutaneously drained and antibiotics were administered. Five weeks following discharge he presented with complains of worsened abdominal pain. He had developed a foul smelling pus-draining wound at site of the drainage. A repeated CT abdomen revealed persistent hepatic abscess with small bubbles of free air adjacent to the inferior hepatic edge with a thin enhancing tract suggesting an early enterohepatic fistula (Figure 2) and an enterocutaneous fistula in the lateral abdominal wall between the bowel and the skin (Figure 3). He underwent a right hemicolectomy with drainage of the hepatic abscesses and repair of the enterocutaneous and enterohepatic fistula. The biopsies from the ileo-cecal region showed extensive ulceration with underling transmural inflammation of mucosa and extensive active inflammation of visceral serosa with reactive fibrosis, suggestive of severe CD. His postoperative recovery was uneventful. Routine colonoscopy evaluation of the ileo-colonic anastomosis two months later showed erythema and inflammation at the anastomosis site with granular inflammation throughout the colon (Figure 4). He is currently doing well on Infliximab and has not reported further complications. DISCUSSION: Liver abscess and solid organ to intestinal fistulas are rare complications of CD. The incidence of liver abscess is higher in patients with CD compared with the general population. The diagnosis of liver abscesses is frequently delayed as patients present similar to a CD exacerbation. Unlike the patient in this report, intestinal symptoms may be absent leaving little to no evidence to suggest the presence of a liver abscess on clinical presentation. Imaging including CT scans and ultrasound help to facilitate the diagnosis of this rare condition. In this case, we have shown that surgical intervention, antibiotics and immunotherapy can help with successful outcomes in cases of liver abscesses, enterohepatic and enterocutaneous fistulas.

Clinicopathological study and management of liver abscess in tertiary care center

Background: Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies.Methods: During the period of the month from August 2017 to August 2018, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of SMIMER Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess.Results: Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate).Conclusions: Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.

Liver Abscesses in Cancer Patients Associated with Poor Prognosis: A Single Center Experience

Background: Liver abscesses are uncommon, but they are associated with a hospital mortality rate of 10% in patients without cancer. However, its relevance in cancer patients in terms of survival and length of hospitalization is unknown. Patients and Methods: We conducted an observational study in order to analyze the impact of liver abscesses in hospitalized cancer patients. Eligible patients were adults with a solid tumor, received antineoplastic treatment and were hospitalized in our department with a diagnosis of liver abscesses. Primary end-points of the study were overall survival (OS) and mean hospital stay (MHS). Secondary end-points were the description of risk factors of liver abscesses, isolated microorganisms and the specific treatment. Results: In our study the incidence of liver abscesses in cancer patients was 1.18%. Median age was 63 years, 60% were men, and the vast majority of patients had an advanced bilio-pancreatic tumor (85%). With a median follow-up of 18 months, median OS was 6 months (95% CI: 1-11); and OS probability at 18-month was 19%. MHS was 27.2 days (95% CI: 20.3-40.7). Risk factors for developing liver abscesses were: a) bilio-pancreatic cancers; b) chemotherapy administration; c) severe malnutrition; and d) biliary drainage/prosthesis. Ten patients (50%) had bacteremia, and the most common isolated microorganism was E.coli (30%). Percutaneous drainage of abscesses was performed in 40% of the patients, and all patients were treated with broad-spectrum antibiotics. Conclusions: Although liver abscesses were uncommon, they were associated with a prolonged hospitalization and poor outcome in cancer patients.

Entamoeba histolytica Calreticulin Induces the Expression of Cytokines in Peripheral Blood Mononuclear Cells Isolated From Patients With Amebic Liver Abscess.

Calreticulin (CRT) is a highly conserved protein in the endoplasmic reticulum that plays important roles in the regulation of key cellular functions. Little is known about the participation of E. histolytica CRT (EhCRT) in the processes of pathogenicity or in the modulation of the host immune response. The aim of this study was to evaluate the role of CRT in the proliferation and the cytokine profile in peripheral blood mononuclear cells (PBMCs) from patients with amebic liver abscess (ALA) during the acute phase (AP-ALA) of the disease compared to patients during the resolution phase (R-ALA). The PBMCs from each participant were cocultured with EhCRT and tested by the colorimetric method to evaluate their proliferation index (PI). The supernatants were subjected to an enzyme-linked immunosorbent assay (ELISA) to evaluate the concentration of cytokines. The mean values of all groups were compared using the independent t-test. When the PIs of individuals without diagnosis of liver abscess (NEG) were compared, there were no statistically significant differences in the proliferation of PBMCs between patients with AP-ALA and R-ALA when stimulated with EhCRT or concanavalin A (ConA). However, the levels of interleukins [IL-6, IL-10, granulocyte colony stimulating factor (GCSF), and transforming growth factor β1 (TGFβ1)] were higher in patients with AP-ALA, whereas in patients with R-ALA, higher levels of interferon gamma (IFNγ) were detected. These results suggest that EhCRT acts as a mitogen very similar to the activity of ConA. In addition, EhCRT is an excellent immunogen for the specific activation of PBMCs, inducing the differential expression of ILs depending on the outcome of disease, determining the type of immune response: a Th2 cytokine profile during the acute phase and a Th1 profile during the resolution phase.