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Palumbo VD, Di Trapani B, Bruno A, Feo M, Molinelli B, Tomasini S, Lo Monte AI, Messina M, Tomasello G. Recurrent retroperitoneal abscess after biliary tract surgery in an elderly patient: a minimally invasive nonsurgical approach and its consequences: a case report. J Med Case Rep 2019; 13:43. [PMID: 30798788 PMCID: PMC6388486 DOI: 10.1186/s13256-019-1973-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Hepatic abscess can be defined as an encapsulated collection of suppurative material within the liver parenchyma. Hepatic abscess can be distinguished as pyogenic, amebic, or fungal. Biliary tract disease remains the most common cause of hepatic abscess today, and the most common complications range from pleural effusion, empyema, and bronchohepatic fistula to subphrenic abscess and rupture into the peritoneal cavity, stomach, colon, vena cava, or kidney. A large abscess compressing the inferior vena cava and the hepatic veins may result in Budd-Chiari syndrome. In this report, we present a rare case of hepatic abscess with an unusual evolution that was treated with a noninvasive approach. Case presentation A 79-year-old Caucasian woman underwent endoscopic bile stone extraction and laparoscopic cholecystectomy. Six months later, a hepatic abscess in association with bilateral effusion was diagnosed. The prompt imaging-guided drainage solved the case. Three years later, she came to our attention complaining of dull, diffuse abdominal pain and high body temperature (38 °C). A retroperitoneal abscess was diagnosed that was spreading to the right lateral wall of the abdomen and extending across the muscular wall to the subcutaneous layer. The fluid collection also involved the right pleural cavity, forming an empyema. Also in this case, an imaging-guided drainage was performed, and the patient’s clinical picture resolved in a few days. The retroperitoneal abscess recurred 14 months later, and it was dealt with using the same treatment. Three months from the last follow-up, the patient came back to our attention with an evident swelling of her right lumbar region. Computed tomography revealed a right inferior lumbar hernia comprising adipose tissue and the right kidney. A surgical intervention was recommended to the patient, but, owing to her poor general health, she refused any invasive approach. Conclusions Retroperitoneal abscess is an uncommon complication of biliary tract surgery and represents a potential cause of death, especially in those patients with multiple diseases. Prompt drainage is crucial to the treatment. Failure in eliminating the primary infective focus could bring complications and, in general, a weakness of lumbar muscular wall, even resulting in a rare case of lumbar hernia.
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Affiliation(s)
- Vincenzo Davide Palumbo
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy. .,Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | - Benedetto Di Trapani
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy.,Casa di Cura Torina, Palermo, Italy
| | - Antonio Bruno
- Department of Diagnostic and Preventive Medicine, University of Bologna, Sant'Orsola, Malpighi Hospital, Bologna, Italy
| | | | | | | | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | | | - Giovanni Tomasello
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Via Emerico Amari, 123, 90139, Palermo, Italy.,Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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Son DJ, Hong JY, Kim KH, Jeong YH, Myung DS, Cho SB, Lee WS, Kang YJ, Kim JW, Joo YE. Liver abscess caused by Clostridium haemolyticum infection after transarterial chemoembolization for hepatocellular carcinoma: A case report. Medicine (Baltimore) 2018; 97:e0688. [PMID: 29742715 PMCID: PMC5959397 DOI: 10.1097/md.0000000000010688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Liver abscesses caused by Clostridium species infection are extremely rare. PATIENT CONCERNS The authors report the first case of a liver abscess due to Clostridium haemolyticum, which occurred after transarterial chemoembolization (TACE) for hepatocellular carcinoma, in a 76-year-old woman who presented with right upper quadrant pain and fever. DIAGNOSES Computed tomography of the abdomen after the second TACE showed an air-filled abscess around a compact, lipiodolized lesion in the right hepatic lobe. Pus culture showed the growth of C haemolyticum. INTERVENTIONS Broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole, were administered, and a percutaneous 10-French pigtail catheter for pus drainage and culture was inserted in the liver abscess. OUTCOMES Despite administering intensive treatments, she presented with rapid deterioration in mental status, liver function, and infection markers. She was transferred to the local hospital for palliative conservative treatment. LESSONS Clostridia infections, including those involving C haemolyticum, are extremely rare, but should be considered as one of the causative organisms of liver abscess formation after TACE because of its rapid and fatal clinical course.
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Affiliation(s)
- Dong-Jun Son
- Department of Internal Medicine, Chonnam National University Medical School
| | - Ji-Yun Hong
- Department of Internal Medicine, Chonnam National University Medical School
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Young-Hoon Jeong
- Department of Internal Medicine, Chonnam National University Medical School
| | - Dae-Seong Myung
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Medical School
| | - Yang-Jun Kang
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School
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Mavilia MG, Molina M, Wu GY. The Evolving Nature of Hepatic Abscess: A Review. J Clin Transl Hepatol 2016; 4:158-68. [PMID: 27350946 PMCID: PMC4913073 DOI: 10.14218/jcth.2016.00004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 12/19/2022] Open
Abstract
Hepatic abscess (HA) remains a serious and often difficult to diagnose problem. HAs can be divided into three main categories based on the underlying conditions: infectious, malignant, and iatrogenic. Infectious abscesses include those secondary to direct extension from local infection, systemic bacteremia, and intra-abdominal infections that seed the portal system. However, over the years, the etiologies and risks factors for HA have continued to evolve. Prompt recognition is important for instituting effective management and obtaining good outcomes.
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Affiliation(s)
- Marianna G. Mavilia
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA
- *Correspondence to: Marianna G. Mavilia, University of New England College of Osteopathic Medicine, 11 Hills Beach Road, Biddeford, ME 04005, USA. Tel: +1-617-435-1185, Fax: +1-860-679-6582,
| | - Marco Molina
- Department of Radiology, UCONN Health, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, UCONN Health, Farmington, CT, USA
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