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Arya R, Kumar R, Priyadarshi RN, Narayan R, Anand U. Vascular complications of liver abscess: A literature review. World J Meta-Anal 2024; 12:94519. [DOI: 10.13105/wjma.v12.i3.94519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/23/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation. While pyogenic liver abscesses account for the majority of liver abscesses in the Western world, amebic liver abscesses are more prevalent in tropical and developing nations. Most liver abscesses heal without complications. However, various vascular complications can occur in these patients, including compression of the inferior vena cava, thrombosis of the portal vein and/or hepatic veins, hepatic artery pseudoaneurysm, direct rupture into major vessels or the pericardium, and biliovascular fistula. These complications can present significant clinical challenges due to the potential for haemorrhage, ischemia, and systemic embolism, thereby increasing the risk of morbidity and mortality. Mechanical compression, flow stasis, inflammation, endothelial injury, and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess. For the diagnosis, thorough assessment, and therapeutic planning of vascular complications, more sophisticated imaging techniques such as multidetector computed tomography angiography or magnetic resonance angiography may be necessary. Although most vascular complications resolve with abscess treatment alone, additional interventions may be required based on the nature, severity, and course of the complications. This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses, offering insights into their pathogenesis, diagnosis, and management strategies.
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Affiliation(s)
- Rahul Arya
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Rajeev N Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Ruchika Narayan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
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Kumar R, Patel R, Priyadarshi RN, Narayan R, Maji T, Anand U, Soni JR. Amebic liver abscess: An update. World J Hepatol 2024; 16:316-330. [PMID: 38577528 PMCID: PMC10989314 DOI: 10.4254/wjh.v16.i3.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.
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Affiliation(s)
- Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
| | - Rishabh Patel
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | | | - Ruchika Narayan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, India
| | - Tanmoy Maji
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Jinit R Soni
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
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Usuda D, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Takano H, Shimozawa S, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. Amebic liver abscess by Entamoeba histolytica. World J Clin Cases 2022; 10:13157-13166. [PMID: 36683647 PMCID: PMC9851013 DOI: 10.12998/wjcc.v10.i36.13157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
Amebic liver abscesses (ALAs) are the most commonly encountered extraintestinal manifestation of human invasive amebiasis, which results from Entamoeba histolytica (E. histolytica) spreading extraintestinally. Amebiasis can be complicated by liver abscess in 9% of cases, and ALAs led to almost 50000 fatalities worldwide in 2010. Although there have been fewer and fewer cases in the past several years, ALAs remain an important public health problem in endemic areas. E. histolytica causes both amebic colitis and liver abscess by breaching the host’s innate defenses and invading the intestinal mucosa. Trophozoites often enter the circulatory system, where they are filtered in the liver and produce abscesses, and develop into severe invasive diseases such as ALAs. The clinical presentation can appear to be colitis, including upper-right abdominal pain accompanied by a fever in ALA cases. Proper diagnosis requires nonspecific liver imaging as well as detecting anti-E. histolytica antibodies; however, these antibodies cannot be used to distinguish between a previous infection and an acute infection. Therefore, diagnostics primarily aim to use PCR or enzyme-linked immunosorbent assay to detect E. histolytica. ALAs can be treated medically, and percutaneous catheter drainage is only necessary in approximately 15% of cases. The indicated treatment is to administer an amebicidal drug (such as tinidazole or metronidazole) and paromomycin or other luminal cysticidal agent for clinical disease. Prognosis is good with almost universal recovery. Establishing which diagnostic methods are most efficacious will necessitate further analysis of similar clinical cases.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hayabusa Takano
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
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Priyadarshi RN, Kumar R, Anand U. Amebic liver abscess: Clinico-radiological findings and interventional management. World J Radiol 2022; 14:272-285. [PMID: 36160830 PMCID: PMC9453321 DOI: 10.4329/wjr.v14.i8.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 02/08/2023] Open
Abstract
In its classic form, amebic liver abscess (ALA) is a mild disease, which responds dramatically to antibiotics and rarely requires drainage. However, the two other forms of the disease, i.e., acute aggressive and chronic indolent usually require drainage. These forms of ALA are frequently reported in endemic areas. The acute aggressive disease is particularly associated with serious complications, such as ruptures, secondary infections, and biliary communications. Laboratory parameters are deranged, with signs of organ failure often present. This form of disease is also associated with a high mortality rate, and early drainage is often required to control the disease severity. In the chronic form, the disease is characterized by low-grade symptoms, mainly pain in the right upper quadrant. Ultrasound and computed tomography (CT) play an important role not only in the diagnosis but also in the assessment of disease severity and identification of the associated complications. Recently, it has been shown that CT imaging morphology can be classified into three patterns, which seem to correlate with the clinical subtypes. Each pattern depicts its own set of distinctive imaging features. In this review, we briefly outline the clinical and imaging features of the three distinct forms of ALA, and discuss the role of percutaneous drainage in the management of ALA.
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Affiliation(s)
- Rajeev Nayan Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
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Silvestri V, Ngasala B. Hepatic aneurysm in patients with amoebic liver abscess. A review of cases in literature. Travel Med Infect Dis 2022; 46:102274. [DOI: 10.1016/j.tmaid.2022.102274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/31/2022]
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Priyadarshi RN, Kumar P, Kumar R, Anand U, Shyama. Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications. Abdom Radiol (NY) 2020; 45:652-660. [PMID: 31955219 DOI: 10.1007/s00261-020-02409-6.[epub] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT. METHOD MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. RESULT The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT. CONCLUSION Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.
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Affiliation(s)
| | - Prem Kumar
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Utpal Anand
- Department of G.I. Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shyama
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Priyadarshi RN, Kumar P, Kumar R, Anand U. Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications. Abdom Radiol (NY) 2020; 45:652-660. [PMID: 31955219 DOI: 10.1007/s00261-020-02409-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT. METHOD MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. RESULT The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT. CONCLUSION Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.
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Affiliation(s)
| | - Prem Kumar
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Utpal Anand
- Department of G.I. Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
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Ohara H, Ishibashi Y, Yoshimura S, Yamazaki R, Hatao F, Koshiishi T, Morita Y, Imamura K. Intratumoral pseudoaneurysm within a liver metastasis of gastric cancer: a case report. Surg Case Rep 2020; 6:39. [PMID: 32072324 PMCID: PMC7028880 DOI: 10.1186/s40792-020-00806-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intrahepatic artery pseudoaneurysms are mostly iatrogenic and result from hepatobiliary interventions. The incidence of intrahepatic artery pseudoaneurysms within liver tumors without prior intervention is extremely rare. We presented herein the first report of a case of an intratumoral pseudoaneurysm within a liver metastasis of gastric cancer without any prior intervention during chemotherapy. CASE PRESENTATION A 59-year-old male patient underwent a distal gastrectomy and D2 lymph node dissection for gastric cancer. He was treated in the emergency room for right abdominal pain following the 4th cycle of nivolumab administration as second-line chemotherapy after adjuvant chemotherapy with S-1 and first-line chemotherapy for a liver metastasis of gastric cancer with ramucirumab plus paclitaxel. CT showed a 72-mm metastatic liver tumor containing a 9-mm pseudoaneurysm and fluid collection around the hepatic edge. Intrahepatic artery pseudoaneurysm within the metastatic liver tumor was diagnosed, with the surrounding fluid indicating potential, active bleeding. An emergency angiography confirmed the presence of a pseudoaneurysm in the intrahepatic artery, which was embolized using microcoils. The contributory causes of the intratumoral pseudoaneurysm were assumed to be the following: (1) tumor necrosis leading to encasement, erosion of the vessel wall, and subsequent arterial wall weakening; and (2) inhibition of vascular endothelial growth by ramucirumab resulting in a vessel wall breach and pseudoaneurysm formation. CONCLUSION It is necessary to recognize that pseudoaneurysms can arise within a metastatic liver tumor during chemotherapy.
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Affiliation(s)
- Hiroki Ohara
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan.
| | - Shuntaro Yoshimura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Ryoto Yamazaki
- Department of Surgery, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya-ku, Tokyo, 156-0057, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Takeshi Koshiishi
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
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