S2652 Occult Hepatic Abscess Incurred Post-ERCP

Coles, Michael; Masood, Muaaz; Madray, Victoria; Uy, Pearl Princess

doi:10.14309/01.ajg.0000712656.44533.d7

Cited by 1 publication

(2 citation statements)

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“…CT is often the radiological modality of choice for differentiating between hepatic abscesses and non-infective fluid collections, with reported diagnostic sensitivity as high as 97% 5 6. While many studies have identified post-ERCP hepatic abscesses on CT,1–4 there are cases of hepatic abscesses being missed on both ultrasound7 and, more rarely, CT scans 8 9. It is therefore possible that both our ultrasound and CT results are false negatives.…”

Section: Discussionmentioning

confidence: 99%

“…Well-documented complications of ERCP include pancreatitis, cholangitis, postprocedural haemorrhage and duodenal perforation. The development of hepatic abscesses following ERCP has been cited as a rare complication in the literature 1–4. Hepatic abscesses carry a high mortality; therefore, considering this as a differential in patients who remain unwell post-ERCP is imperative, to ensure early detection and timely management.…”

Section: Introductionmentioning

confidence: 99%

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Multifocal hepatic abscess post-ERCP

Patel,

Southall,

Varghese

2023

BMJ Case Rep

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A woman in her 40s presented to hospital with cholangitis. A magnetic resonance cholangiopancreatography showed a moderately dilated common bile duct and mild intrahepatic duct dilatation with sludge. She underwent a successful endoscopic retrograde cholangiopancreatography (ERCP) and sphincteroplasty. She subsequently developed recurrence of fevers and abdominal pain with rising inflammatory markers. Initial investigations and imaging were unremarkable. A positron emission tomography scan demonstrated multiple fluorodeoxyglucose (FDG)-avid hepatic lesions, and subsequent imaging confirmed multifocal liver abscesses without a drainable collection. The patient was managed with intravenous co-amoxiclav initially before switching to oral antibiotics, however, represented 1 week later with similar symptoms. Her antibiotic coverage was broadened to intravenous pipercillin-tazobactam, and she was discharged on this with follow-up in clinic. This case report highlights the rare complication of hepatic abscesses following ERCP and the importance of considering this as a differential in patients who present with sepsis following the procedure.

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