Multiple Pyogenic Liver Abscesses Research Articles

Een geriatrische patiënte met een perirectaal abces, pyleflebitis en multipele pyogene leverabcessen: een gevalsbespreking

A geriatric patient with a perirectal abscess, pylephlebitis and multiple pyogenic liver abscesses: a case-report. In this case study, an 86-year-old patient is presented with fever, anorexia and drowsiness, a very high C-reactive protein (CRP) level and elevated liver enzymes. Given the frailty of the patient, a non-invasive diagnostic approach was chosen. Initially, a pancreatic carcinoma with liver metastases was suspected, but the presence of positive blood cultures raised doubts about the initially suggested diagnosis. Ultimately, a perirectal abscess with Streptococcus intermedius bacteremia, pylephlebitis and multiple liver and pancreatic abscesses were diagnosed. After a course of 9 weeks of antibiotics, the patient's condition improved. The vague complaints in this geriatric patient and the lack of invasive diagnostics pose a challenge for the clinician in recognizing this disease.

Lactobacillus gasseri liver abscess and bacteremia: a case report

BackgroundLactobacillus is a genus of Gram-positive non-spore-forming rods usually found in the microbiota of the oral cavity, gastrointestinal tract, and female genitourinary tract. Also, they are commonly used in the food industry as supplements and probiotics. Lactobacilli are normally considered non-pathogenic to the human body, however, under certain circumstances such as immunosuppression, they can cause severe infections, with only a few cases of bacteremia, infective endocarditis, pneumonia, meningitis, and intra-abdominal infections reported. Among these presentations, a pyogenic liver abscess is rather rare.Case presentationWe describe the case of a 59-year-old man with a history of diabetes mellitus and multiple abdominal surgeries with the latest being in 2014 presenting with bacteremia and multiple large pyogenic liver abscesses due to Lactobacillus gasseri, which did not appear to be related to the use of probiotics or immunosuppression.ConclusionsGiven the high prevalence of diabetes mellitus and the increased use of probiotics, it is expected that in the future we will see an increase in infections caused by Lactobacilli. Medical management with antibiotics and percutaneous drainage were successful strategies for the treatment of this unusual case of pyogenic liver abscesses and bacteremia caused by Lactobacillus gasseri.

Therapeutic Success in Amoebic and Pyogenic Liver Abscesses

A 52 year old male patient presented with complaints of upper right abdominal pain since 1 month ago, worsening in the last 1 day. Fever has been complained of since 1 month ago, fever fluctuates indefinitely, comes down with fever-reducing drugs, complained of weakness. There is nausea and vomiting, vomiting 1-2 times per day, black vomit like coffee is not there. Complained about weight loss. BAK is like strong tea. Liquid defecation has been complained of since 5 weeks ago, initially liquid defecation was accompanied by mucus and blood with a frequency of 3-4 times per day for 3 days, at that time the patient went to the health center and complaints were reduced and now liquid CHAPTER 1-2 times a day is yellow, liquid, no mucus, no blood for the past 1 month. The patient is an agricultural instructor with his daily activities going down to the farm. History. History of diabetes mellitus denied. Patients diagnosed with multiple pyogenic liver abscess were treated at RSUDZA and received bed rest therapy, 1800 kcal / day soft food diet, IVFD NaCl 0.9% 20 drops per macro minute, metronidazole drip 500 mg every 8 hours, ciprofloxacin 2x 500 mg, intravenously paracetamol 1 gram every 8 hours. The patient was treated for 17 days, on the 10th day of hospitalization the patient was performed a laparotomy and multiple incisions of the liver abscess, purulent abscess fluid mixed with blood. The abscess fluid was cultured as a result of Entamoeba Colli, and metronidazole antibiotic therapy was continued. During treatment, the patient experienced clinical improvement, the patient was opened surgical sutures on the 10th and 15th day after laparotomy, the surgical wound improved, the patient experienced clinical improvement, currently the patient is still a control at the Internal Medicine and Surgery Department at Cut Nyak Dhien Meulaboh Hospital.

Multiple Pyogenic Liver Abscesses Due to Streptococcus intermedius

Streptococcus intermedius is part of the normal oropharyngeal, genitourinary and gastrointestinal flora, and can cause purulent infections characterized by abscess formation involving the brain and the liver tissue. In this report, multiple pyogenic liver abscesses due to S. intermedius in a 46-year-old male admitted to the emergency department with complaints of fever, cough, and weakness, […]

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

BackgroundWe experienced a rare case of benign arterial stricture of the right posterior hepatic artery (RPHA) caused by atherosclerosis in a patient with hilar cholangiocarcinoma.Case presentationA 75-year-old man was referred to our hospital for the detailed investigation of serum hepatobiliary enzyme elevation. The patient had a history of hypertension, type 2 diabetes mellitus, and an operative history of coronary artery bypass grafting 10 years before. Endoscopic retrograde cholangiography found strictures of the right and left hepatic ducts with involvement of right anterior and posterior bile ducts. Adenocarcinoma was evident by brush cytology. We diagnosed these findings as hilar cholangiocarcinoma and planned left trisectionectomy including bile duct reconstruction. Although the tumor and RPHA were not adjacent, preoperative multidetector computed tomography revealed a stricture of the RPHA that was 5.6 mm in length. We suspected that atherosclerosis caused the stricture, and we performed digital subtraction angiography and intravascular ultrasonography that showed stricture of the RPHA accompanied by thick plaques in the arterial wall. We placed a bare-metal stent in the RPHA and then performed left trisectionectomy. Since this patient developed bile leakage postoperatively, percutaneous drainage was performed. The bile leakage was successfully controlled, and the patient was discharged 3 months after surgery. Unfortunately, 4 months after hepatectomy, he was re-hospitalized with multiple pyogenic liver abscesses. We performed intensive multimodal treatment for the liver abscesses and stabilized the disease; however, we eventually lost this patient due to liver failure 14 months after surgery.ConclusionTo the best of our knowledge, there is no previous literature on atherosclerosis of the RPHA, which was evident preoperatively in our case. Because arterial complications may lead to critical biliary complications in patients who undergo left trisectionectomy, we first performed prophylactic arterial stent placement. We speculate that existing chronic microscopic injury of the peribiliary plexus might have caused the liver abscesses. We successfully diagnosed atherosclerosis of the RPHA preoperatively. However, further investigation of patients is warranted to determine if left trisectionectomy is contraindicated in these patients.

Pyogenic Liver Abscess as a Fatal Complication of Colonoscopy: a case report

Background: Colonoscopy is a safe and routinely-performed diagnostic and screening procedure for different colorectal diseases. The diagnostic and screening colonoscopy for is different for colon diseases. In order for colonoscopy, colon cleansing is required to prepare a detailed view into the intestinal lumen. Aim: This is a case report study of a patient with multiple pyogenic liver abscesses following colonoscopy (unprep). Methods: After studying hospital records of patient in GI section of Imam Reza Hospital and searching the websites, pubmed, Scopus, and Medline, we found no earlier reports of liver abscess after colonoscopy. Results: A diabetic patient suffered from fever, abdominal pain and drowsiness following unprepared full colonoscopy with biopsy. In laboratory tests leukocytosis with a shift to left and coagulopathy were reported. CT scan showed multiple pyogenic liver abscesses. The patient received broad-spectrum intravenous antibiotics and hydration, but after 96 hours, the patient did not respond to supportive treatment and died due to septic shock. Methicillin-resistant staphylococcus aureus was reported in blood culture. Conclusion: Although colonoscopy is a convenient and relatively safe diagnostic procedure, doctors should always consider rare complications of colonoscopy, especially in patients with risk factors such as diabetes mellitus, immunodeficiency and malignancies of the liver and liver transplantation. In addition, complete colonoscopy and other diagnostic procedures such as biopsy or polypectomy in patients with inadequate bowel preparation for colonoscopy should be avoided.

Multiple Pyogenic Liver Abscess

Multiple liver abscess is a life threatening condition with high mortality. We present a case of a 59 yr old gentleman who developed multiple hepatic abscesses due to an appendicular mass. He was treated with parenteral antibiotics and ultrasound guided needle aspiration of the largest abscess was done. He recovered promptly with complete resolution of the liver abscesses. The main aim of this case report is to highlight the fact that multiple pyogenic liver abscesses can be managed with antibiotic treatment and needle aspiration. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8725 Asian Journal of Medical Science, Volume-5(2) 2014: 137-139

Multiple pyogenic liver abscesses with the decline in neutrophil phagocytic function: a case report

Multiple pyogenic liver abscesses with the decline in neutrophil phagocytic function: a case report

Post-partum pyogenic abscess containing Ascaris lumbricoides

We report an unusual case of multiple pyogenic liver abscesses containing Ascariasis lumbricoides in a 35-year-old post-partum female who had delivered 1 month back. Open drainage of liver abscess along with liver worm was done. Patient did well post-operatively.

Multiple pyogenic liver abscesses formed after appendectomy: The role of percutaneous drainage in a critically ill patient

Multiple pyogenic liver abscesses formed after appendectomy and their percutaneous treatment with multiple catheters have been rarely described. We report a case of multiple pyogenic liver abscesses in a critically ill patient, formed after appendectomy and treated successfully by antibiotics and drainage with six catheters that were introduced simultaneously under ultrasound control. Even though this was a case of liver abscess secondary to appendicitis, today very rare in Western countries, but still a serious complication in developing countries, it was successfully resolved by percutaneous drainage, along with antibiotic therapy. We emphasize the advantages of percutaneous treatment compared with surgery regarding the avoidance of perioperative complications and the risks of general anesthesia.

Colopleural fistula: Case report and review of the literature

We report a 28-year-old woman, pregnant, at 24 weeks, with 3-day history of right-sided chest pain and shortness of breath. Few hours after admission, she delivered a dead baby. She had a history of right partial hepatic lobotomy and cholecystectomy at UK on May 2004 because of multiple pyogenic liver abscesses. Chest examination revealed signs of hydrothorax on the right side. Chest X-ray showed pleural effusion on the right side. Pleural fluid was exudative with high neutrophils. Gram stain and culture showed multiple organisms. CT scan chest and abdomen with contrast, combined with barium enema, revealed right colothorax communication. Colothorax fistula was closed surgically. On the following days, the patient's symptoms resolved, and she was consequently discharged.

Percutaneous Needle Aspiration of Multiple Pyogenic Abscesses of the Liver: 13-Year Single-Center Experience

The aim of this study was to report 13 years of experience in the management of multiple pyogenic liver abscesses with only percutaneous needle aspiration of the abscess cavities under sonographic guidance. From December 1991 to October 2004, 39 consecutively registered patients (29 men and 10 women; age range, 37-82 years; mean age, 64 years) with 118 pyogenic liver abscesses were treated with sonographically guided percutaneous needle aspiration at our institution. The number of pyogenic liver abscesses per patient ranged from two to 15 (mean, 3.0). Eighty-seven percutaneous needle aspirations were performed on 39 patients with 118 pyogenic liver abscesses (range, 1-4 aspirations per patient; mean, 2.2 aspirations per patient). Because they were close to another aspirated abscess in the right lobe of the liver, 31 (26.3%) of 118 abscesses were aspirated without removal of the needle from the liver. Thirty-six (92.3%) of 39 patients were treated with a single aspiration of an abscess in a single session. The other three patients needed two aspiration sessions. No patient needed imaging-guided percutaneous catheter drainage or open surgical drainage. Complete reconstitution of liver parenchyma occurred within a maximum of 80 days. No abscesses recurred during the follow-up period, which ranged from 7 to 42 months (mean, 18 months). Percutaneous needle aspiration of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure. In our experience, percutaneous needle aspiration was acceptable to patients. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery.

Multiple pyogenic liver abscess

Multiple pyogenic liver abscesses have been rarely described. We report a fatal case of multiple pyogenic liver abscesses affecting a 38-year-old woman requiring surgical drainage. Evolution was marked by occurrence of a septic shock with multi-organ system failure. The patient died 48 h after surgery. Causes, therapeutics and outcome of the disease are discussed.

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.

Giant liver abscess due to almost asymptomatic common bile duct stone

Solitary pyogenic liver abscess is usually caused by a metastatic infection through the portal blood flow or through the hepatic arterial blood flow from extra-abdominal pyogenic foci. Besides, it may be the result of local inflammatory diseases, such as cholecystitis, hydatid cyst, haematomas particularly with retained foreign bodies, etc. Suppurative cholangitis usually causes multiple pyogenic liver abscesses. Solitary pyogenic abscess is rarely caused by cholangitis, but practically always by suppurative cholangitis. Giant pyogenic liver abscess due to asymptomatic or mild cholangitis is a rarity. We present on a 63 year old man who developed a giant solitary pyogenic liver abscess in whom no other possible cause could be found or anticipated except practically almost asymptomatic choledocholithiasis accompanied with mild elevation of bilirubin content, alkaline phosphatase and gamma-GT. The patient was successfully treated operatively. Over 1800 ml. of pus was aspirated from the abscess cavity. Operative cholangiography performed in spite of the absence of gall bladder stones undilated and noninflamed common bile duct stone showed a small nonobstructing distal common bile duct stone. The duct was not dilated, the bile was clear and there were no signs of cholangitis in the inside of the common bile duct. Cholecystectomy and abscess cavity drainage led to uneventful recovery. The patient has been symptom-free for more than 3.5 years.

Single and Multiple Pyogenic Liver Abscesses: Etiology, Clinical Course, and Outcome

Background: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. Methods: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. Results: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. Conclusions: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

PYOGENIC LIVER ABSCESSES SECONDARY TO CARCINOMA OF THE SIGMOID COLON-A CASE REPORT AND REVIEW OF THE LITERATURE-

We report a case of multiple pyogenic liver abscesses. The patient was a 47-year-old woman with liver abscesses secondary to sigmoid colon cancer. The liver abscesses disappeared after antimicrobial treatment and sigmoidectomy. Histological examination of the resected specimen disclosed circumferential colon cancer and inflammatory adhesion to the bladder and the ileum with formation of small abscesses around the tumor. No evidence of ascending biliary infection, sepsis, nor diverticular disease in the colon were observed. Detailed reports of coloreetal cancer presenting with liver abscesses in the absence of hepatic metastases are extremely rarc. Clinical findings of patients reported to date in the context of literature review are discussed.

Pyogenic Liver Abscess.

The percutaneous approach-specifically, ultrasound-guided percutaneous catheter drainage-associated with intravenous administration of antibiotics is the therapy of choice in patients with single or multiple pyogenic liver abscesses. The initial empiric antibiotic therapy should be modified based on results of blood and pus cultures. Surgery should be reserved for patients in whom antibiotic therapy and percutaneous drainage is unsuccessful.

A CASE OF LEIOMYOSARCOMA OF THE DUODENUM CAUSING MULTIPLE PYOGENIC LIVER ASSCESSES

A case of leiomyosarcoma of the duodenum causing multiple pyogenic liver abscess is reported. A 55-year-old man was admitted to the hospital because of lasting fever of unknown orign. Ultrasound scan of the abdomen revealed multiple low density areas in the liver parenchyma, also seen CT scanning as multiple areas of low attenuation coefficient. And CT scanning of the abdomen depicated a duodenal hypervascular mass measuring 4.0cm in diameter. Duodenoscopy revealed a submucosal tumor with ulceration. The clinical presentation was consistent with that of liver abscess. But the possibility of the necrotic hepatic metastases could not be ruled out. Pancreatoduodenectomy was performed. Histopathologically this tumor was leiomyosarcoma arising from the descending portion of the duodenum with multiple pyogenic hepatic abscesses. It is etiologically thought that the leiomyosarcoma was associated with central necrosis which had a communication with gastrointestinal lumen to form infectious foci locally, and the infection affected the liver via portal veins to form liver abscesses.

Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment.

A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.