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Le Goff M, Martino F, Rossi G, Toussaint A, Moncomble E, Reuter D, Garret C, Decavèle M, Fraissé M, Herault A, Argaud L, Garçon P, Saccheri C, Meunier J, Voriot G, Cadoz C, Yvin É, Laurent V, Calvet L, de Montmollin E, Schmidt J, Issa N, Leclerc M, Das V, Lemiale V, Mariotte É. Prognosis of liver abscess in the intensive care unit (POLAIR), a multicentre observational study. Crit Care 2025; 29:146. [PMID: 40197508 PMCID: PMC11974115 DOI: 10.1186/s13054-025-05376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/17/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Liver abscess (LA) is a rare but potentially serious condition with a high mortality rate. Current epidemiological data of LA patients requiring intensive care unit (ICU) admission are limited. METHODS This multicentre retrospective study included adults admitted to 24 ICUs in France between January 2010 and December 2020. Risk factors for mortality were identified by multivariate analysis. A propensity score was used to adjust for confounders related to the presence of portal vein thrombosis. RESULTS 335 patients were enrolled. The median age was 66 years [53-73] and 68% were male. Commons comorbidities included diabetes (29.9%) and cancer or haematological disease. Septic shock was the main reason for admission (58%). The median SAPS2 score at ICU admission was 42 [31-53] and the SOFA score was 6 [3-9]. The putative origin of LA was biliary (31%), while 40% were cryptogenic. Most patients (60%) had a solitary LA, involving the right lobe (38.8%), with a median diameter of 67 mm [47-91]. Associated portal vein thrombosis (PVT) was present in 13.4% of cases. Microbiological documentation was obtained in 82% of patients, showing gram-negative bacilli (59.7%), mainly Escherichia coli (19.6%) and Klebsiella spp. (19.1%), and gram-positive cocci (29.6%), mainly Streptococcus spp. (17.1%). Drainage was performed in 62% of cases, 40% within 48 h. The median duration of antibiotic therapy was 35 days [21-42]. During hospitalisation, 62% of patients required vasopressors and 29% required mechanical ventilation. In-ICU mortality was 11.6%. Multivariate analysis showed that organ dysfunction illustrated by SOFA score (HR 3.45 [1.95-6.09], p < 0.001) and PVT (HR 3.14 [1.54-6.39], p = 0.001) were significant risk factors for mortality. Drainage was not associated with improved short-term survival (HR 1.22 [0.65-2.72], p = 0.52). In the population matched for PVT confounders, a higher sofa score was the only factor associated with mortality (HR 3.11 [1.76-5.49] IC95%, p = 0.001). CONCLUSIONS This multicentre study illustrates the severity of LA in French intensive care units and identifies organ dysfunction (SOFA score) and portal vein thrombosis as major risk factors for mortality. Prospective studies are needed to improve management strategies, as the survival benefit of drainage is unclear.
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Affiliation(s)
- Marie Le Goff
- AP-HP, Hôpital Saint-Louis, Medical ICU, Paris, France.
| | - Frédéric Martino
- Intensive Care Unit, CHU de Guadeloupe, Chemin Chauvel, Les Abymes, Guadeloupe
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord, Université Paris Cité, Clichy, France
| | | | - Elsa Moncomble
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, CHU Henri Mondor, 51, Av. de Lattre de Tassigny, 94010, Créteil CEDEX, France
| | - Danielle Reuter
- Medical-Surgical Intensive Care Unit, Sud Francilien Hospital, Corbeil, France
| | - Charlotte Garret
- Medical Intensive Care, Hôtel Dieu University Hospital, Nantes, France
| | - Maxence Decavèle
- Service de Médecine Intensive et Réanimation (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Megan Fraissé
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, Boulogne, France
| | | | - Laurent Argaud
- Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France
| | - Pierre Garçon
- Medical and Surgical Intensive Care Unit, Grand Hôpital de L'Est Francilien Site Marne-la-Vallée, Jossigny, France
| | | | | | - Guillaume Voriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Hôpitaux de Paris, Paris, France
| | - Cyril Cadoz
- Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
| | - Élise Yvin
- Département de Médecine Intensive-Réanimation, CHU Angers, Angers, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France
| | - Laure Calvet
- CHU de Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | | | - Julien Schmidt
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nahema Issa
- Medical Intensive Care and Infectious Diseases Unit, Hôpital Saint André, Bordeaux, France
| | - Maxime Leclerc
- Service de Réanimation et Soins Intensifs Polyvalents, CH Mémorial Saint-Lô, Saint-Lô, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | | | - Éric Mariotte
- AP-HP, Hôpital Saint-Louis, Medical ICU, Paris, France
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Wang Y, Wang H, Liu Z, Chang Z. Evolution of transarterial chemoembolization-related liver abscess over time: a systematic review and meta-analysis. Quant Imaging Med Surg 2025; 15:2707-2721. [PMID: 40235776 PMCID: PMC11994569 DOI: 10.21037/qims-24-1166] [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: 06/10/2024] [Accepted: 02/21/2025] [Indexed: 04/17/2025]
Abstract
Background Transarterial chemoembolization (TACE) is a primary method for treating malignant liver tumors; however, the occurrence of liver abscesses after TACE has always been a concern. With the evolution of time, TACE techniques and practical experience continue to advance, leading to a deeper understanding of post-TACE liver abscesses. This meta-analysis aimed to comprehensively examine the occurrence of liver abscesses after TACE and focus on its changing trends. Methods Two researchers reviewed the databases of PubMed, Embase, and Web of Science to identify articles that reported liver abscess formation after TACE in patients with hepatic malignant tumor. The search was conducted from the date of establishment of each database up to January 2023. After screening the articles and extracting the data, we used Review Manager 5.3 and Stata 16.0 for analysis and processing. Results This meta-analysis included a total of 32 studies, comprising 254,408 TACE patients, of whom 642 developed liver abscesses after TACE. The pooled incidence rate of liver abscess formation after TACE was 0.54%. The heterogeneity was considerable and significant. Subgroup analysis revealed a significant impact of the evolution of time on the incidence of liver abscess formation after TACE. The incidence was shown to have decreased from 0.61% in the initial 5 years to 0.47% in the most recent 5 years, with statistical significance. Liver metastasis and type 2 biliary abnormality were significantly associated with the development of liver abscess. Mortality directly associated with liver abscess was 7.73% and was gradually decreasing, from over 50% in the 1990s to 5.48% in the past decade, with a statistically significant difference. Conclusions The formation of liver abscess was a relatively low-incidence complication following TACE for malignant liver tumors, with clearly defined risk factors. Moreover, both the incidence and mortality rates of liver abscess were gradually decreasing. These findings provide valuable insights for future clinical practice.
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Affiliation(s)
- Yunan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hairui Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Giorgio A, Ciracì E, De Luca M, Stella G, Giorgio V. Hepatic abscess and hydatid liver cyst: European infectious disease point of view. World J Hepatol 2025; 17:103325. [PMID: 40027570 PMCID: PMC11866163 DOI: 10.4254/wjh.v17.i2.103325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/25/2024] [Accepted: 01/21/2025] [Indexed: 02/20/2025] Open
Abstract
This manuscript is based on a recent study by Pillay et al that was published in recently. Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin. The incidence rate in Europe is lower than in developing countries, but it is a major complication with high morbidity, particularly in immunocompromised patients. They are most frequently caused by Enterobacterales infections, but hypervirulent Klebsiella strains are an emerging problem in Western countries. Amoebiasis has been a public health problem in Europe, primarily imported from other endemic foci. At the same time, this infection is becoming an emerging disease, as the number of infected patients who have not traveled to endemic areas is rising. Treatment options for hydatid liver cyst include chemotherapy, open or laparoscopic surgery, percutaneous treatment (percutaneous aspiration, re-aspiration and injection and its modification) and ''wait and watch'' strategy. Most hydatid liver cyst patients in Pillay et al's study received surgical treatment, but several studies have confirmed the safety and efficacy of percutaneous aspiration, re-aspiration and injection.
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Affiliation(s)
- Antonio Giorgio
- Liver Unit, Athena Clinical Center, Piedimonte 81016, Caserta, Italy.
| | - Emanuela Ciracì
- Ospedale Civile di Ostuni (BR), Medicina Interna, Ostuni 72017, Brindisi, Italy
| | | | - Giuseppe Stella
- Department of Pediatric and Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Del Sacro Cuore, Rome 00168, Italy
| | - Valentina Giorgio
- Department of Pediatric and Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Del Sacro Cuore, Rome 00168, Italy
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Pillay K, Khan ZA, Nweke EE, Omoshoro-Jones J. Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals. World J Hepatol 2024; 16:1417-1428. [PMID: 39744201 PMCID: PMC11686533 DOI: 10.4254/wjh.v16.i12.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 10/02/2024] [Accepted: 10/29/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries. AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals. METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed. RESULTS In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group (P < 0.0002 and P < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% (n = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% (n = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%. CONCLUSION In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
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Affiliation(s)
- Krevosha Pillay
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa.
| | - Zafar Ahmed Khan
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
| | - Ekene Emmanuel Nweke
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
| | - Jones Omoshoro-Jones
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
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Zhang S, Xu Q, Liu C, Wu Z, Chen Z, Gu S. Management and prognostic prediction of pyogenic liver abscess in a Chinese tertiary hospital: Percutaneous needle aspiration vs catheter drainage. PLoS One 2024; 19:e0315371. [PMID: 39680538 DOI: 10.1371/journal.pone.0315371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 11/24/2024] [Indexed: 12/18/2024] Open
Abstract
Pyogenic liver abscess (PLA) is a serious infectious disease with high mortality. The aim of our study was to compare the efficacy of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) for PLA and to assess risk factors for unfavorable prognosis. This retrospective study was performed between 2017 to 2019 in a Chinese tertiary care hospital. We compared the therapeutic effectiveness of PNA versus PCD for PLA and analyzed the risk factors of treatment failure in PLA patients using multivariate logistic regression. A total of 445 patients with PLA were enrolled. The ultrasound-guided percutaneous treatment showed good therapeutic effects on PLA, with a total primary cure rate of 90.1%. PNA appeared to have advantages over PCD, with higher success rates, lower costs, and shorter hospital stays, as well as fewer puncture-induced pain, especially in patients with abscesses of 5-10 cm in diameter. The presence of positive blood culture (OR: 3.32, p = 0.002), liver cirrhosis (OR: 3.31, p = 0.023), and the length of fever resolution (OR: 1.043, p = 0.001) were independent predictors of primary treatment failure. PNA is more advantageous than PCD and is worth considering as a first-line treatment.
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Affiliation(s)
- Shumeng Zhang
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiaomai Xu
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changhong Liu
- Department of Hepatology, The Fifth People's Hospital of Ganzhou, Ganzhou Institute of Hepatology, Ganzhou, China
| | - Zhengjie Wu
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Silan Gu
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Deng WQ, Wei B, Li ZY, Liu K. Case report: Brain infarction following percutaneous drainage of a liver abscess post-chemotherapy for pancreatic head cancer. Front Med (Lausanne) 2024; 11:1453533. [PMID: 39726681 PMCID: PMC11670067 DOI: 10.3389/fmed.2024.1453533] [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: 06/23/2024] [Accepted: 11/18/2024] [Indexed: 12/28/2024] Open
Abstract
Bacterial liver abscesses commonly occur in patients with immune deficiencies such as diabetes, post-chemotherapy, or post-immunosuppressive therapy. The recommended treatment for liver abscesses exceeding 5 cm in a diameter is anti-infection therapy combined with percutaneous catheter drainage. Complications may include local spread to adjacent tissues or organs and thrombosis of the liver and portal veins. Rare hematogenous spread to distant sites, such as endophthalmitis and central nervous system embolism, have been reported, though such complications are uncommon post-drainage. This case report details a patient who suffered a brain infarction shortly after percutaneous drainage of a large liver abscess.
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Affiliation(s)
- Wan-qiu Deng
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wei
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng-yan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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Gupta SV, Akami K, Garg S, Bishnoi S, Kumar Bansal L, Jain A, Kapur N. The Gupta-Akami technique for percutaneous drainage of superficial liver abscess: An indigeneous economic method for low resources setups. Turk J Surg 2024; 40:275-282. [PMID: 39980643 PMCID: PMC11832002 DOI: 10.47717/turkjsurg.2024.6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 11/05/2024] [Indexed: 02/22/2025]
Abstract
Objectives Liver abscesses, which are purulent cavities within the liver, pose significant health challenges, particularly in developing countries where treatment resources are limited. Despite advancements in imaging and drainage technologies, conventional methods such as pigtail catheters and surgical interventions are often financially prohibitive and inaccessible in low-resource settings. This study proposes Gupta-Akami technique, an indigenous and economically viable method for percutaneous drainage, utilizes simple, readily available materials and offers a potential solution for these settings. Material and Methods The study was conducted at a tertiary care hospital over a period of six months. It included 21 patients with liver abscesses meeting specific criteria (abscess volume >500 mL, intervening liver parenchyma <5 cm, and skin-to-abscess distance <10 cm). Results The average age of the patients was 45.6 years and there were more men than women. Most patients presented with fever and abdominal pain; nausea/vomiting was observed in the majority, and jaundice was noted in a few. Mean abscess volume was 890 mL. The procedure effectively drained over 87% of the abscess volume and only one patient requiring additional aspiration. Post-procedural pain decreased significantly from an average of 3.15 on a visual analog scale at 0 hours to 0.84 before discharge. The average hospital stay was 2.57 days. No complications or mortality were reported. Conclusion The Gupta-Akami technique demonstrates efficacy as a low-cost, accessible method for percutaneous drainage of liver abscesses in resource-limited settings. It offers a promising alternative to more expensive traditional methods, potentially improving patient outcomes and accessibility in low-resource environments.
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Affiliation(s)
- Shardool Vikram Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kewecho Akami
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Siddharth Garg
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Srishti Bishnoi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar Bansal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Atul Jain
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Neeti Kapur
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Yasumoto T, Yamada K, Koh H, Oh RJ. Innovative Techniques for Image-guided Percutaneous Puncture: Navigating Complex Cases for Successful Outcomes. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:99-111. [PMID: 39559809 PMCID: PMC11570161 DOI: 10.22575/interventionalradiology.2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/11/2024] [Indexed: 11/20/2024]
Abstract
This article emphasizes image-guided puncture, a common technique used by interventional radiologists. It focuses on ultrasound, fluoroscopy, computed tomography, and computed tomography fluoroscopy-guided procedures. While techniques vary, successful outcomes without complications still heavily rely on operators' skill and judgment. Operators need knowledge of needle characteristics and expert needle manipulation. Continual skill refinement through daily practice is essential, aiming maximum results with minimal invasiveness. This article examines challenging cases of percutaneous needle biopsy, biliary intervention, radiofrequency ablation, and percutaneous abscess drainage while referencing previous review articles and discusses how to succeed in these cases by employing various techniques and approaches in various image-guided procedures. This article aimed to provide interventional radiologists with a comprehensive and practical guide for enhancing their image-guided puncture techniques, ultimately leading to successful outcomes.
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Affiliation(s)
- Taku Yasumoto
- Department of Interventional Radiology, Miyakojima IGRT Clinic, Japan
| | - Koichi Yamada
- Department of Interventional Radiology, Miyakojima IGRT Clinic, Japan
| | - Hakketsu Koh
- Department of Interventional Radiology, Miyakojima IGRT Clinic, Japan
| | - Ryoong-Jin Oh
- Department of Interventional Radiology, Miyakojima IGRT Clinic, Japan
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Dobek A, Kobierecki M, Ciesielski W, Grząsiak O, Kosztowny K, Fabisiak A, Białek P, Stefańczyk L. Comparative efficacy of contrast-enhanced ultrasound versus B-mode ultrasound in the diagnosis and monitoring of hepatic abscesses. Pol J Radiol 2024; 89:e470-e479. [PMID: 39507891 PMCID: PMC11538908 DOI: 10.5114/pjr/192184] [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: 05/22/2024] [Accepted: 08/09/2024] [Indexed: 11/08/2024] Open
Abstract
Purpose This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in diagnosing and monitoring hepatic abscesses (HA). Material and methods This retrospective study included 29 patients (9 females, 20 males) with 64 HA. Computed tomography (CT) served as the diagnostic benchmark, compared with CEUS and B-mode ultrasound (B-mode). Two radiologists assessed the presence, size, and characteristics of the HA. Results The contrast enhancement pattern on CEUS matched post-contrast CT. Lesion size detected by CEUS ranged from 1.16 cm to 15.33 cm (median 5.74 cm). CT classified lesions into four types: I (tumor-like) - 2, II (honeycomb) - 5, III (lacunar) - 23, IV (cystic-like) - 34. CEUS fully agreed with these classifications. B-mode missed two type I lesions. For type III abscesses, agreement with CEUS was perfect (κ = 1, 100%), and moderate with B-mode (κ = 0.50, 79.7%). For type IV abscesses, agreement with CEUS was perfect (κ = 1, 100%), and high with B-mode (κ = 0.88, 93.75%). Pus enhancement remained stable (± 15 dB), while the abscess pouch background varied (± 11 dB to ± 6 dB). The Mann-Whitney U test confirmed these observations (arterial: p = 1.02e-14, portal: p = 3.79e-12, late venous: p = 4.53e-13). No significant difference in enhancement values was found based on abscess size (> 4 cm vs. < 4 cm). Conclusions CEUS is superior to B-mode for diagnosing and monitoring HA, offering clearer views of the abscess pouch, septa, and liver parenchyma. The purulent part lacks contrast, allowing accurate assessment. CEUS can replace CT for monitoring and aid in patient selection for percutaneous intervention.
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Affiliation(s)
- Adam Dobek
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Mateusz Kobierecki
- Department of Diagnostic Imaging, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Wojciech Ciesielski
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Konrad Kosztowny
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Piotr Białek
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Ludomir Stefańczyk
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
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Harada K, Fujikawa T, Uemoto Y, Matsuoka T, Kawamura Y. Successful Multidisciplinary Treatment of Severe Pyogenic Liver Abscess Caused by Fish Bone: A Case Report. Cureus 2024; 16:e71102. [PMID: 39512956 PMCID: PMC11542997 DOI: 10.7759/cureus.71102] [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] [Accepted: 10/07/2024] [Indexed: 11/15/2024] Open
Abstract
Pyogenic liver abscess (PLA) is a potentially fatal infection that can lead to sepsis and shock. Among the various causes of PLA, ingestion of foreign bodies such as fish bones is relatively rare. Unless there are specific symptoms such as painful swallowing, patients rarely remember having ingested foreign bodies, making it often difficult to identify the cause of PLA. In addition, the treatment strategy and perspectives for PLA caused by foreign bodies are controversial. Herein, we present a successful case of multidisciplinary treatment for sepsis due to a PLA caused by a fish bone with a literature review.
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Affiliation(s)
- Kei Harada
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Dobek A, Kobierecki M, Kosztowny K, Grząsiak O, Fabisiak A, Falenta K, Stefańczyk L. Utility of Contrast-Enhanced Ultrasound in Optimizing Hepatic Abscess Treatment and Monitoring. J Clin Med 2024; 13:5046. [PMID: 39274258 PMCID: PMC11396598 DOI: 10.3390/jcm13175046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/12/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Untreated hepatic abscesses (HAs) have an 80% mortality rate and can be caused by bacteria and fungi. Previously managed with surgery, current treatments now utilize interventional radiology and antibiotics, reducing complications to 2.5%. This study evaluates contrast-enhanced ultrasound (CEUS) for better drainage placement and monitoring, overcoming conventional ultrasound's limitations in detecting the HA liquefied portion. Methods: We conducted a retrospective study of 50 patients with HAs confirmed via computed tomography (CT) scans. Inclusion criteria comprised specific clinical symptoms and laboratory parameters. Both B-mode and CEUS were utilized for initial and follow-up imaging. Results: In the CEUS studies, the mean size of HAs was 6.26 cm, with pus displaying significantly lower echogenicity compared to the HA pouch and liver parenchyma in all phases. Classification by size (>6 cm, <6 cm) and volume (>113 mL, <113 mL) revealed differences in the assessment of fluid volume between CEUS and B-mode. Conclusions: CEUS is valuable for diagnosing, performing therapeutic procedures, and monitoring HA. It provides precise real-time assessment of HA morphology, including dimensions and volume. If the liquefied volume of an HA exceeds 113 mL, it may qualify for drainage placement. CEUS can replace CT as an effective, less harmful, and cheaper method, eliminating the need for multiple radiological departments. While CEUS is a safer, cost-effective alternative to CT for HA evaluation and monitoring, comprehensive clinical evaluation remains essential. Therefore, CEUS should be part of a broader diagnostic and monitoring strategy, not a stand-alone solution.
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Affiliation(s)
- Adam Dobek
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Mateusz Kobierecki
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institite, 90-153 Lodz, Poland
| | - Konrad Kosztowny
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Krzysztof Falenta
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
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12
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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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13
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Isaac-Coss G, Chow A, Reddy M, Kumar V, Nawaz M. Beyond the Liver: A Unique Case of Pyogenic Liver Abscess Caused by Peptostreptococcus micros Penetrating the Chest Wall. Cureus 2024; 16:e64177. [PMID: 39119388 PMCID: PMC11309587 DOI: 10.7759/cureus.64177] [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] [Accepted: 07/06/2024] [Indexed: 08/10/2024] Open
Abstract
Liver abscesses are uncommon pyogenic infections with diverse microbiology, often involving enteric gram-negative bacilli such as Escherichia coli and Klebsiella pneumoniae. Standard management includes antibiotic therapy and abscess drainage. We present a case of a 37-year-old male with chronic right upper quadrant abdominal pain, who was found to have an enlarging liver mass infiltrating the chest wall and right-side chest ribs, ultimately diagnosed as a large pyogenic liver abscess (PLA) extending into the chest wall. Notably, the abscess was attributed to Peptostreptococcus micros, a rarely isolated pathogen in liver abscesses. Despite initial unsuccessful percutaneous drainage, surgical intervention proved necessary for definitive treatment. This case underscores the diagnostic challenge posed by uncommon pathogens in liver abscesses and emphasizes the effectiveness of surgical drainage in managing refractory cases.
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Affiliation(s)
| | - Alex Chow
- Infectious Diseases, State University of New York (SUNY) Downstate Health Sciences University, New York, USA
| | - Madhavi Reddy
- Gastroenterology and Hepatology, The Brooklyn Hospital Center, New York, USA
| | - Vikash Kumar
- Internal medicine, Jinnah Sindh Medical University, Karachi, PAK
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Mohammad Nawaz
- Gastroenterology and Hepatology, The Brooklyn Hospital Center, New York, USA
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14
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Hu Q, Lu J, Deng B, Tang X, Hou Z. Clinical characteristics, effectiveness and cost of different treatment methods for invasive Klebsiella pneumoniae liver abscess syndrome. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2024; 49:748-757. [PMID: 39174889 PMCID: PMC11341225 DOI: 10.11817/j.issn.1672-7347.2024.240063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Bacterial liver abscess is one of the common infectious diseases of the digestive system. Invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) refers to cases where, in addition to liver abscess, there are migratory infections foci or other invasive manifestations. The clinical characteristics and risk factors of IKLAS are not fully elucidated, and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods. This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS, and explore effective and economical treatment methods. METHODS This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023. A total of 201 patients were included, dividing into an IKLAS group (n=37) and a non-IKLAS group (n=164). Differences in demographics, symptoms and signs, laboratory indicators, imaging characteristics, comorbidities, treatment methods, treatment outcomes, and direct treatment costs between 2 groups were analyzed. The study also compared the effectiveness and costs of different treatment methods. RESULTS Compared with the non-IKLAS group, the proportion of patients with diabetes, Quick Sequential Organ Failure Assessment (qSOFA)≥2, immune deficiency, anemia, and thrombocytopenia in the IKLAS group was higher, and the level of procalcitonin at the onset in the IKLAS group was also higher (all P<0.05). In terms of symptoms and signs, the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain (both P<0.05). In terms of complications, the incidence of combined pleural effusion, pulmonary infection, acute renal failure, respiratory failure, and multiple organ failure was higher in the IKLAS group (all P<0.05). The IKLAS group had a higher proportion of patients treated with antibiotics alone (24.32% vs 11.59%), while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage (86.59% vs 64.86%, both P<0.05). The overall effective rate of the IKLAS group (83.78%) was lower than that of the non-IKLAS group (95.73%), and the treatment and drug costs were higher (all P<0.05). The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100% improvement rate, antibiotics combined with abscess puncture and drainage had an 84.9% improvement rate, and in antibiotics alone had an 82.1% improvement rate, with statistical differences among the 3 treatment methods (P<0.05). In terms of treatment costs, antibiotics alone were the most expensive (P<0.05). CONCLUSIONS Patients with IKLAS have poorer prognosis and higher direct medical costs. The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone, suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.
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Affiliation(s)
- Qin Hu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008.
| | - Jingying Lu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Binbin Deng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xuemei Tang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhouhua Hou
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410008, China.
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15
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Baltagiannis EG, Tsili A, Goussia A, Glantzouni A, Frigkas K, Charchanti A, Glantzounis GK, Gomatos IP. Complex cystic liver lesions: classification, diagnosis, and management. Ann Gastroenterol 2024; 37:255-265. [PMID: 38779639 PMCID: PMC11107409 DOI: 10.20524/aog.2024.0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 05/25/2024] Open
Abstract
Cystic liver disease has been increasingly reported in the literature, with a prevalence as high as 15-18%. Hepatic cysts are usually discovered incidentally, while their characterization and classification rely on improved imaging modalities. Complex cystic liver lesions comprise a wide variety of novel, re-introduced, and re-classified clinical entities. This spectrum of disorders ranges from non-neoplastic conditions to benign and malignant tumors. Their clinicopathological features, prognostic factors, and oncogenic pathways are incompletely understood. Despite representing a heterogeneous group of disorders, they can have similar clinical and imaging characteristics. As a result, the diagnosis and management of complex liver cysts can become quite challenging. Furthermore, inappropriate diagnosis and management can lead to high morbidity and mortality. In this review, we aim to offer up-to-date insight into the diagnosis, classification, and management of the most common complex cystic liver lesions.
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Affiliation(s)
- Evangelos G. Baltagiannis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina (Evangelos G. Baltagiannis, Georgios K. Glantzounis)
| | - Athina Tsili
- Department of Radiology, University Hospital of Ioannina and School of Medicine, University of Ioannina (Athina Tsili)
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina and School of Medicine, University of Ioannina (Anna Goussia)
| | - Anastasia Glantzouni
- Department of Radiology, G. Hatzikosta General Hospital, Ioannina (Anastasia Glantzouni)
| | - Konstantinos Frigkas
- Department of Radiology, University Hospital of Alexandroupolis and School of Medicine, Democritus University of Thrace, Alexandroupolis (Konstantinos Frigkas)
| | - Antonia Charchanti
- Department of Anatomy-Histology-Embryology, School of Medicine, University of Ioannina (Antonia Charchanti)
| | - Georgios K. Glantzounis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina (Evangelos G. Baltagiannis, Georgios K. Glantzounis)
| | - Ilias P. Gomatos
- Department of Transplant Surgery, “Laiko” General Hospital of Athens (Ilias P. Gomatos), Greece
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16
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Gadour E, Awad A, Hassan Z, Shrwani KJ, Miutescu B, Okasha HH. Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis. World J Gastroenterol 2024; 30:742-758. [PMID: 38515947 PMCID: PMC10950627 DOI: 10.3748/wjg.v30.i7.742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases. AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy. METHODS PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software. RESULTS Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%). CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.
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Affiliation(s)
- Eyad Gadour
- Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia
- Department of Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan
| | - Abeer Awad
- Department of Hepatogastroenterology, Kasar Alainy Hospital, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Zeinab Hassan
- Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
| | - Khalid Jebril Shrwani
- Public Health Authority, Saudi Center for Disease Prevention and Control, Jazan 45142, Saudi Arabia
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, School of Medicine and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
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17
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Decker C, Liu D. Non-Traumatic Hepatobiliary Emergencies. Surg Clin North Am 2023; 103:1171-1190. [PMID: 37838462 DOI: 10.1016/j.suc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Hepatobiliary emergencies typically present with a constellation of different symptoms including abdominal pain, fevers, nausea, vomiting, jaundice, coagulopathy, and in some instances, encephalopathy. The differential can be broad and may include infectious, inflammatory, and even iatrogenic etiologies. Workup with appropriate lab and imaging studies can help discern between different pathologies and thus guide their management. Interventions can range broadly from conservative management with medical therapy to endoscopic options or surgery. This article explores the diagnostic workup and evaluation as well as the current therapeutic interventions for a variety of these nontraumatic hepatobiliary emergencies based on the most current literature.
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Affiliation(s)
- Christopher Decker
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA.
| | - Dorothy Liu
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA
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18
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Curran J, Mulhall C, Pinto R, Bucheeri M, Daneman N. Antibiotic treatment durations for pyogenic liver abscesses: A systematic review. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2023; 8:224-235. [PMID: 38058494 PMCID: PMC10697100 DOI: 10.3138/jammi-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/03/2023] [Indexed: 12/08/2023]
Abstract
Background We sought to systematically review the existing research on pyogenic liver abscesses to determine what data exist on antibiotic treatment durations. Methods We conducted a systematic review and meta-analysis of contemporary medical literature from 2000 to 2020, searching for studies of pyogenic liver abscesses. The primary outcome of interest was mean antibiotic treatment duration, which we pooled by random-effects meta-analysis. Meta-regression was performed to examine characteristics influencing antibiotic durations. Results Sixteen studies (of 3,933 patients) provided sufficient data on antibiotic durations for pooling in meta-analysis. Mean antibiotic durations were highly variable across studies, from 8.4 (SD 5.3) to 68.9 (SD 30.3) days. The pooled mean treatment duration was 32.7 days (95% CI 24.9 to 40.6), but heterogeneity was very high (I2 = 100%). In meta-regression, there was a non-significant trend towards decreased mean antibiotic treatment durations over later study years (-1.14 days/study year [95% CI -2.74 to 0.45], p = 0.16). Mean treatment duration was not associated with mean age of participants, percentage of infections caused by Klebsiella spp, percentage of patients with abscesses over 5 cm in diameter, percentage of patients with multiple abscesses, and percentage of patients receiving medical management. No randomized trials have compared treatment durations for pyogenic liver abscess, and no observational studies have reported outcomes according to treatment duration. Conclusions Among studies reporting on antibiotic durations for pyogenic liver abscess, treatment practices are highly variable. This variability does not seem to be explained by differences in patient, pathogen, abscess, or management characteristics. Future RCTs are needed to guide optimal treatment duration for patients with this complex infection.
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Affiliation(s)
- Jennifer Curran
- Antimicrobial Stewardship Program, Sinai Health/University Health Network, Toronto, Ontario, Canada
| | | | | | - Mohamed Bucheeri
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Taddei R, Riccardi N, Tiseo G, Galfo V, Biancofiore G. Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians. Antibiotics (Basel) 2023; 12:1316. [PMID: 37627736 PMCID: PMC10451386 DOI: 10.3390/antibiotics12081316] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Despite recent advances in the transplant field, infectious complications after orthotopic liver transplantation (OLT) are major causes of morbidity and mortality. Bacterial intra-abdominal infections (IAIs) are predominant during the first month post-transplantation and affect patient and graft survival. Recently, the emergence of multidrug resistant bacteria has generated great concern in OLT patients. We performed this narrative review of the literature in order to propose a "ready-to-use" flowchart for reasoned empirical antibiotic therapy in the case of suspected post-OLT IAIs. The review was ultimately organized into four sections: "Epidemiology and predisposing factors for IAI"; "Surgical-site infections and perioperative prophylaxis"; "MDRO colonization and infections"; and "Reasoned-empirical antibiotic therapy in early intra-abdominal infections post OLT and source control". Multidisciplinary teamwork is warranted to individualize strategies for the prevention and treatment of IAIs in OLT recipients, taking into account each patient's risk factors, the surgical characteristics, and the local bacterial epidemiology.
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Affiliation(s)
- Riccardo Taddei
- Division of Transplant Anesthesia and Critical Care, Department of Anesthesia, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy; (N.R.); (G.T.); (V.G.)
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy; (N.R.); (G.T.); (V.G.)
| | - Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy; (N.R.); (G.T.); (V.G.)
| | - Giandomenico Biancofiore
- Division of Transplant Anesthesia and Critical Care, Department of Anesthesia, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
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20
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Bläckberg A, Jönsson A, Svensson E, Sunnerhagen T, Kiasat A, Ljungquist O. A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess. Open Forum Infect Dis 2023; 10:ofad352. [PMID: 37547858 PMCID: PMC10400158 DOI: 10.1093/ofid/ofad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pyogenic liver abscess (PLA) is a rare entity that is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.1-3.9]), malignancy (OR, 3.7 [95% CI, 1.9-7.1]), liver failure (OR, 6.3 [95% CI, 2.7-14.5]), and polymicrobial findings (OR, 3.8 [95% CI, 2.2-6.9]) were associated with death within 90 days (P < .05). Male sex (OR, 2.1 [95% CI, 1.2-3.6]), malignancy (OR, 2.1 [95% CI, 1.3-3.6]), age (64-74 years: OR, 2.5 [95% CI, 1.3-4.8]), and chronic liver disease (OR, 3.0 [95% CI, 1.4-6.5]) were associated with the risk of subsequent PLA (P ≤ .01). Conclusions Identifying different clinical variables associated with an unfavorable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.
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Affiliation(s)
- Anna Bläckberg
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden
| | - Ali Kiasat
- Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Ljungquist
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
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Chan KS, H’ng MWC, Shelat VG. Is there a role for percutaneous needle aspiration in the multimodal management of pyogenic liver abscess? ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:306. [PMID: 37404991 PMCID: PMC10316104 DOI: 10.21037/atm-23-1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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22
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Obed A, Abuassi M, Alsakarneh S, Jaber F, Fakhri M, Abufares F, Bashir A, Syam M, Jarrad A, Abdelhadi O, Ghoz H. Does Liver Resection Remain a Viable Option in Patients With Pyogenic Liver Abscess? A Single-Center Experience. Gastroenterology Res 2023; 16:184-191. [PMID: 37351080 PMCID: PMC10284645 DOI: 10.14740/gr1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Pyogenic liver abscesses (PLAs) are relatively rare but often fatal if left untreated. Antibiotic therapy combined with percutaneous procedures has replaced surgery as the cornerstone of treatment. However, open surgical drainage or liver resection may be a last resort. This study aimed to review our experience in treating PLA, with a focus on the conditions requiring partial liver resection as the last viable curative option. Medical records of patients with PLA admitted to Jordan Hospital between October 2014 through October 2020 were retrospectively reviewed. Medical and demographic data of all 43 patients admitted to our facility with a diagnosis of PLA were extracted. We reviewed these patients and extracted the cases that required surgical intervention. Four (three males and one female) of the 43 patients with PLA required surgical intervention. The underlying causes of liver abscesses were as follows: one traumatic due to shrapnel injury from an explosion, one following chemoembolization for hepatocellular carcinoma, and two patients with no apparent etiology. All patients were diagnosed with a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Two patients had negative cultures. All patients received broad-spectrum antibiotics, and all underwent CT- or ultrasound-guided percutaneous drainage or aspiration. All four patients required partial hepatic resection due to treatment failure or inaccessible percutaneous procedures with clinical improvement. Although antimicrobial and interventional therapy remains the primary treatment option in PLA, the surgical option with open surgical drainage or partial liver resection remains viable and curative in selected patients.
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Affiliation(s)
- Aiman Obed
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mohammad Abuassi
- Internal Medicine Department, Jordan Hospital, Amman, Jordan
- These authors contributed equally to this study
| | - Saqr Alsakarneh
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
- These authors contributed equally to this study
| | - Fouad Jaber
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mahmoud Fakhri
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Fadi Abufares
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Abdalla Bashir
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mahmood Syam
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Anwar Jarrad
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Ody Abdelhadi
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Hassan Ghoz
- Gastroenterology Department, University of Missouri-Kansas City, Kansas City, MO, USA
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23
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JinHua C, YaMan L, Jian L. Double pigtail tube drainage for large multiloculated pyogenic liver abscesses. Front Surg 2023; 9:1106348. [PMID: 36713673 PMCID: PMC9877412 DOI: 10.3389/fsurg.2022.1106348] [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: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aims to investigate the efficacy and safety of double pigtail tube drainage compared with single pigtail tube drainage for the treatment of multiloculated pyogenic liver abscesses greater than 5 cm. Patients and Methods This study retrospectively analyzed patients with pyogenic liver abscess admitted in the Affiliated Hospital of Chengde Medical College between May 2013 and May 2021. Patients with pyogenic liver abscess more than 5 cm in size, who underwent drainage of the abscess with either double pigtail or single pigtail tube, were included. Results A total of 97 patients with pyogenic liver abscesses larger than 5 cm were studied. These included 34 patients with double pigtail tube drainage and 63 patients with single pigtail tube drainage. The postoperative hospital stay (13.39 ± 4.21 days vs. 15.67 ± 7.50 days; P = 0.045), and time for removal of the catheter (17.23 ± 3.70 days vs. 24.11 ± 5.83 days; P = 0.038) were lower in the double pigtail tube group compared with the single pigtail tube group. The rate of reduction, in three days, of c-reactive protein levels was 26.61 ± 14.11 mg/L/day in the double pigtail tube group vs. 20.06 ± 11.74 mg/L/day in the single pigtail tube group (P = 0.025). The diameter of the abscess cavity at discharge was 3.1 ± 0.07 cm in the double pigtail tube group as compared with 3.7 ± 0.6 cm in the single pigtail tube group (P = 0.047). There was no bleeding in any of the patients despite abnormal coagulation profiles. There was no recurrence of abscess within six months of discharge and no death in the double pigtail tube group. Conclusion: Double pigtail tube drainage treatment in multiloculated pyogenic liver abscesses greater than 5 cm in size, is safe and effective.
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Affiliation(s)
- Cui JinHua
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Liu YaMan
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Li Jian
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China,Correspondence: Li Jian
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24
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Nie S, Lin D, Li X. Clinical characteristics and management of 106 patients with pyogenic liver abscess in a traditional Chinese hospital. Front Surg 2023; 9:1041746. [PMID: 36684358 PMCID: PMC9852512 DOI: 10.3389/fsurg.2022.1041746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
This is a retrospective study of clinical data from 106 patients with pyogenic liver abscess (PLA) treated in a traditional Chinese hospital during the eight years preceding this publication. We aimed to provide evidence to improve the diagnosis accuracy and the treatment strategies for PLAs. We collected records of patients treated at the Guangxing Hospital, which is affiliated to the Zhejiang Traditional Chinese University in Hangzhou, and we collected their general background information, laboratory and imaging features, and clinical manifestations and outcomes to perform a retrospective analysis. Diabetes mellitus (45.3%, 48/106), biliary calculi (36.8%, 39/106), and history of abdominal surgery (15.1%, 16/106) were the three most common PLA risk factors present in our cohort. Fever and chills (95.3%, 101/106), right upper quadrant pain/epigastric discomfort (68.9%, 73/106), nausea and vomiting (38.8%, 41/106), and cough and sputum (14.2%, 15/106) were the most common clinical manifestations of PLA. Most patients had the abscesses in the right liver lobe, and the most commonly found bacteria were Klebsiella pneumoniae (54.8%, 42/76), Escherichia coli (35.1%, 27/76), and Streptococcus pneumoniae (3.9%, 3/76). Liver Doppler ultrasound is a conventional and effective method to identify liver abscesses. Most patients were treated using a percutaneous puncture under B-ultrasound guidance. Most patients (n = 104 or 98.1%) were cured, one patient (0.9%) died, and one was discharged with multiple abscesses post treatment.
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Affiliation(s)
- ShiJiao Nie
- Department of Hospital Infection Management, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Da Lin
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - XiaoWen Li
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,Correspondence: XiaoWen Li
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25
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Lam JC, Lang R, Stokes W. How I manage bacterial prostatitis. Clin Microbiol Infect 2023; 29:32-37. [PMID: 35709903 DOI: 10.1016/j.cmi.2022.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bacterial prostatitis is a highly prevalent infection responsible for significant morbidity among men. The diagnosis and treatment for bacterial prostatitis remains complicated. The difficulty in diagnosis is in part owing to the paucity of high-quality evidence that guides a clinician's interpretation of patients' history, physical examination, and laboratory findings. Treatment is challenging because of the few antimicrobials capable of prostate penetration, growing antimicrobial resistance limiting effective treatment options, and the high risk of recurrence. OBJECTIVES We aimed to provide a useful resource for clinicians in effectively diagnosing and managing acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). SOURCES A PubMed literature search on prostatitis was performed with no restrictions on publication date. CONTENT The epidemiology, pathophysiology, diagnosis, and treatment for ABP and CBP are explored using a clinical vignette as relevant context. IMPLICATIONS Bacterial prostatitis can be diagnosed through a focused history and microbiological investigations. The Meares-Stamey 4-glass test or modified 2-glass test can help confirm the diagnosis if uncertainty exists. Typical uropathogens are common contributors to bacterial prostatitis but there is growing interest in exploring the role atypical and traditional non-pathogenic organisms may have. Fluoroquinolones remain first-line therapy, followed by trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline if the pathogen is susceptible. Fosfomycin has emerged as a repurposed and useful agent because of the increasing incidence of multidrug-resistant pathogens. Selection of appropriate antimicrobial regimens can be challenging and is dependent on the host, chronicity of symptoms, uropathogens' susceptibilities, antimicrobials' side effect profile, and the presence of prostatic abscesses or calcifications. ABP can typically be treated similar to other complicated urinary tract infections. However, CBP requires prolonged therapy, with a minimum of 4 weeks and up to 12 weeks of therapy.
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Affiliation(s)
- John C Lam
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States.
| | - Raynell Lang
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William Stokes
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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Muacevic A, Adler JR, Orlando M, Boyd S, Kulchinsky R. Acute Liver Failure Secondary to Pyogenic Hepatic Abscess. Cureus 2023; 15:e34258. [PMID: 36855481 PMCID: PMC9968402 DOI: 10.7759/cureus.34258] [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] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
Hepatic abscesses are rare and can be pyogenic or amebic. Pyogenic hepatic abscesses are treated with antibiotics, percutaneous drainage when larger than 5 cm, and rarely requires surgical treatment. Clinical and laboratory manifestations of pyogenic hepatic abscesses include fever, abdominal pain, and elevations in liver enzymes. There is little documentation that a pyogenic hepatic abscess can cause acute liver failure. We present a case of a patient who developed acute liver failure secondary to a 14 cm pyogenic liver abscess. The patient's hepatic function normalized with percutaneous drain placement and antibiotics.
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27
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Abstract
Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.
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Affiliation(s)
- Vikram Saini
- Division of Infectious Disease (Drs Saini and Bhanot), Division of Pulmonary and Critical Care Medicine (Drs Saini and Ashraf), Department of General Surgery (Dr Babowice), and Division of Trauma Surgery and Surgical Critical Care (Ms Hamilton and Dr Khan), Allegheny Health Network, Pittsburgh, Pennsylvania
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28
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Ishihara Y, Kaneshiro S, Ikehara Y. Giant liver abscess with Streptococcus intermedius bacteremia treated without any drainage. IDCases 2022; 31:e01662. [PMID: 36589763 PMCID: PMC9801097 DOI: 10.1016/j.idcr.2022.e01662] [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: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
A 66-year-old man with hypertension presented with fever which has started three days prior. Computed tomography (CT) revealed the presence of multiple low-density areas in the liver, the largest of which was over 10 cm in diameter, with clear demarcation. Streptococcus intermedius was detected in the blood culture, thus we diagnosed suspected liver abscess with bacteremia. Because the patient refused invasive drainage and was not poor general appearance, we had initiated intravenous meropenem followed by ceftriaxone plus metronidazole without any abscess drainage. After 6 weeks antibiotics treatment, liver abscess was almost completely diminished on the CT scan. To the best of our knowledge, this is the first report of a giant liver abscess caused by Streptococcus intermedius treated successfully without drainage.
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Affiliation(s)
- Yo Ishihara
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan,Correspondence to: Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanagawa 247-8533, Japan.
| | - Sayaka Kaneshiro
- Department of General Internal Medicine, Uji Tokushukai Hospital, Kyoto, Japan
| | - Yasukazu Ikehara
- Department of Surgery, Ishigakijima Tokushukai Hospital, Okinawa, Japan
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29
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Liu Y, Li Z, Liu A, Xu J, Li Y, Liu J, Liu Y, Zhu H. Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study. Ann Med 2022; 54:2269-2277. [PMID: 35975970 PMCID: PMC9387318 DOI: 10.1080/07853890.2022.2110612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Percutaneous catheter drainage (PCD) has been viewed as first-line treatment for pyogenic liver abscess (PLA), yet detailed guidance is lacking for best practice of PCD. This study investigated characteristics of patients with PLA who had received PCD, identified factors associated with prolonged fever, and aimed to evaluate the relationship between timing of PCD and clinical improvement. METHODS This was a retrospective study of patients with PLA who had undergone PCD over a 7-year period. PCD performed when the liquefaction degree of abscesses was less than 30% and/or within 1 week after fever onset was defined as early PCD. Patients were grouped and analysed based on the timing of PCD (early vs. delayed). Factors associated with prolonged fever were also analysed using univariate and multivariate logistic regression. RESULTS Among 231 patients with PLA, 81 treated with PCD were included in the study after exclusion. The size of abscesses ranged from 3.4 to 16 cm in diameter. Interestingly, the abscesses were predominantly multiloculated in this cohort (82.7%). The most common pathogen isolated from pus was Klebsiella pneumoniae (60.5%), followed by Escherichia coli (8.6%). The duration of fever was significantly shortened with early PCD as compared to delayed PCD intervention (p = .042). No statistical differences were found between the two groups with regard to catheter adjustment and salvage drainage. Maximum body temperature and diameter of abscess > 7.5 cm were found to be associated with prolonged fever while early PCD was inversely related to prolonged fever. Multivariate analysis suggested that early PCD treatment was an independent protective factor of prolonged fever (p = .030). CONCLUSIONS Large abscesses with loculation could be successfully treated with PCD, and early PCD protected patients with PLA from prolonged fever. Our findings suggest that early intervention should be provided if PCD is indicated in clinical practice.KEY MESSAGESLarge abscesses and multiloculated abscesses can be treated with percutaneous catheter drainage.Early percutaneous catheter drainage is identified as a protective factor of prolonged fever among patients with pyogenic liver abscesses.Early intervention should be provided if percutaneous catheter drainage is indicated for pyogenic liver abscesses.
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Affiliation(s)
- Yang Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zexi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anlei Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Xu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jihai Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yecheng Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Al‐Sayaghi KM, Alhujaily M, Zaky MK, Alhasan AS, Babikir TB, Alnehmi FS, Abdalrahman HH, Abdelmalik MAA, Ali AM, Fadlalmola HA, Swamy DSV. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: an updated systematic review and meta‐analysis. ANZ J Surg 2022; 93:840-850. [PMID: 36285842 DOI: 10.1111/ans.18129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD). METHODS A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software. RESULTS Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR = 1.23; 95% CI [1.12, 1.36], P < 0.00001), time for achieving 50% reduction of cavity size (MD = -2.32; 95% CI [-3.07, -1.57], P < 0.00001), and time for clinical improvement (MD = -1.92; 95% CI [-2.55, -1.28], P < 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P = 0.36, P = 0.06 and P = 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P = 0.39). CONCLUSION PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.
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Affiliation(s)
- Khaled Mohammed Al‐Sayaghi
- Department of Medical Surgical Nursing, College of Nursing Taibah University Al‐Madinah Al‐Munawarah Saudi Arabia
- Nursing Division, Faculty of Medicine and Health Sciences Sana'a University Sana'a Yemen
| | - Muhanad Alhujaily
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences University of Bisha Bisha Saudi Arabia
| | - Mohamed Khaled Zaky
- Department of Surgery, College of Medicine Taibah University Al‐Madinah Al‐Munawarah Saudi Arabia
- Department of Surgery, College of Medicine Cairo University Cairo Egypt
| | - Ayman S. Alhasan
- Department of Radiology, College of Medicine Taibah University Medina Saudi Arabia
| | | | - Fawwaz Saleh Alnehmi
- Department of Radiology, Prince Mohammed Bin AbdulAziz Hospital Ministry of National Guard Health Affairs Medina Saudi Arabia
| | | | - Mohammed Abdelkrim Adam Abdelmalik
- Department of Nursing, College of Applied Medical Sciences Shaqra University Shaqra Saudi Arabia
- Faculty of Medicine and Health Sciences, Nursing University of El Imam El Mahdi Kosti Kosti Sudan
| | - Adel Mohamed Ali
- College of Applied Medical Sciences Shaqra University Shaqra Saudi Arabia
| | - Hammad Ali Fadlalmola
- Department of Community Health Nursing, College of Nursing Taibah University Al‐Madinah Al‐Munawarah Saudi Arabia
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31
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Chan KS, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Aging is Associated with Prolonged Hospitalisation Stay in Pyogenic Liver Abscess-A 1:1 Propensity Score Matched Study in Elderly Versus Non-Elderly Patients. Malays J Med Sci 2022; 29:59-73. [PMID: 36474543 PMCID: PMC9680999 DOI: 10.21315/mjms2022.29.5.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mortality of pyogenic liver abscess (PLA) is high ranging 10%-40%. Old age predicts outcomes in many diseases but there is paucity of data on PLA outcomes. We aim to compare the morbidity and mortality between elderly and non-elderly in PLA. METHODS This is a retrospective study from 2007-2011 comparing elderly (≥ 65 years old) and non-elderly (< 65 years old) with PLA. A 1:1 propensity score matching (PSM) was performed. Baseline clinical profile and outcomes were compared. RESULTS There were 213 patients (elderly patients = 90 [42.3%], non-elderly patients = 123 [57.7%]). Overall median age is 62 (interquartile range [IQR] = 53-74) years old. PSM resulted in 102 patients (51 per arm). Length of hospitalisation stay (LOS) was significantly longer in elderly patients in both unmatched (16 [IQR = 10-24.5] versus 11 [IQR = 8-19] days; P < 0.001) and matched cohorts (17 [IQR = 13-27] versus 11 [IQR = 7-19] days; P = 0.001). In-hospital mortality was significantly higher in elderly patients in the unmatched cohort (elderly patients = 21.1%, non-elderly patients = 7.3%; P = 0.003) but was insignificant following PSM (elderly patients = 15.7%, non-elderly patients = 9.8%; P = 0.219). Duration of antibiotic therapy and need for percutaneous drainage (PD) were comparable before and after PSM. CONCLUSION Age ≥ 65 years old is associated with longer LOS. In-hospital mortality though higher in elderly patients, was not statistically significant.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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32
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Priyadarshi RN, Kumar R, Anand U. Amebic liver abscess: Clinico-radiological findings and interventional management. World J Radiol 2022; 14:272-285. [PMID: 36160830 PMCID: PMC9453321 DOI: 10.4329/wjr.v14.i8.272] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 02/08/2023] Open
Abstract
In its classic form, amebic liver abscess (ALA) is a mild disease, which responds dramatically to antibiotics and rarely requires drainage. However, the two other forms of the disease, i.e., acute aggressive and chronic indolent usually require drainage. These forms of ALA are frequently reported in endemic areas. The acute aggressive disease is particularly associated with serious complications, such as ruptures, secondary infections, and biliary communications. Laboratory parameters are deranged, with signs of organ failure often present. This form of disease is also associated with a high mortality rate, and early drainage is often required to control the disease severity. In the chronic form, the disease is characterized by low-grade symptoms, mainly pain in the right upper quadrant. Ultrasound and computed tomography (CT) play an important role not only in the diagnosis but also in the assessment of disease severity and identification of the associated complications. Recently, it has been shown that CT imaging morphology can be classified into three patterns, which seem to correlate with the clinical subtypes. Each pattern depicts its own set of distinctive imaging features. In this review, we briefly outline the clinical and imaging features of the three distinct forms of ALA, and discuss the role of percutaneous drainage in the management of ALA.
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Affiliation(s)
- Rajeev Nayan Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
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Li F, Zheng W, Yu J, Zhao L. Klebsiella pneumoniae liver abscess with purulent meningitis and endogenous endophthalmitis: A case report. Front Surg 2022; 9:894929. [PMID: 36090343 PMCID: PMC9448882 DOI: 10.3389/fsurg.2022.894929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
This is a rare but typical case of a Klebsiella pneumoniae liver abscess with migratory infections including purulent meningitis and endogenous endophthalmitis. The patient had a chief complaint of 7 days of fever, 4 days of blurry vision, and 4 h of glossolalia. Ultrasound scan and computed tomography (CT) suggested a liver abscess. Both blood and drainage fluid cultures grew K. pneumoniae with a high mucosal phenotype. The patient was finally diagnosed with a K. pneumoniae liver abscess, purulent meningitis, and endogenous K. pneumoniae endophthalmitis in the right eye. Ultrasound-guided percutaneous catheter drainage (PCD) of the liver abscess was performed, and meropenem was used to control infection. The patient was given 0.1 ml of vancomycin (10 g/L) and 0.1 ml of ceftazidime (20 g/L) were by intravitreal injection for the treatment of endophthalmitis. The infection was gradually controlled after such treatments. The patient was discharged from our hospital with an improved condition. However, during the time of follow-up, she developed complications due to severe pneumonia and eventually died in a local hospital. This case revealed that a rapid diagnosis followed by appropriate treatment would improve prognosis and prevent severe metastatic complications.
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Affiliation(s)
- Fang Li
- Department of Stroke Center, Dalian Municipal Central Hospital, Dalian, China
| | - Wenfei Zheng
- Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jian Yu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
- Correspondence: Zhao Linyan Yu Jian
| | - Linyan Zhao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
- Correspondence: Zhao Linyan Yu Jian
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Cecchini A, Othman A, Burgess R, Sadiq MS, Cecchini A. Liver Abscess Formation After Laparoscopic Radiofrequency Ablation of Metastatic Colon Cancer. Cureus 2022; 14:e27556. [PMID: 36059345 PMCID: PMC9429521 DOI: 10.7759/cureus.27556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/05/2022] Open
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Abello Vaamonde JA, White EG, López AM, Lorenzo Silva JM. Minimally invasive treatment of an amebic empyema secondary to the transdiaphragmatic rupture of a liver abscess: a case report. J Surg Case Rep 2022; 2022:rjac334. [PMID: 35892123 PMCID: PMC9307268 DOI: 10.1093/jscr/rjac334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
Liver abscesses are a common complication in patients with amebiasis. Rarely, these will rupture across the diaphragm causing life-threatening empyemas. Evidence justifies performing surgical debridement or decortication for their treatment, given the better overall performance in comparison to open surgeries. However, no current guideline specifies which is the best approach. This report presents the case of a 39-year-old male with clinical, radiographical and microbiological evidence of an amebic empyema secondary to an amebic liver abscess, who received treatment by video-assisted thoracoscopy. The case description highlights the surgical technique, findings and operative outcomes that could be taken into consideration by other physicians to timely manage similar cases. The latter is especially relevant in underdeveloped and developing countries, where the burden of amebiasis appears to be greater. To the best of the authors’ knowledge, this is the first description of a transdiaphragmatic amebic infection treated in a minimally invasive fashion.
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Affiliation(s)
| | - Elizabeth Gil White
- Thoracic Surgery Division, Hospital Español de Mexico, Ciudad de Mexico, Mexico
| | - Alfredo Muñoz López
- Thoracic Surgery Division, Hospital Español de Mexico, Ciudad de Mexico, Mexico
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36
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Chen G, Tuan S, Ou T. Unusual abdominal gas bubbles in a middle‐aged diabetic female. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guan‐Bo Chen
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
| | - Sheng‐Hui Tuan
- Department of Rehabilitation Medicine Cishan Hospital, Ministry of Health and Welfare Kaohsiung Taiwan
- Department of Physical Therapy Shu‐Zen Junior College of Medicine and Management Kaohsiung Taiwan
| | - Tzu‐Ming Ou
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
- Division of Gastroenterology, Department of Internal Medicine Tri‐Service General Hospital, National Defense Medical Center Taipei Taiwan
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Rossi G, Nguyen Y, Lafont E, Rossi B, Canouï E, Roux O, Dokmak S, Bert F, Fantin B, Lefort A. Large retrospective study analysing predictive factors of primary treatment failure, recurrence and death in pyogenic liver abscesses. Infection 2022; 50:1205-1215. [PMID: 35316531 DOI: 10.1007/s15010-022-01793-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Pyogenic liver abscess (PLA) is a severe disease, which unfavourable evolution remains frequent. Our objective was to assess predictive factors of unfavourable outcome in patients with PLA. METHODS We conducted a retrospective study in a French tertiary care centre. All patients admitted for PLA between 2010 and 2018 were included. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence of PLA after an initial cure, or death within 3 months after diagnosis. Hazard ratios (95% CI) were calculated with multivariable Cox proportional hazard models. RESULTS 302 patients were included among which 91 (30.1%) patients had an unfavourable outcome because of PTF, recurrence or death in 55 (18.2%), 28 (9.2%) and 32 (10.6%) patients, respectively. Hepatic metastases (HR 2.08; 95% CI 1.04-4.15), a nosocomial infection (2.25; 1.14-4.42), portal thrombosis (2.12; 1.14-3.93), and the isolation of Enterococcus spp. (2.18; 1.22- 3.90) were independently associated with PTF. Ischemic cholangitis (6.30; 2.70-14.70) and the isolation of Streptococcus spp. (3.72; 1.36-10.16) were associated with the risk of recurrence. Charlson comorbidity index (HR 1.30 per one point; 95% CI 1.15-1.46; p < 0.001), portal thrombosis (3.53; 1.65-7.56) and the presence of multi-drug-resistant organisms (3.81; 1.73-8.40) were associated with mortality within 3 months following PLA diagnosis. PLA drainage was the only factor associated with a lower mortality (0.14; 0.06-0.34). CONCLUSION Identification of specific risk factors may help to improve the management of PLA and to elaborate targeted recommendations according to patient's and disease's characteristics.
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Affiliation(s)
- Geoffrey Rossi
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Yann Nguyen
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Emmanuel Lafont
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Benjamin Rossi
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600, Aulnay-sous-bois, France
| | - Etienne Canouï
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Olivier Roux
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Safi Dokmak
- Service de Chirurgie Viscérale Et Digestive, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Frédéric Bert
- Service de Microbiologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Bruno Fantin
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600, Aulnay-sous-bois, France
| | - Agnès Lefort
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
- IAME, UMR1137, Université de Paris and INSERM, Paris, France.
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Prasad D, Ahmad M, Katyal S, Thakral AK, Husain M, Mohsin M. Large Solitary Pyogenic Liver Abscesses: A Review of Their Management at a Tertiary Care Hospital. Cureus 2022; 14:e23170. [PMID: 35433141 PMCID: PMC9008598 DOI: 10.7759/cureus.23170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Liver abscesses are one of the common surgical diseases to be treated as an emergency in any tertiary care hospital in India. The formation of abscesses in the liver is still a major problem and associated with significant morbidity in developing countries. We come across all types of liver abscesses, such as amoebic (most common), pyogenic, mixed, and occasionally fungal. There have been several studies on the percutaneous modality of treatment for pyogenic liver abscesses. Most of the studies suggest that percutaneous catheter drainage (PCD) offers a better approach than aspirations for treating pyogenic liver abscesses. However, a few recent studies suggest that percutaneous aspiration leads to equally good results when compared to percutaneous drainage. In this study, we aimed to review the management of solitary large pyogenic liver abscesses and to assess the effectiveness of ultrasonography (USG)-guided aspiration in the procedure. Methods A retrospective study was carried out at the Department of General Surgery of our institute. In this study, a total of 27 patients treated for solitary pyogenic liver abscess were included. All patients with a large liver abscess greater than 5 cm without the features of frank peritonitis were included. These patients were followed up regularly for six months. Results The single-attempt USG-guided aspiration was successful in 70.3% of patients. Repeat USG-guided aspiration was performed in 18.5% of patients. In 7.4% of patients, a USG-guided percutaneous pigtail catheter was placed. And only 3.7% of cases required exploratory laparotomy. Conclusion Based on our findings, USG-guided aspiration is a fairly efficient method for treating a large solitary pyogenic abscess with acceptable results, shorter hospital stays, and minimal complications.
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Cheng KL, Huang YK. Pyogenic liver abscesses with an elevated carcinoembryonic antigen level. J Med Ultrasound 2022; 30:226-228. [DOI: 10.4103/jmu.jmu_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/04/2022] Open
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40
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Chan KS, Shelat V. Pyogenic Liver Abscess. THE IASGO TEXTBOOK OF MULTI-DISCIPLINARY MANAGEMENT OF HEPATO-PANCREATO-BILIARY DISEASES 2022:509-519. [DOI: 10.1007/978-981-19-0063-1_66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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Ndong A, Tendeng JN, Diallo AC, Dieye A, Diao ML, Diallo S, Diop S, Diallo MK, Diedhiou M, Fall ML, Ma Nyemb PM, Konaté I. Efficacy of laparoscopic surgery in the treatment of hepatic abscess: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 75:103308. [PMID: 35198179 PMCID: PMC8850317 DOI: 10.1016/j.amsu.2022.103308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Liver abscess is a common cause of intra-abdominal infection and its treatment depends on the presentation. Laparoscopy, in addition to its classic benefits, has particular advantages in the management of liver abscess but its role is not well defined and studies done in that field are heterogenous. The objective of this systematic review is to evaluate the efficacy of laparoscopic surgery in the management of liver abscess. Methods We realized a systematic review and meta-analysis including studies published in the 20 last years. The primary outcome was the pooled prevalence of recurrent or residual liver abscess after laparoscopic treatment. Results We retrieved 190 studies regarding laparoscopic surgery in liver abscess and 17 studies were included in the quantitative and qualitative synthesis. A total of 608 patients was included and 299 of them (49.1%) were treated by laparoscopic surgery. The indications were mainly failure of first line treatment (antibiotic treatment and/or percutaneous drainage and/or needle aspiration) and ruptured multiloculated, or caudate lobe liver abscess. The surgical gesture performed was laparoscopic drainage in all studies. The post-operative rate of recurrent or residual liver abscess after treatment by laparoscopy was 4.22% (95% CI: 2.29–7.07). Conclusions This systematic review showed that laparoscopic drainage had a considerable place in the management. The post-operative rate of recurrence was low with no mortality suggesting that laparoscopy is safe and feasible for liver abscess management.
Surgery in the treatment for liver abscess has its indications limited to ruptured liver abscess, particularly in the peritoneal cavity. Laparoscopy can be used both for unruptured and ruptured liver abscess when there are failure or contraindications of percutaneous drainage. This review suggest the safety and feasibility of laparoscopy with a low rate of post-operative recurrent or residual liver abscess.
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Affiliation(s)
- Abdourahmane Ndong
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
- Corresponding author. @DrNdong
| | | | | | - Alassane Dieye
- Department of Infectious Diseases, Gaston Berger University, Saint-Louis, Senegal
| | | | - Sidy Diallo
- Department of Hepato-Gastro-Enterology, Gaston Berger University, Saint-Louis, Senegal
| | - Saer Diop
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - Mamadou Ka Diallo
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - Moustapha Diedhiou
- Department of Anaesthesiology, Gaston Berger University, Saint-Louis, Senegal
| | - Mohamed Lamine Fall
- Department of Anaesthesiology, Gaston Berger University, Saint-Louis, Senegal
| | | | - Ibrahima Konaté
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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Kumar S, Midha NK, Ahari K, Kumar D, Gopalakrishnan M, Kumar B, Bohra GK, Garg P, Sureka B, Garg MK. Role of Pigtail Catheter Drainage Versus Percutaneous Needle Aspiration in the Management of Liver Abscess: A Retrospective Analysis. Cureus 2021; 13:e20528. [PMID: 35070562 PMCID: PMC8767523 DOI: 10.7759/cureus.20528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction A liver abscess is an important health concern in tropical countries. Effective management of liver abscesses includes appropriate antibiotics and drainage of the abscess cavity. Percutaneous abscess drainage by pigtail catheterization is now gaining popularity. We analyzed the role of pigtail catheter drainage over percutaneous aspiration in the treatment of liver abscesses. Methods and material This was a retrospective analytical study conducted in a tertiary care center in western India. Patients of age ≥ 18 years admitted with the diagnosis of liver abscess were included in this study. To find the effectiveness of different treatment modalities, data were analyzed in three groups: Group A (Conservative treatment), Group B (Percutaneous needle aspiration), and Group C (Pigtail catheter drainage). Results A total of 64 patients with a liver abscess were analyzed. There was male predominance (93.75%). Mean abscess volume in Group C (307.9 ± 212.8 ml) was significantly higher when compared to Group A (130.8 ± 72.9 ml, p = 0.03) and Group B (177.2 ± 129.5; p = 0.024). The duration of hospital stay and residual abscess volume at the time of discharge did not show a statistically significant difference between treatment groups. Pigtail catheterization of abscesses with volume >150 ml shortened the hospital stay, whereas it prolonged the hospital stay in patients with abscess volume <150 ml. Conclusion Percutaneous pigtail catheterization would be an operative decision for the management of liver abscess. We concluded that the use of pigtail catheterization of patients with abscess volume > 150 ml improved the clinical outcome.
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Kania BE, Koj J, Farokhian A, Mekheal N, Bellardini A. Pyogenic Liver Abscess Secondary to Appendicitis. Cureus 2021; 13:e19188. [PMID: 34873528 PMCID: PMC8635680 DOI: 10.7759/cureus.19188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
A pyogenic liver abscess secondary to appendicitis infection is a rare manifestation that has not been well illustrated in the United States due to its infrequency and the variability of each clinical presentation. Here, we discuss a 55-year-old male who presented with abdominal pain, fever, chills, and weight loss and was found to have a pyogenic liver abscess suspected secondary to radiographic-proven acute appendicitis. The purpose of this article is to describe a patient who presented with noteworthy clinical features and a rare cause of hepatic abscess, to aid in the treatment and diagnosis of future patients.
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Affiliation(s)
- Brooke E Kania
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Jalal Koj
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Alisa Farokhian
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Nader Mekheal
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Angelo Bellardini
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
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Sbeit W, Kadah A, Mahamid M, Mari A, Khoury T. A state-of-the-art comprehensive review summarizing the emerging data on endoscopic ultrasound-guided liver diseases management. Eur J Gastroenterol Hepatol 2021; 33:e13-e20. [PMID: 32804852 DOI: 10.1097/meg.0000000000001893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Liver diseases are among the most common diseases worldwide accounting for substantial morbidity and mortality. Most liver diseases necessitate radiological evaluation or accurate diagnosis and recently for management as well. In the last decade, the application of therapeutic endoscopic ultrasound (EUS) procedure has been increasingly utilized for the management of various liver diseases. In this comprehensive narrative review article, we provide systematic overview on EUS-guided therapeutic interventions in various liver diseases summarizing most updated data regarding technical success, outcomes and safety profiles. Overall, 35 articles have reported on the use of EUS in the treatment of liver diseases with excellent technical success, favorable radiological response and high safety profiles for EUS-guided treatment of solid and cystic liver lesion and for EUS-guided angiotherapy for gastric varices, except for EUS-guided cyanoacrylate glue injection which was associated with life-threatening fatal systemic embolization adverse events. This suggests that EUS-guided intervention is a new promising therapeutic intervention for the treatment of various liver diseases with durable effect and a limited potential for adverse events.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
| | - Mahmud Mahamid
- Gastroenterology Department, Sharee Zedek Medical Center, Jerusalem
| | - Amir Mari
- Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed
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Juwita PM, Yudhawati R. Secondary pleuropulmonary amoebiasis due to liver abscess rupture: A complication case report in low resource setting. Int J Surg Case Rep 2021; 85:106231. [PMID: 34314973 PMCID: PMC8326431 DOI: 10.1016/j.ijscr.2021.106231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pleuropulmonary amoebiasis caused by complications of amoebic liver abscess (ALA) is rare. CASE PRESENTATION A 23 years old male, presented with shortness of breath, cough with yellowish phlegm, right chest pain, fever, bulging stomach, yellow eyes, and swelling of both legs. Abdominal ultrasound and CT scan thorax and abdomen revealed right fluidopneumothorax and liver abscess. Serological testing leads to Entamoeba histolytica infection, which was treated with metronidazole but no significant improvement on empyema and abscess liver size. Surgery was performed after percutaneous aspiration drainage failed to evacuate the abscess. HE and PAS staining from surgical tissue showed Entamoeba hystolitica infection. DISCUSSION Serological testing and radiological examination will be more useful in the early detection of cases of Entamoeba hystolitica infection. Surgery may be considered when purulent drainage does not show improvement in the patient's condition. CONCLUSION ALA complication that causes pulmonary empyema can be surgically treated if the pus cannot be drained.
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Affiliation(s)
- Putri Mega Juwita
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Resti Yudhawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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Peters L, Burkert S, Grüner B. Parasites of the liver - epidemiology, diagnosis and clinical management in the European context. J Hepatol 2021; 75:202-218. [PMID: 33636243 DOI: 10.1016/j.jhep.2021.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.
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Affiliation(s)
- Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Goyal A, Dhaliwal HS, Nampoothiri RV, Singh R, Abraham J, Sharma R, Soloman R, Lahan S, Kaur P, Bansal P, Gill CS. Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections. Abdom Radiol (NY) 2021; 46:2855-2864. [PMID: 33469690 DOI: 10.1007/s00261-021-02949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/27/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear. METHODS Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days. RESULTS A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4-9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively. CONCLUSION Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.
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Affiliation(s)
- Amandeep Goyal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpal S Dhaliwal
- Department of Gastroenterology, GTBS (C) Hospital, Ludhiana, Punjab, 141002, India.
| | - Ram V Nampoothiri
- Department of Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ripudaman Singh
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - John Abraham
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajan Sharma
- Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - Rajat Soloman
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Shubham Lahan
- Department of Internal Medicine, University College of Medical Sciences, New Delhi, India
| | - Preetraj Kaur
- Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - Pankaj Bansal
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Medicine and Science, Eau Claire, WI, 54702, USA
| | - Chiranjiv Singh Gill
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Particulars of Medical and Surgical Treatment of Liver Abscess in Septic Patient– Case Report. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
First described by Bright in 1836, who reports two cases secondary to suppurative angiocolitis and pilephlebitis, intrahepatic suppurations were, until the era of the discovery of antibiotics, one of the most dreaded causes of mortality, reaching a rate of almost 100%. Today, both the incidence of liver abscesses and the mortality rate have been significantly reduced, as the introduction of antibiotics has dramatically reduced the number of septic piles due to peritoneal outbreaks. Their etiology is more recently, most frequently, a biliary or neoplastic disease. On the other hand, the improvement of germ isolation techniques has made it possible to identify anaerobic germs with maximum frequency, and diagnostic and treatment performance has increased so much with the advent of non-invasive or minimally-invasive procedures that the overall mortality rate of 70% in 1975 is now about 30–38%.
We present the case of a 75-year-old male patient with no known history of ilnesses who is admitted for fever, chills, myalgia, arthralgia and visual disturbances with onset of approximately one week. Biologically he presents with leukocytosis with marked neutrophilia, mild thrombocytopenia and significant biological inflammatory syndrome. Suspicion is raised for a diagnosis of Sepsis with unspecified starting point with possible pyogenic cavernous sinus thrombosis, a complication suggested by the presence of visual disturbances. Neuro-imaging evaluation by CT and brain MRI is performed, with the diagnosis of thrombosis being refuted. Abdominal CT is performed which identifies a space replacement formation in the left hepatic lobe for which MRI evaluation is required. MRI detects an expansive hepatic formation with semiology suggestive of liver abscess. Treatment was instituted with a combination of broad-spectrum antibiotics and antifungal treatment, but the evolution was unfavourable with maintenance of leukocytosis with marked neutrophilia and progression of inflammatory samples. It was necessary to evaluate the case by a multidisciplinary team (infectious disease specialist, gastroenterologist, surgeon) to establish the appropriate therapeutic management, with surgical resolution of the case, with a favourable postoperative evolution.
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Jindal A, Pandey A, Sharma MK, Mukund A, Vijayaraghavan R, Arora V, Shasthry SM, Choudhary A, Sarin SK. Management Practices and Predictors of Outcome of Liver Abscess in Adults: A Series of 1630 Patients from a Liver Unit. J Clin Exp Hepatol 2021; 11:312-320. [PMID: 33994714 PMCID: PMC8103324 DOI: 10.1016/j.jceh.2020.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The management practices of liver abscess (LA) have evolved over time. The precise diagnosis of etiology and complications is pivotal for appropriate management. METHODS Descriptive analyses of consecutive patients treated for LA using electronic medical records at a liver unit between years 2010 and 2020 and investigate relationships between clinical, imaging, laboratory and microbiological findings, treatment strategies and mortality. RESULTS Of 1630 LA patients, the most common aetiologies were amoebic liver abscess (ALA; 81%) and pyogenic liver abscess (PLA; 10.3%, mainly related to biliary disease and/or obstruction). Abdominal pain (86%) and fever (85.3%) were the commonest presenting symptoms (median duration-10 days). Almost 10% had jaundice at presentation, 31.1% were diabetic, 35.5% had chronic alcohol use and 3.3% had liver cirrhosis. Nearly 54% LA were solitary, 77.7% localized to the right liver lobe (most commonly segment VII/VIII). Patients with large LA (>10 cm, 11.9%) had more frequent jaundice and abscess rupture (p-0.01). Compared with ALA, patients with PLA were older, more often had multiple and bilobar abscesses with local complications. Over four-fifth of the patients received percutaneous interventions (catheter drainage [PCD; 36.1%] alone and needle aspiration [PNA] plus PCD [34.1%] as most common). Fifty-eight patients underwent endoscopic retrograde cholangiography for intrabiliary abscess rupture (n = 36) or cholangitic abscess (n = 22). The median duration of hospital stay and PCD were 7 (4-10) days and 5 (4-8 days), respectively. The overall in-hospital mortality was 1.1%. Presence of septic encephalopathy (HR: 20.8; 95% CI: 1.9-220.7; p-0.012), liver cirrhosis (HR: 20.1; 95% CI: 2.7-146.9; p-0.003) and jaundice (HR: 7.6; 95% CI:1.7-33.1; p-0.006) were independent predictors of mortality. CONCLUSIONS The commonest presentation was middle age male with right lobe solitary ALA. Patients with large, bilobar and/or pyogenic abscess had more complications. Nearly 70% patients require percutaneous interventions, which if given early improve treatment outcomes. Presence of jaundice, liver cirrhosis and septic encephalopathy were independent predictors of mortality.
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Key Words
- ALA, amoebic liver abscess
- CI, Confidence interval
- ERC, endoscopic retrograde cholangiography
- HR, Hazard ratio
- IHA, indirect haemagglutination assay
- IQR, Interquartile range
- KPC, Carbapenemase producing Klebsiella
- LA, Liver abscess
- MELD, Model for end-stage liver disease
- PCD, percutaneous catheter drainage
- PLA, pyogenic liver abscess
- PNA, percutaneous needle aspiration
- SD, standard deviation
- amebiasis
- drainage
- liver abscess
- pyogenic
- treatment
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Affiliation(s)
- Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Apurva Pandey
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Manoj K. Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Amar Mukund
- Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Rajan Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Vinod Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Saggere M. Shasthry
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Ashok Choudhary
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
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Deliwala SS, Hussain M, Ponnapalli A, Awuah D, McDonald P, Bachuwa G. Serrating through vascular access catheters: a great masquerader with severe systemic manifestations. BMJ Case Rep 2021; 14:14/4/e242013. [PMID: 33827881 PMCID: PMC8030668 DOI: 10.1136/bcr-2021-242013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Serratia marcescens, time and again, has demonstrated its ability to easily adhere and infect vascular access catheters, making them a bona fide source of hospital outbreaks and contributing to adverse patient outcomes. We present a unique case of a severe recurrent Serratia infection, leading to persistent bacteria in the blood, haematogenous dissemination and subsequent development of abscesses, to a degree not reported in the literature before. These infections are exceedingly challenging to eradicate, owing to multiple virulence mechanisms and the deep seeding ability of this microorganism. Serratia infections require a multifaceted approach with intricacies in identification, therapeutics and surveillance, all of which are sparsely reported in the literature and reviewed in this report.
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Affiliation(s)
| | - Murtaza Hussain
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | - Dominic Awuah
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Philip McDonald
- Division of Infectious Diseases, Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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