Hepatic abscess as a complication of the sump syndrome

Abstract

We report a case of hepatic abscess associated with the sump syndrome. The patient was a 66-year-old woman who had undergone cholecystectomy and side-to-side choledochoduodenostomy for a common bile duct (CBD) stone in 1983, and who presented with fever and right lower chest pain. A hepatic abscess was diagnosed; after it was drained, percutaneous transhepatic biliary drainage was performed. Bacteriological studies revealed the presence of Bacteroides fragilis and Streptococcus intermedius in the pus in the hepatic abscess cavity, and Klebsiella pneumoniae and Pseudomonas aeruginosa in the bile. The hepatic abscess and cholangitis rapidly resolved in response to two drainage procedures. At surgery, simple closure of the anastomosis was performed, because free drainage was observed from the distal CBD into the duodenum, despite the existence of a periampullary diverticulum.

Pneumoperitoneum caused by ruptured gas-containing liver abscess

“…Gastrointestinal and biliary tract diseases have replaced infections through the portal vein and biliary tract as the most common etiologic sources of pyogenic liver abscess. [1][2][3][4][5] Nevertheless, in our patient, the computed tomography findings did not show Abstract An 84-year-old woman was admitted to our hospital with high fever, and she suddenly complained of severe abdominal pain the next day. Computed tomography revealed a gascontaining abscess in the lateral segment of the liver, with spontaneous pneumoperitoneum.…”

“…Most such cases reported to date were in patients with postoperative biliary tract infections and/or a past history of diabetes mellitus. Gastrointestinal and biliary tract diseases have replaced infections through the portal vein and biliary tract as the most common etiologic sources of pyogenic liver abscess . Nevertheless, in our patient, the computed tomography findings did not show cholecystolithiasis or biliary tract abnormality, and the patient had had no previous gastrointestinal or biliary tract operations.…”

Lessons and Tips from the Experience of Pediatric Robotic Choledochal Cyst Resection

“…Hepaticojejunostomy has the structure of the Roux-en-Y limb that can prevent the reflux of bowel contents to the biliary tract, so it has less possibility of causing the sump syndrome. [3][4][5][6][7][8] We believe that the most important principle of treatment for a choledochal cyst is the total resection of the pathological cyst and the safe reconstruction of the biliary tree (hepaticojejunostomy), and these principles should be applied for minimally invasive surgery of the choledochal cyst. We believed that despite the high cost, the robotic surgical system is the alternative minimally invasive surgery that is able to overcome the limitations of laparoscopic surgery in complex biliary procedures.…”

Long-Term Prognosis After Treatment of Patients with Choledocholithiasis

“…19 However, side-to-side anastomosis of the bile duct and the duodenum can cause foreign bodies to enter into the residual bile duct after surgery, triggering the onset of intractable and recurrent cholangitis and liver abscess, which is defined as sump syndrome. 20,21 End-to-side anastomosis should be performed to prevent this intractable syndrome.…”