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Chen M, Chen J, Zhuang Z, He X, Wang Y, Liang J, Lin R, Cai G. Septic shock caused by emphysematous hepatitis complicated with intracranial infection. IDCases 2025; 39:e02159. [PMID: 39995820 PMCID: PMC11848804 DOI: 10.1016/j.idcr.2025.e02159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 01/15/2025] [Indexed: 02/26/2025] Open
Abstract
Purpose Emphysematous hepatitis is an uncommon and life-threatening hepatic infection, characterized by the presence of gas within the liver and high mortality. There are few reports of this condition. Method We report a case of septic shock caused by emphysematous hepatitis complicated with intracranial infection, and review the current literature on emphysematous hepatitis. Results A 57-year-old male with uncontrolled diabetes mellitus developed emphysematous hepatitis complicated with intracranial infection, which progressed to septic shock. The patient was treated with antibiotics and received percutaneous liver puncture drainage early and was discharged preferably in remission. From the literature review, we found 16 previously published cases of emphysematous hepatitis. Conclusion Given our experience and the literature review, percutaneous liver puncture drainage or surgical treatment in the early stage may be beneficial to patients with emphysematous hepatitis.
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Affiliation(s)
- Miao Chen
- Department of Emergency, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jianbo Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Zhengzhi Zhuang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Xiaojun He
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Yue Wang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Junwen Liang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Runpei Lin
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
| | - Gengxin Cai
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District Foshan City, Foshan, Guangdong, China
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Bayerl C, Berg AK, Angermair S, Kim D, Hamm B, Beyer K, Schineis C. First successful treatment of Clostridium perfringens-associated emphysematous hepatitis: a case report. Front Med (Lausanne) 2023; 10:1164466. [PMID: 37265483 PMCID: PMC10229863 DOI: 10.3389/fmed.2023.1164466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/18/2023] [Indexed: 06/03/2023] Open
Abstract
Emphysematous diseases of the abdomen are rare with an often inconspicuous presentation of symptoms and rapid lethal outcome if untreated. We report the first successfully treated case of Clostridium perfringens-associated emphysematous hepatitis. In the emergency room, a 79-year-old man presented with shortness of breath and deteriorated general condition since the morning of admission. Initial CT scans showed a small but rapidly expanding gas collection in liver segment 6. Emergency surgery with atypical liver resection was performed immediately. With early resection and prolonged administration of antibiotics in the presence of sepsis, the patient recovered successfully and was discharged 37 days after admission. As in our case, prompt diagnosis with early surgical treatment is crucial for the management of emphysematous hepatitis.
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Affiliation(s)
- Christian Bayerl
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Ann-Kathrin Berg
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Stefan Angermair
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Damon Kim
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Bernd Hamm
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Katharina Beyer
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Christian Schineis
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Berlin, Germany
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Palko C, Durkan S. Medical management of feline emphysematous hepatitis-A case report. Clin Case Rep 2023; 11:e7352. [PMID: 37229397 PMCID: PMC10203037 DOI: 10.1002/ccr3.7352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Case report summary: A 9-year-old male castrated domestic shorthair feline was presented to the emergency department with a chief complaint of constipation of 3-day duration, decreased urination of 1-day duration, vomiting, and hind limb weakness. Physical examination abnormalities included hypothermia, dehydration, and generalized paresis with inability to stand for a prolonged period of time. Abdominal ultrasonography showed pinpoint hyperechoic foci throughout the hepatic parenchyma, small gas foci circulating within the portal vasculature consistent with emphysematous hepatitis, and mild volume of ascites. Cytology of the ascites was consistent with inflammatory effusion. Hepatic cytology was consistent with mixed inflammation/hepatitis with no apparent cause for inflammation noted. Urine culture yielded a negative result. Surgical liver biopsy and culture were declined by the patient's family. Ultrasound changes were presumed to be most likely secondary to an ascending infection.
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Affiliation(s)
- Corinna Palko
- Pittsburgh Veterinary Specialty and Emergency CenterPittsburghPennsylvaniaUSA
| | - Samuel Durkan
- Pittsburgh Veterinary Specialty and Emergency CenterPittsburghPennsylvaniaUSA
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Pan N, Wang S, Miao Z. Emphysematous hepatitis with successful treatments: A rare case report. Medicine (Baltimore) 2023; 102:e32530. [PMID: 36705361 PMCID: PMC9875965 DOI: 10.1097/md.0000000000032530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Emphysematous hepatitis (EH) is a rare and fulminant gas-forming liver infection. Only 3 patients were successfully treated. Diabetes mellitus and a history of digestive system cancer may predispose individuals to EH. Computed tomography (CT) findings support the diagnosis of EH and monitor progress. PATIENT CONCERNS A 48-year-old man with diabetes presented with nausea, vomiting (gastric contents) and diarrhea. Laboratory test results revealed elevated levels of inflammatory indicators and abnormal liver function. CT showed a large-scale air collection with some remaining parenchymal debris in the left lobe of the liver. Remarkably, no fluid was observed inside the lesion. DIAGNOSE The abdominal CT features and laboratory examination results rationalized the diagnosis of EH. INTERVENTIONS AND OUTCOMES The patient finally recovered from this severe disease through a series of effective treatments, including strict glucose control, sensitive antibiotic therapy, and subsequent percutaneous drainage. LESSONS EH generally deteriorates rapidly and eventually leads to death. This case will raise awareness of the rare and severe disease, strengthen diagnostic capacities, and provide advice to treat it.
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Affiliation(s)
- Nannan Pan
- Department of Radiology, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
| | - Shuo Wang
- Department of Orthopaedic Surgery, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
| | - Zhenwei Miao
- Department of Radiology, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
- * Correspondence: Zhenwei Miao, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, No.8 Guangchuan Road, Baodi, Tianjin 301800, China (e-mail: )
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Francois S, Aerts M, Reynaert H, Van Lancker R, Van Laethem J, Kunda R, Messaoudi N. Step-up approach in emphysematous hepatitis: A case report. World J Hepatol 2022; 14:464-470. [PMID: 35317184 PMCID: PMC8891666 DOI: 10.4254/wjh.v14.i2.464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/04/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients. CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement. CONCLUSION EH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.
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Affiliation(s)
- Silke Francois
- Department of Gastroenterology, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium.
| | - Maridi Aerts
- Department of Gastroenterology and Hepatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
| | - Hendrik Reynaert
- Department of Gastroenterology and Hepatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
| | - Ruth Van Lancker
- Department of Intensive Care, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
| | - Johan Van Laethem
- Department of Infectious Diseaeses, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
| | - Rastislav Kunda
- Department of Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
| | - Nouredin Messaoudi
- Department of Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
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Estébanez-Ferrero B, Fuentes-Porcel O, Lorenzo-Liñán MÁ, Rico-Morales MDM. Emphysematous hepatitis: a very rare entity with a poor prognosis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:612-614. [PMID: 33733799 DOI: 10.17235/reed.2021.7795/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 67-year-old female, with no alterations in glucose metabolism or other relevant history, presented to the Emergency Department due to abdominal pain and vomiting after a syncopal episode. Physical examination revealed a poor general condition, mild stupor and a distended abdomen, painful on palpation in the right hypochondrium, with localized rigidity. On arrival at the Emergency Department, the patient's blood pressure (BP) was 150/66 mmHg, heart rate (HR) was 110 beats/minute and temperature 35 °C.
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Calderon H, Serfin J. 13-Hour progression of emphysematous hepatitis as depicted on repeat computerized tomography. J Surg Case Rep 2020; 2020:rjaa089. [PMID: 32373313 PMCID: PMC7191883 DOI: 10.1093/jscr/rjaa089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Emphysematous hepatitis is a rare, rapidly progressive and often fatal condition, which occurs predominantly in patients with uncontrolled diabetes mellitus. It results in the replacement of liver parenchyma by a collection of gas. Emphysematous infections of other abdominal and pelvic organs have long been established, but relatively little is known about the equivalent emphysematous infection of the liver with very few examples in the published literature. A review of the literature shows variability regarding timing of presentation and implicated organisms. To date, computerized tomography imaging has been purported to be diagnostic and vital to early management, as it clearly shows the characteristic appearance of air bubbles within the liver parenchyma. We report a case with inconclusive initial radiographic findings.
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Affiliation(s)
- Holly Calderon
- Western University of Health Sciences COMP-NW, Lebanon, OR, USA
| | - Jennifer Serfin
- Samaritan Health Services - General Surgery, Corvallis, OR, USA
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Gas-Forming Liver Abscess versus Emphysematous Hepatitis: A Radiologic Diagnostic Dilemma-A Case Report and Review of the Literature. Case Reports Hepatol 2019; 2019:5274525. [PMID: 31380128 PMCID: PMC6662457 DOI: 10.1155/2019/5274525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/08/2019] [Indexed: 12/30/2022] Open
Abstract
A 38-year-old diabetic woman, with history of cholecystectomy and ventral hernia repair, was hospitalized due to sudden-onset abdominal pain and fever. Computed tomography revealed a mixed collection containing necrotic debris and emphysematous change in the left lobe of the liver mainly in segments II and III. These radiological findings suggested emphysematous hepatitis (EH). The patient's condition deteriorated rapidly, and she was rushed to the operating room for urgent exploratory laparotomy where debridement was performed. Intraoperatively the patient was found to have an abscess with incomplete capsule concurrent with hepatic necrosis suggesting the co-occurrence of abscess and EH. The patient survived and was discharged after 13 days. Relevant literature was reviewed, and to the best of our knowledge, EH is an extremely rare entity with limited data regarding its pathogenesis, causative organisms, and management. EH is a rapidly invasive disease process that can be fatal if appropriate therapeutic intervention is delayed. Initial presentations are usually subtle, thus high clinical and radiological suspicion is required for early diagnosis and management to decrease associated mortality and morbidity. We hence report the first successfully treated case of EH with review of the literature.
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