Sudden Death after Pancreatic Head Resection: Rupture of Hepatic Artery Caused by Clostridial Infection

Königsrainer, Ingmar; Kurth, Ralf; Haack, Birgit; Braun, Alexander; Marschal, Matthias; Heininger, Alexandra; Bültmann, B.; Königsrainer, Alfred

doi:10.1089/sur.2006.068

Cited by 3 publications

(2 citation statements)

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“…51 When C. perfringens affects splanchnic arteries, it may cause massive exsanguination and sudden death. Königsrainer et al 52 described a case of sudden death due to a ruptured hepatic artery caused by C. perfringens infection after pancreatic head resection. If abundant gas production occurs within the arteries of vital organs, it can cause circulatory disturbances and sudden death, as reported in the case of cerebral gas embolism.…”

Section: Discussionmentioning

confidence: 99%

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Chinen¹

2020

Autops. Case Rep.

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Section: Discussionmentioning

confidence: 99%

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Chinen¹

2020

Autops. Case Rep.

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“…Rezvani et al reported on a late liver abscess after Whipple procedure associated with stenting of the bile duct and recently, fatal cases of liver gasgangrene after pancreatic surgery have been described [45][46][47]. A mixed infection with the reported three unusual pathogens has not been described thus far.…”

Section: Discussionmentioning

confidence: 99%

Liver abscess due to Eikenella corrodens, Prevotella meloninogenica, and Lactobacillus spp. following pancreatoduodenectomy: Case report and review of the literature

et al. 2010

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Leberabszess durch Eikenella corrodens, Prevotella meloninogenica und Lactobacillus spp.Zusammenfassung. Grundlagen: Leberabszesse sind seltene Komplikationen bei Patienten, welche sich einer Pankreatektomie unterziehen. Eikenella corrodens ist ein Gram-negatives Stäbchen, welches bei Patienten mit Sepsis und Endokarditis isoliert wurde.Methodik: Wir berichten über einen Patienten, welcher 3 Monate nach Pankreatektomie und Polychemotherapie einen Leberabszess entwickelte. Drei untypische Erreger wurden nach Abszessdrainage isoliert. Bislang in der Literatur beschriebene Fälle von Leberabszessen mit Beteiligung dieser seltenen Erreger wurden zusammengefasst.Ergebnisse: Der 8 cm große Leberabszess wurde erfolgreich perkutan drainiert und Eikenella corrodens, Prevotella melaninogenica, and Lactobacillus spp. wurden aus dem Punktat isoliert. Die antibiotische Therapie umfasste initial Piperazillin=Tazobactam gefolgt von Ertapenem, und es kam innerhalb von 4 Wochen zur vollstän-digen Abheilung der schweren Infektion. Der Großteil bislang in der Literatur beschriebener Leberabszesse mit Beteiligung dieser Erreger wurde mittels perkutaner Drainge und gezielter antibiotischer Therapie erfolgreich behandelt. Eikenella corrodens (n ¼ 10) and Prevotella (n ¼ 8) wurden typischerweise bei polymikrobiellen Infektionen isoliert, während Lactobacillus (n ¼ 6) Leberabszesse häufig monomikrobiell waren.Schlussfolgerungen: Patienten, welche sich einer Pankreasresektion unterziehen und eine Chemotherapie erhalten, haben ein erhöhtes Infektionsrisiko. Seltene Krankheitsbilder wie Leberabszesse und seltene Erreger wie Eikenella corrodens sollten differentialdiagnostisch in Erwägung gezogen werden. Bei entsprechend frühzei-tiger Erkennung und adäquater Behandlung können diese Komplikationen durchaus erfolgreich behandelt werden.Schlüsselwörter: Leberabszess, Pankreaskarzinom, Pankreasresektion, Eikenella corrodens.Summary. Background: Liver abscess may be a complication after pancreatectomy. Eikenella corrodens is a rare pathogen associated with sepsis and endocarditis among other infections.Methods: We report on a patient who developed a polymicrobial liver abscess with three unusual pathogens three months following pylorus preserving pancreatoduodenectomy and adjuvant chemotherapy for pancreatic adenocarcinoma. A review of the literature with regard to liver abscesses caused by the rare pathogens was performed.Results: The eight cm pyogenic liver abscess, which grew Eikenella corrodens, Prevotella melaninogenica, and Lactobacillus spp., was successfully treated with percutaneous drainage and antibiotic therapy using piperacillin=tazobactam followed by ertapenem. Literature review for previously reported cases of liver abscesses due to these organisms revealed that most were percutaneously drained and had good outcome. Eikenella corrodens (n ¼ 10) and Prevotella (n ¼ 8) liver abscesses were typically polymicrobial, whereas Lactobacillus (n ¼ 6) liver abscesses were more commonly monomicrobial.

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Clostridium perfringensLiver Abscess after Pancreatic Resection

Tabarelli

Bonatti

Cejna

et al. 2009

Surgical Infections

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Sudden Death after Pancreatic Head Resection: Rupture of Hepatic Artery Caused by Clostridial Infection

Abstract: Close monitoring and early recourse to invasive diagnostic and therapeutic procedures may be advisable in the presence of suspect findings after pancreatic surgery to prevent this fatal complication.

Cited by 3 publications

References 14 publications

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Liver abscess due to Eikenella corrodens, Prevotella meloninogenica, and Lactobacillus spp. following pancreatoduodenectomy: Case report and review of the literature

Clostridium perfringensLiver Abscess after Pancreatic Resection

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