Hepato-Duodenal Fistula Complicating a Pyogenic Liver Abscess: An Unusual Presentation

Lamba, Amtoj Singh; Singh, Bhavneet; Gupta, Monica; Dahiya, Sushila; Saini, Ruchika

doi:10.7759/cureus.12236

Cited by 4 publications

(7 citation statements)

References 8 publications

(14 reference statements)

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“…Complicated factors in patients with PLA may be portal vein thrombosis (PVT) [ 6 ] and the development of difficult-to-treat hepatogastric or enterohepatic fistulas [ 11 , 12 ]. The risk of recurrence of PLA has been estimated to be 10%, in which biliary etiology has been reported to be a related factor [ 13 , 14 ].…”

mentioning

confidence: 99%

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Bläckberg

Jönsson

Svensson

et al. 2023

Open Forum Infectious Diseases

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Aim Pyogenic liver abscess (PLA) is a rare entity but, is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in Southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern part of Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (OR 2.0, 95% CI 1.1-3.9), malignancy (OR 3.7, 95% CI 1.9-7.1), liver failure (OR 6.3, 95% CI 2.7-14.5) and polymicrobial findings (OR 3.8, 95% CI 2.2-6.9) were associated with death within 90 days, p < 0.05. Male sex (OR 2.1, 95% CI 1.2-3.6), malignancy (OR 2.2, 95% CI 1.3-3.6), age (65-74 years) (OR, 2.2, 95% CI 1.2-4.1) and chronic liver disease (OR 3.0, 95% CI 1.4-6.4) were associated with the risk of subsequent PLA, p ≤ 0.01. Conclusions Identifying different clinical variables associated with an unfavourable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.

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confidence: 99%

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Bläckberg

Jönsson

Svensson

et al. 2023

Open Forum Infectious Diseases

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“…1 Detection of air in a liver abscess cavity should raise the possibility of either a hepatobronchial fistula, hepatoenteric fistula or secondary bacterial infection by an air-producing organism. 2 The common sites of fistulisation include stomach, colon and duodenum. 2 3 Contrast-enhanced CT scan with positive oral contrast or instillation of contrast through the drainage catheter placed in the abscess cavity are the definitive investigations for demonstration of the fistula.…”

Section: Descriptionmentioning

confidence: 99%

Pyogenic liver abscess complicated by a hepatoduodenal fistula

et al. 2021

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“…Without proper treatment, intrahepatic abscesses can rupture, develop pleuropulmonary complications, and even embolize or form gastroenteric fistulas [2][3]. Hepatic abscess fistulization with various segments of the gastrointestinal tract, including the duodenum, stomach, hepatic flexure of the large intestine, or ascending colon, occurs significantly less frequently compared to other intrahepatic abscess complications [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Initial diagnosis of a hepatoduodenal fistula can be seen in a contrast-enhanced computed tomography (CT) scan of the abdomen followed with a confirmatory fistulogram [4][5][6][7]. Currently, there are no established treatment guidelines for hepatoduodenal fistulas.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there are no established treatment guidelines for hepatoduodenal fistulas. Treatment varies from conservative antibiotic therapy and catheter drainage to invasive surgical resection [4][5][6][7]. Although conservative management with antibiotics and catheter drainage provides symptomatic relief of hepatoduodenal fistulas, the patient must tolerate the inconvenience of an intrahepatic drain.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fix the Flat: Applying the Principles of Tire Aerosol Repair to Prevent Exsanguination From a Hemorrhagic Intrahepatic Mass

Tenewitz¹,

Harmon²,

Matteo³

et al. 2021

Cureus

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Metastatic neoplasias often require increased blood supply for proliferation. Tumors that outgrow their blood supply can undergo necrosis, leading to the formation of mass-like abscesses. Depending on the location, these lesions can form fistulas with nearby organs resulting in poor patient outcomes. Interventional operators may use unconventional methods to the benefit of patients when resolving these complex lesions. The following case describes a patient with a large right hemorrhagic intrahepatic collection and formation of a duodenal fistula, resulting in acute blood loss anemia. Although there is not a standardized treatment for this complication, we present a novel therapeutic technique that incorporates similar principles analogous to the standard canned aerosol tire repair device.

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Hepato-Duodenal Fistula Complicating a Pyogenic Liver Abscess: An Unusual Presentation

Cited by 4 publications

References 8 publications

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Pyogenic liver abscess complicated by a hepatoduodenal fistula

Fix the Flat: Applying the Principles of Tire Aerosol Repair to Prevent Exsanguination From a Hemorrhagic Intrahepatic Mass

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