[A Thrombus in the Right Atrium Associated with Pyogenic Liver Abscess].

Hepatic abscesses are divided into bacterial and amoebic types. Although the prognosis of bacterial liver abscesses has improved owing to progress in drainage techniques and antimicrobial agents, poor outcomes remain common. While there have been some reports of amoebic liver abscesses complicated by thrombosis, bacterial liver abscesses and subsequent thrombus in the right atrium are very rare. We herein report the case of an 82-year-old man. He had suffered acute obstructive suppurative cholangitis 10 months previously, and bile culture yielded Enterococcus faecalis. In the present case, a right atrial thrombus caused by a bacterial liver abscess was observed and the causative organism was thought to be Enterococcus faecalis, for which was detected in a blood culture was positive. The patient was successfully treated with hepatic abscess drainage and surgical right atrial thrombectomy under cardiopulmonary bypass with a beating heart.

Clinical characteristics of pyogenic liver abscess with and without biliary surgery history: a retrospective single-center experience.

BACKGROUND & AIMS: Pyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS). METHODS: The study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group (n = 91) and the non-BS group (n = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n = 22) and non-bilioenteric anastomoses group (non-BEA, n = 69). Clinical characteristics were recorded and analyzed. RESULTS: The percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities (P = 0.009 and P = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus (P < 0.001) and solitary abscesses (P = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures (P = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history (P = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%). CONCLUSIONS: Patients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.

Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study.

Percutaneous catheter drainage is the first-line treatment for pyogenic liver abscess (PLA). Some patients need hepatectomy because of underling hepatobiliary pathology or unresponsiveness to nonoperative treatment, the traditional method is open hepatectomy (OH). Laparoscopic hepatectomy (LH) for PLA is rarely reported. The purpose of this study is to describe our experience of LH for treating PLA and to compare LH with OH. The medical records of patients who underwent LH for treating PLA were retrospectively analyzed, and the results were compared with those of patients with OH. From January 2015 to December 2021, 61 patients with PLA underwent hepatectomy, and 28 patients who underwent LH (LH group) were compared with 33 patients who underwent OH (OH group). There were no significant differences in the basic data between the 2 groups. Two patients in the LH group were converted to open surgery due to hemorrhage and dense perihepatic adhesions, there was no significant difference between the 2 groups in the operation time (186.2 ±â€…85.6 vs. 175.9 ±â€…76.7 minutes, P = .239), Institut Mutualiste Montsouris classification, extent of hepatectomy and drainage tube removal time, however, the blood loss (200.0 ±â€…100.5 vs. 470.9 ±â€…120.1 mL, P = .003), numerical rating scale (5.2 ±â€…1.8 vs. 9.1 ±â€…1.6, P = .042), the time to resume oral diet (12.3 ±â€…6.5 vs. 24.6 ±â€…10.2 hours, P = .005), the ambulant time (20.2 ±â€…7.3 vs. 40.2 ±â€…10.8 hours, P = .010), incidence of postoperative complications (14.3% vs.33.3%, P = .002), comprehensive complication index (46.2 vs. 60.6, P = .013), postoperative hospital stay (8.5 ±â€…7.3 vs. 13.5 ±â€…10.2 days, P = .025) in the LH group was significantly less than that in the OH group. Wit experience laparoscopic surgeons, treating PLA by LH is safe and feasible and compares favorably with OH.

Absceso hepático piógeno. Presentación de un caso / Pyogenic liver abscess. Presentation of a case / Abscesso hepático piogênico. Apresentação de um caso

RESUMEN Se presentó el caso clínico de un anciano de 79 años de edad con alcoholismo crónico y otras comorbilidades asociadas, ingresado por fiebre de tres días de evolución y sospecha de dengue en el Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", de la provincia Santiago de Cuba. Por consenso multidisciplinario se diagnosticó absceso hepático piógeno de los subsegmentos VII-VIII del hígado. Se realizó laparotomía de urgencia con drenaje de la colección purulenta. Presentó infección superficial del sitio operatorio, pero la evolución posoperatoria fue satisfactoria y se egresó curado 7 días después.

ABSTRACT The clinical case of a 79-year-old man with chronic alcoholism and other associated comorbidities presented, admitted with a fever of three days of evolution and suspected diagnosis of dengue at the Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", from Santiago de Cuba province. By multidisciplinary consensus, a pyogenic liver abscess of subsegments VII-VIII of the liver was diagnosed. An emergency laparotomy was performed with drainage of the purulent collection. He presented superficial infection of the surgical site, but the postoperative evolution was satisfactory and he was discharged cured 7 days later.

RESUMO Foi apresentado o caso clínico de um idoso de 79 anos com alcoolismo crónico e outras comorbidades associadas, internado por febre de três dias de evolução e suspeita de dengue no Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", da província de Santiago de Cuba. Por consenso multidisciplinar, foi diagnosticado um abscesso hepático piogênico dos subsegmentos VII-VIII do fígado. Foi realizada laparotomia de emergência com drenagem da coleção purulenta. Apresentou infecção superficial no sítio operatório, mas a evolução pós-operatória foi satisfatória e teve alta curado 7 dias após.

Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic.

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.

[Pyogenic liver abscesses]. / Abcès hépatique pyogène.

Pyogenic-liver abscess is a relatively rare entity in Europe. Due to unspecific clinical and biological findings, the diagnosis can be difficult. Imaging by ultrasound, CT-scan or MRI is important to confirm the diagnosis and to determine further investigations and treatment. According to the characteristics of the abscess, a surgical intervention may be necessary, particularly is the abscess diameter is bigger than 5 cm. This can be done either by surgery or by percutaneous drainage (needle aspiration versus catheter drainage). Obtaining adequate microbiologic cultures is important to identify the responsible pathogens and their resistance profile before starting broad spectrum antibiotics. Antibiotic treatment should be adapted to microbiologic results. The recommended treatment duration is usually between 4 and 6 weeks according to clinical evolution.

L'abcès hépatique pyogène (AHP)est un abcès causé par des bactéries. Le diagnostic peut être difficile à poser en raison d'un tableau clinique et biologique aspécifique. L'examen radiologique qu'il soit par échographie, scanner ou IRM a un rôle clé afin d'asseoir le diagnostic. Les caractéristiques morphologiques de l'AHP permettent de déterminer le traitement, qu'il soit conservateur par antibiothérapie seule ou invasif par voie percutanée ou chirurgical. Les examens bactériologiques ont un rôle clé afin d'identifier les bactéries responsables ainsi que leur profil de résistance. Une antibiothérapie empirique doit être introduite dès que les prélèvements bactériologiques ont été effectués, puis être par la suite adapté aux résultats microbiologiques. La durée de traitement est de 4 à 6 semaines selon l'évolution clinique.

Minimally Invasive Surgical Management as Effective First-Line Treatment of Large Pyogenic Hepatic Abscesses.

Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (<3 cm), PD for type II (≥3, unilocular), and surgical intervention (minimally invasive drainage or resection, when possible) for type III (≥3 cm, multilocular). Outcomes were compared between patients who received first-line treatment following the algorithm versus alternate therapy. Of 330 patients with PHA, 201 met inclusion criteria. Type III abscesses had significantly lower failure following algorithmic approach with surgery compared with PD (4% vs 28%, P = 0.018). Type II abscesses failed first-line PD in 27 per cent (13/48) with 11 patients requiring surgical rescue, whereas first-line surgery failed in only 13 per cent (2/15). No deaths occurred after any surgical intervention, and there was no statistical difference in major complications between first-line surgical intervention and PD for type II or III abscesses. These results support the algorithmic approach and demonstrate that minimally invasive surgical intervention is a safe and effective modality for large PHA. We recommend that select patients with large, complex abscesses should be considered for a first-line minimally invasive surgical approach depending on surgical experience and available resources.

HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH?

BACKGROUND: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. AIM: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. METHODS: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). RESULTS: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. CONCLUSION: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

The Value of Ozone in CT-Guided Drainage of Multiloculated Pyogenic Liver Abscesses: A Randomized Controlled Study.

Objective: This study was designed to compare the effects of catheter drainage alone and combined with ozone in the management of multiloculated pyogenic liver abscess (PLA). Methods: The prospective study included 60 patients diagnosed with multiloculated PLA. All patients were randomly divided into two groups: catheter drainage alone (group I) and catheter drainage combined with ozone (group II). Drainage was considered successful when (1) the abscess cavity was drained and (2) clinical symptoms were resolved. Kruskal-Wallis nonparametric test was used to compare the success rates, length of stay (LOS), and need for further surgery of the two groups. P < 0.05 indicates significant difference. Results: All patients' catheters were successfully placed under CT guidance. Group I was treated with catheters alone and group II was treated with catheters and ozone. The success rates of groups I and II were 86% and 96%, respectively (P < 0.05). And compared with group II, the duration of fever in group I was longer (P < 0.05), and the LOS was also longer (P < 0.05). Conclusion: Catheter drainage combined with ozone is an effective and safe treatment in multiloculated PLA. The Clinical Registration Number is ChiCTR1800014865.

Pyogenic Liver Abscess Secondary to Foreign Body (Fish Bone) Treated by Laparoscopy: A Case Report.

Liver abscess due to perforation of the gastrointestinal tract by a foreign body is a rare and possibly fatal event. Diagnosing this pathology is complicated by the lack of specific symptoms and unfamiliarity of ingestion by the patient and low clinical suspicion of this disease. In the case of liver abscess unresponsive to aspiration and administration of antibiotics, this hypothesis must be made, despite its low incidence. This case report describes and illustrates a case of liver abscess secondary to fish bone ingestion with consequent piercing of the lesser gastric curvature, diagnosed by computed tomography and specific anamnesis. Laparoscopy was performed to extract the foreign body, without complications; the patient is currently asymptomatic and does not present any abnormal physical examination findings. We believe this represents the first case report of a successful laparoscopic treatment in South America for the removal of an ingested foreign body associated with pyogenic liver abscess.

Hepatectomy for pyogenic liver abscess treatment: exception approach? / Hepatectomia para o tratamento do abscesso hepático piogênico: abordagem de exceção?

ABSTRACT Background: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

RESUMO Racional: A drenagem percutânea do abscesso hepático piogênico tem sido considerada padrão-ouro para o tratamento na maioria dos casos. Mais raramente, quando essa abordagem falha ou em casos de abscessos multiloculados, a ressecção daquele segmento ou lobo destruído pode resolver o contexto infeccioso. Objetivo: Relatar uma série de doentes com abscesso hepático que foram submetidos a hepatectomia. Método: Onze doentes foram operados. A idade variou de 45-73 anos (média e mediana 66). Foram oito homens e três mulheres. As causas foram: idiopática (n=4), biliar (n=2), radiofrequência (n=2), portal (n=1), arterial (n=1), e extensão direta (n=1). A média do tamanho das lesões foi 9,27 cm (6-20). Resultados A média de tempo cirúrgico foi de 180 min (120-300). A média de sangramento intra-operatório foi de 448 ml (50-1500 ml). Os procedimentos cirúrgicos foram: hepatectomia D (n=4), hepatectomia E (n=3), setorectomia lateral E (n=1), setorectomia posterior D (n=2), ressecção do S8 (n=1) e S1 (n=1). A morbidade pós-operatória foi 30%, enquanto a mortalidade foi nula. Mediana de internação foi de 18 dias (5-45). A mediana de seguimento foi 49 meses (13-78). Houve uma única recidiva de lesão. Conclusão: Embora a hepatectomia possa ser considerada conduta de exceção para tratamento do abscesso hepático piogênico, ela deve ser boa opção terapêutica em situações especiais.

[Successful Treatment of Acute Empyema Due to Rupture of Pyogenic Liver Abscess].

Cases of rescue after rupture of pyogenic liver abscess into the thorax are rare. Here, we report 2 cases of rescue in patients with acute empyema due to rupture of a suppurative abscess into the thorax. Case 1:A 61-year-old male had high fever of 39 °C and right abdominal pain. Thoracic computed tomography(CT) showed encapsulated pleural effusion in the right thorax and ring-like enhancement in the right liver. The diagnosis was acute empyema caused by rupture of liver abscess. The pathogenic bacteria were Streptococcus group. The drain was removed after 6 days and the patient was discharged 32 days after surgery without reefing the diaphragm. Case 2:A 74-year-old male had a high fever of 39 °C and right chest pain. CT showed encapsulated pleural effusion in the right thorax, but not in the lung, and a low density area in the posterior segment of the liver. The diagnosis was acute empyema caused by rupture of liver abscess. The pathogenic bacteria were Streptococcus group and Bacteroides. The drain was removed after 8 days and the patient was discharged 32 days after surgery without reefing the diaphragm. CONCLUSION: Pathogenic bacteria in a pyogenic liver abscess are usually Gram-negative rods, but recently have also been reported to be Streptococcus anginosus group( SAG). Coinfection with SAG and anaerobic bacteria occurs in elderly patients, compromised hosts, and patients with a severe malignant disease. Therefore, early drainage using surgical treatment regardless of reefing the diaphragm should be considered to control severe infection due to liver abscess rupture.

Laparoscopic Treatment of a Pyogenic Hepatic Abscess Caused by Transmural Duodenal Perforation of a Toothpick.

The development of pyogenic hepatic abscess resulting from perforation of the gastrointestinal tract is a rare pathologic finding. It is a condition that can be fatal making early detection and subsequent removal of the inciting foreign body critical to avoid more deleterious sequela. Yet, its initial presentation tends to be nonspecific and typically is only discovered once surgical investigation into the cause of persisting abscess formation is performed. In this study, laparoscopic treatment of a 52-year-old male with a non-resolving hepatic abscess due to transmural gastrointestinal perforation of a toothpick is presented. Although a rare finding, reports of foreign body induced hepatic abscess have recently increased in the world literature, allowing some preliminary efforts in proposing diagnostic characterization. Yet, more case studies will be required to permit validation of these findings making continued reporting of this pathologic process critical.

Hepatocolic fistula: a rare presentation of pyogenic liver abscess.

A 58-year-old man was admitted due to a 4-month history of colicky right upper quadrant pain, intermittent fever, anorexia and weight loss. A contrast-enhanced CT scan of the abdomen showed an encapsulated, peripherally enhancing focus occupying the right liver lobe exhibiting capsular rupture and extension to the walls of the hepatic flexure. He immediately underwent emergency ultrasound-guided percutaneous catheter drainage and cultures of the purulent fluid later revealed Escherichia coli A colonoscopy was then performed which showed a pinpoint opening with draining pus at the hepatic flexure. A fistulogram confirmed a fistulous tract arising from the inferior aspect of the abscess cavity, draining into the posterosuperior aspect of the hepatic flexure. He was started on intravenous antibiotics and after 1 week of decreasing output, a repeat ultrasound showed very minimal residual fluid. The percutaneous catheter drain was then removed after 2 weeks and the patient was discharged improved.

Feasibility of radiofrequency ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses: A retrospective cohort study.

This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs).From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients' blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established.RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics.Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention.

Abscesso hepático polimicrobiano por perfuração gástrica por corpo estranho / Polymicrobial hepatic abscess due to gastric perforation by foreign body

Abscesso hepático piogênico é uma condição incomum, com incidência inferior a 1% das internações hospitalares. O abscesso hepático causado por corpo estranho é uma condição extremamente rara, com possibilidade de desfecho fatal devido às dificuldades em se estabelecer o diagnóstico. Relata-se o caso de uma paciente de 52 anos, feminina, com dor abdominal difusa há 1 semana em epigástrio e hipocôndrio direito, associado a diarreia e vômitos há 5 dias e febre de 40°C. Apresentava abdome doloroso, leucocitose de 17.000 p/mm³, bilirrubina total elevada à custa de fração direta, sorologias para HIV 1 e 2 e Hepatite B e C negativas. Em ultrassonografia de abdome total, demonstrou-se imagem heterogênea de 78x61mm em segmento II e III. Na tomografia computadorizada de abdome total observou-se imagem hipodensa, hipovascular, medindo 100x81x78, em lobo hepático esquerdo. Iniciou-se antibioticoterapia empírica e realizou-se drenagem percutânea guiada por ultrassom, demonstrando infecção polimicrobiana em cultura do material. Em ultrassonografia de controle, permanecia área heterogênea, medindo 77x72x49mm em lobo hepático esquerdo. A paciente então foi submetida à laparotomia exploratória, evidenciando no intraoperatório adesão do estômago a parede posterior do fígado. Após descolamento da estrutura, observou-se corpo estranho representado por espinha de peixe no interior do parênquima hepático, oriundo de perfuração da parede anterior do estômago. Embora seja uma etiologia rara, a hipótese diagnóstica de corpos estranhos deve ser considerada em todo caso de abscesso hepático refratário ao tratamento habitual, a fim de reduzir a morbidade e mortalidade do quadro (AU)

Pyogenic hepatic abscess is an uncommon condition, with incidence below 1% of hospitalizations. Hepatic abscess caused by foreign body is an extremely rare condition, with the possibility of fatal outcome due to difficulties in establishing the diagnosis. Here the authors report the case of a 52-year-old female patient with diffuse abdominal pain for one week in the epigastrium and right hypochondrium associated with diarrhea and vomiting for 5 days and fever of 40 °C. She presented painful abdomen, leukocytosis of 17,000 p/mm³, elevated total bilirubin at the expense of direct ratio, and negative serologies for HIV 1 and 2 and Hepatitis B and C. In total abdomen ultrasound, a heterogeneous image of 78x61mm was shown in segment II and III. Computed tomography of the total abdomen showed a hypodense, hypovascular image, measuring 100x81x78mm, in the left hepatic lobe. Empirical antibiotic therapy was initiated and ultrasound-guided percutaneous drainage was performed, demonstrating polymicrobial infection in culture of the material. In control ultrasonography, a heterogeneous area remained, measuring 77x72x49mm in the left hepatic lobe. The patient was then submitted to exploratory laparotomy, with intraoperative evidence of adhesion of the stomach to the posterior wall of the liver. After detachment of the structure, we observed a foreign body represented by fishbone inside the hepatic parenchyma, originating from perforation of the anterior wall of the stomach. Although it is a rare etiology, the diagnostic hypothesis of foreign bodies should be considered in all cases of hepatic abscess refractory to usual treatment, in order to reduce the morbidity and mortality of the condition (AU)

PYOGENIC LIVER ABSCESS: DIAGNOSTIC AND THERAPEUTIC MANAGEMENT.

Background: The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Aim: Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Method: Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. Results: The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. Conclusion: The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource.

Racional: O abscesso hepático piogênico tem incidência de 1,1 por 1.000 habitantes com mortalidade podendo chegar a 100%. O uso de recursos menos invasivos diminuem morbimortalidade e tempo de internação hospitalar. Objetivo: Identificar fatores de risco no abscesso hepático piogênico tratado por drenagem percutânea guiada por ultrassom. Método: Total de 10 pacientes foram submetidos ao procedimento. Foram avaliadas características epidemiológicas, marcadores laboratoriais exames de imagem (ultrassom e tomografia). Resultados: Na amostra houve predominância do sexo masculino, com média de idade de 50 anos. Hepatopatia, etilismo e doença da via biliar foram os pródromos mais frequentes. Dor abdominal (90%), febre (70%) e icterícia (40%) foram manifestações clínicas mais comuns. Houve mortalidade de 20% nesta série. Hipoalbuminemia e dias de internação hospitalar tiveram associação positiva com óbito estatisticamente significante. Conclusão: O abscesso hepático piogênico tem evolução subaguda o que dificulta o diagnóstico. Exames de imagem têm sensibilidade alta na propedêutica diagnóstica, notadamente a tomografia computadorizada. A drenagem percutânea, associada à antibioticoterapia, mostrou ser recurso terapêutico seguro e eficaz.

Pyogenic liver abscess: diagnostic and therapeutic management / Abscesso hepático piogênico: manejo dos recursos diagnósticos e terapêuticos

ABSTRACT Background: The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Aim: Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Method: Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. Results: The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. Conclusion: The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource.

RESUMO Racional: O abscesso hepático piogênico tem incidência de 1,1 por 1.000 habitantes com mortalidade podendo chegar a 100%. O uso de recursos menos invasivos diminuem morbimortalidade e tempo de internação hospitalar. Objetivo: Identificar fatores de risco no abscesso hepático piogênico tratado por drenagem percutânea guiada por ultrassom. Método: Total de 10 pacientes foram submetidos ao procedimento. Foram avaliadas características epidemiológicas, marcadores laboratoriais exames de imagem (ultrassom e tomografia). Resultados: Na amostra houve predominância do sexo masculino, com média de idade de 50 anos. Hepatopatia, etilismo e doença da via biliar foram os pródromos mais frequentes. Dor abdominal (90%), febre (70%) e icterícia (40%) foram manifestações clínicas mais comuns. Houve mortalidade de 20% nesta série. Hipoalbuminemia e dias de internação hospitalar tiveram associação positiva com óbito estatisticamente significante. Conclusão: O abscesso hepático piogênico tem evolução subaguda o que dificulta o diagnóstico. Exames de imagem têm sensibilidade alta na propedêutica diagnóstica, notadamente a tomografia computadorizada. A drenagem percutânea, associada à antibioticoterapia, mostrou ser recurso terapêutico seguro e eficaz.