Increased Risk of Pyogenic Liver Abscess after Endoscopic Sphincterotomy for Treatment of Choledocholithiasis

Wu, Cheng‐Kun; Hsu, Chien‐Ning; Cho, Wei-Ru; Yang, Shih‐Cheng; Liu, An-Che; Tai, Wei‐Chen; Lee, Chen‐Hsiang; Yang, Ya‐Chen; Chuah, Seng‐Kee; Liang, Chih‐Ming

doi:10.2147/idr.s312545

Cited by 4 publications

(2 citation statements)

References 24 publications

(29 reference statements)

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“…This, in turn, might facilitate bacterial colonization, cholangitis, or even LA [ 7 ]. Consequently, ES might be associated with the development of PLA as described by several authors [ 4 ].…”

Section: Discussionmentioning

confidence: 94%

“…Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is the gold standard for the management of bile duct stones [ 3 ]. However, ES carries some risk of complications, such as upper gastrointestinal bleeding (UGIB), and, recently, it has been associated with LA formation [ 4 ]. We report a case of PLA and a late massive UGIB following ERCP with ES.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pyogenic Liver Abscess and Delayed Massive Gastrointestinal Bleeding Following Endoscopic Retrograde Cholangiopancreatography (ERCP): Association of Two Rare Complications

Vara-Luiz¹,

Barbosa²,

Albuquerque³

et al. 2022

Cureus

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A liver abscess (LA) is the most common type of visceral abscess. While biliary tract disorders are its most common etiology, clinicians should also consider less frequent causes such as iatrogenic complications due to certain interventions. One of these unusual causes is related to endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES), a usually safe procedure that carries some risk of complications. We present the case of a 71-year-old female with a history of choledocholithiasis who underwent ERCP with ES without any immediate complications; she was discharged after 24 hours and readmitted three days later to the emergency room with fever and abdominal pain. An abdominal CT showed a liver abscess. Blood cultures were positive for Escherichia coli, Streptococcus anginosus, and Enterococcus faecalis, and the patient was started on directed antibiotic therapy with ampicillin, benzylpenicillin, and metronidazole. On day 17, due to hematochezia with hemodynamic instability, an urgent upper gastrointestinal endoscopy was performed, which revealed late post-ES bleeding, refractory to conventional endoscopic therapy. An ERCP was performed to control the bleeding by using a biliary fully covered self-expandable metal stent (FCSEMS), which was removed four weeks later. The follow-up CT showed a significant reduction of LA and the patient was discharged. This case highlights the association of two uncommon complications of ERCP: a LA and a major late post-ES bleeding. Clinicians should maintain a high index of suspicion for these complications in daily practice.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%