Step-up approach in emphysematous hepatitis: A case report

Table 1 Emphysematous hepatitis case reports in the literature

Ref.	Year	Age/sex	History	Imaging	Treatment	Pathogen(s)	Outcome
Blachar et al[1]	2002	43/F	Diabetes mellitus, hyperlipidemia, short-gut duet of multiple ischemic episodes, peripheral vascular disease	CT: Extensive hepatic gas right lobe without fluid collection	IV antibiotics; Radiological drainage	Blood and liver aspirate: Klebsiella pneumoniae	Died 3 d after admission
Lopez Zarraga et al[2]	2006	72/F	Diabetes mellitus	CT: Total gas content in multiple abscesses	NA	Culture of liver lesion post mortem: Klebsiella oxytoca	Died 24 h after admission
Létourneau-Guillon et al[7]	2010	53/M	Three mo before admission: Left hepatectomy with hepaticojejunostomy for hilar cholangiocarcinoma; No adjuvant chemotherapy1 wk before admission: Cellulitis at surgical incision treated with oral cephalexin	CT: 8 cm air-filled cavity in the right lobe, no fluid collection	IV antibiotics	Blood culture: Enterobacter cloacae, Clostridium perfringens	Died 36 h after admission
Chauhan et al[3]	2012	77/F	Diabetes mellitus	CT: Air collection in segment VI and VII without fluid collection	IV antibiotics; Radiological drainage	NA	Died 3 d after admission
Jung Ho et al[8]	2012	80/F	Hilar cholangiocarcinoma; ERCP + stenting was performed 3 mo before admission followed by radiotherapy for 17 d after admission	CT: Hepatic parenchymal gas 6.3 cm × 4.4 cm in the right liver (sVII/sVIII)	IV antibiotics; Radiological drainage	Blood culture: Clostridium perfringens, Escherichia coli	Died 3 d after admission
Dimitriou et al[4]	2014	72/M	Diabetes mellitus	CT: Replacement of liver parenchyma by gas without fluid collection	IV antibiotics	NA	Died within hours after admission
Nada et al[9]	2017	73/F	Pancreatic adenocarcinoma; Whipple performed 8 mo before admission. Lung- and liver metastasis diagnosed 6 wk prior to admission. COPD, hypertension, chronic hepatitis C, pulmonary embolism	CT: Hepatic gas in the right liver lobe, sparing the hepatic metastasis	IV antibiotics	Blood culture: Streptococcus mutans, Enterococcus faecalis	Died within 24 h after admission
Ghosn et al[5]	2019	38/F	Diabetes mellitus, cholecystectomy	CT: Mixed collection 8 cm × 7 cm × 5.5 cm, containing necrotic debris and air	IV antibiotics; Laparotomy urgent	Perioperative fluid: Escherichia coli, Enterococcus faecium	Survived. Discharged 13 d after admission
Calderon et al[6]	2020	80/F	Hypertension, diabetes mellitus, chronic kidney disease	CT at presentation: Indeterminate, scattered, hypo-enhancing lesions in the liver. CT 5 h after admission (clinical deterioration): Gas in the right liver lobe	IV antibiotics	Blood culture: Clostridium perfringens	Died within 16 h after admission
Azri et al[7]	2020	75/F	Hilar cholangiocarcinoma; ERCP + stenting 14 mo prior to admission. Followed by stereotactic radiotherapy until 4 mo prior to admission	CT: Left hepatic parenchymal emphysema and pneumoperitoneum	NA	Blood culture: Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Clostridium perfringens, Aeromonas ichtiosmia	Died
Gonçalos et al[11]	2020	74/M	Hypertension, gastroesophageal reflux	CT: Two areas of gas within the right lobe of the liver	IV antibiotics	Blood culture: Escherichia coli	Died 3 d after admission

COPD: Congestive obstructive pulmonary disease; CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; F: Female; IV: Intravenous; M: Male; NA: Not available.