Right hepatectomy for pyogenic liver abscesses with true multiloculation

Abstract

We report the case of 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.

Clinical Outcomes and Prognostic Factors of Cancer Patients with Pyogenic Liver Abscess

“…13,35 Multiloculated abscess of the liver has been increasingly found with the evolution of diagnostic imaging techniques, yet its mechanism has not been fully elucidated. The possible explanations for this configuration include (a) a coalescent process of clustering 38,39 The abscess characteristics may influence the effectiveness of percutaneous drainage. Barakate and other authors reported that the effectiveness of PCD for multiloculated abscesses might be reduced due to compartmentalization of abscesses with thick, viscid pus and surgical intervention as the initial step for eradication of multiloculated liver abscesses had a favorable result with less treatment failure, less need for secondary procedures, or a shorter hospitalization compared with those receiving percutaneous drainage.…”

Intermittent hepatic artery antibiotic infusion therapy for pyogenic hepatic abscess

“…Side effects have not been reported with intraarterial one-shot injection of antibiotics (6,8,11). We did not observe any complications in our study, except for a small splenic infarction, but the longterm use of an infusion catheter in the hepatic artery has potential complications, such as thrombus formation and arterial occlusion, and hence requires careful monitoring of the patient.…”

“…Intra-arterial one-shot injection of antibiotics for hepatic abscess has been reported to have achieved favorable results (6,8,11). Intra-arterial antibiotic infusion for hepatic abscess can deliver a high concentration of antibiotics selectively to the liver, thereby increasing the drug concentration in the liver tissue and bile.…”

The Usefulness of C-arm CBCT-guided Abscess Drainage with A Flat-panel Detector

“…Percutaneous drainage under imaging guidance is often the first-choice treatment for abscesses because it is relatively easy to perform and minimally invasive 1,12 . Each of the imaging methods used has advantages and disadvantages.…”