Ultrasonido en el punto de atención: reporte de un caso de absceso hepático / Point of care ultrasound diagnostic: a case report of a hepatic abscess

Resumen El ultrasonido en el punto de atención es una herramienta diagnóstica que ha tomado relevancia en el escenario intra y extrahospitalario, al tratarse de un estudio no invasivo que permite que los hallazgos clínicos se correlacionen directamente con los signos y síntomas que presenta el paciente. El objetivo del presente trabajo es evidenciar la utilidad clínica aplicada al caso de una paciente con una bacteremia persistente, en la cual se identificó el foco de infección por evaluación ultrasonográfica, para dirigir posteriormente la terapia. Presentamos un caso clínico en el que, por medio de esta herramienta, se estableció el diagnóstico de un absceso hepático insospechado clínicamente; se demuestra su utilidad clínica como extensión de la valoración médica especializada al obtener una experiencia favorable de su correcta utilización en un caso complejo.

Abstract Point of care Ultrasound is a diagnostic tool that has gained relevance in the hospital and outpatient setting, as it is a non-invasive study that allows direct correlation of clinical findings and the signs and symptoms that the patient presents. The objective of this paper is to show its clinical utility evident as applied to a female patient who had persistant bacteremia, in which the site of infection was identified through ultrasound evaluation. We present a clinical case whose diagnosis of hepatic abscess was possible by the use of ecography and shows its usefullness as an extension of specialized medical evaluation by showing a favorable experience of its correct use in a complex case. We present a clinical case in which the diagnosis of a clinically unsuspected liver abscess was obtained using this tool.

Pediatric hepatic abscess: A ten-year review of the features and outcome at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.</p><p style="text-align: justify;"><strong>Method.</strong> We conducted a review of medical records of admitted patients aged ?18 years diagnosed with hepatic abscess in a tertiary referral center from 2007-2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.</p><p style="text-align: justify;"><strong>Result.</strong> We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.</p>

Intrahepatic cholangiocarcinoma with aberrant hepatic artery presenting as hepatic abscess: a case report

Intrahepatic cholangiocarcinoma (ICC) is a primary hepatic malignancy that originates from epithelial cells of bile duct. Lack of diagnostic measures and therapies leads to an increasing number of deaths from ICC worldwide. Here we described a case of 61-year-old Chinese female, who initially presented with right upper quadrant pain, combined with the results that a low density mass accompanied by multiple nodules occupied the right liver lobe by CT-scan, which also showed an aberrant right hepatic artery that participated in the right liver lobe and origining from the superior mesenteric artery, this patient was clinically considered as hepatic abscess (HA). The patient’s right upper quadrant pain was alleviated after been treated with the infusion chemotherapy of the aberrant right hepatic artery (ARHA) via percutaneous femoral arterial catheterization by Seldinger technique (Meropenem 7 days) following the failure of the liver-puncture drainage.  However, the right upper quadrant pain occurred again 6 days later, serum CA19-9>1000.0 U/ml, which indicated the possibility of hepatic malignancy, so we performed laparotomy. The histopathological result of intraoperative frozen section demonstrated cholangiocarcinoma, unfortunately, it was unresectable. Finally, right lower lung pneumonia and pleural empyema happened to her and she succumbed to respiratory failure 22 days following surgery. In this report, we will discuss the case with reference to the literature.

Gallbladder perforation with concomitant liver abscess: a case report with a review of treatment options

Gallbladder perforation (GBP) management is still controversial in regards to time (early vs. interval), first procedure (surgical vs. drainage) and technique (laparoscopic vs. open). This is the case report of an adult patient with GBP Niemeier type II, complicated with a concomitant hepatic abscess. The patient was treated medically and with laparoscopic drainage of abscess and pyocholecistolithiasis. She was scheduled shortly after for endoscopic retrograde cholangiopancreatography, and posteriorly for definitive treatment with laparoscopic cholecystectomy 1 month later. Satisfactory postsurgical outcome, with uneventful 1-month follow-up.

Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.

Tale of Two: A ‘case report’ of two giant urinary bladder stones and recurrent anemia in a 78-year-old Filipino male

@#BACKGROUND: This is a rare case of two large urinary bladder stones causing severe infection of the urinary tract affecting the bone marrow due to chronic immune stimulation in a patient with recurrent anemia. Urinary bladder calculi are hard masses of minerals. They develop when the minerals in concentrated urine crystallize. This often happens when the bladder cannot be emptied. Signs and symptoms can vary from severe abdominal pain to blood in the urine. Sometimes, bladder stones don't cause any symptoms. If left untreated, bladder stones may lead to infections and other complications such as hepatic abscess via a hematogenous route. CASE: This is a case of a seventy-eight-year-old man with a history of multiple blood transfusions secondary to anemia of unknown cause. He came into our institution for a second opinion. We worked up the patient, which showed hepatic abscess and two large urinary bladder calculi. Further investigation of the anemia later led to a diagnosis of primary myelofibrosis. DIAGNOSTICS: Ultrasound showed a complex mass on the left hepatic lobe measuring 7.5 cm x 6.0 cm x 2.1 cm consistent with a hepatic abscess. The culture of the abscess was positive for E. coli. Computed Tomography (CT) scan of the lower abdomen showed heterogeneous mass measuring 8.6 cm x 8.7 cm x 9.2 cm within the urinary bladder (see Figure 2). Urinalysis was consistent with a urinary tract infection. Urine culture showed E. coli. Video-assisted cystoscopy showed two urinary bladder calculi, measuring 1.5 cm x 3.2 cm x 4.2 cm weighing 30 grams each (see Figure 3). The calculi were composed of 100% Calcium Oxalate. He underwent a series of diagnostic examinations for anemia including gastroscopy to rule out a bleeding ulcer. Complete blood count showed hemoglobin of 77 g/L and a hematocrit of 0.23. Finally, bone marrow core biopsy was done which is consistent with primary myelofibrosis. CONCLUSION: Urinary bladder stones can be asymptomatic and may present only with vague abdominal pain. It should be one of the considerations in asymptomatic patients with long-standing prostatitis or benign prostatic hyperplasia. Detailed history, thorough physical examinations, and cautious diagnostic tests are mandatory to confirm the diagnosis. A hepatic abscess may arise from infections in the urinary tract such as prostatitis through hematogenous extension. Therefore, it is important to address the origin of the infection to prevent such complications. This is a rare case of an elderly man who presented with chronic anemia and later found out to have large urinary bladder stones that caused severe infection leading to immune stimulation of the bone marrow, hence the diagnosis of primary myelofibrosis by bone marrow biopsy. Such a rare case must be thought of holistically and analytically.

Hemoglobinuria paroxística nocturna y absceso hepático: asociación poco frecuente / Paroxysmal nocturnal hemoglobinuria and hepatic abscess: A little frequent association

Resumen: La hemoglobinuria paroxística nocturna es un trastorno adquirido de las células madre hematopoyéticas que se caracteriza por episodios de hemólisis intravascular. Aunque es una enfermedad poco frecuente, afecta en su mayor parte a adultos jóvenes, sin distinción de sexo. Comunicamos el caso de un paciente de 32 años de edad, que acudió a consulta con cuadro clínico de palidez, ictericia, hemoglobinuria y dolor en el hipocondrio derecho. El estudio de citometría de flujo de médula ósea reportó la ausencia de marcadores CD55 y CD59, indicativos del diagnóstico de hemoglobinuria paroxística nocturna, además de una imagen tomográfica hipodensa en el hígado compatible con absceso. En la bibliografía médica éste es el primer caso en el que se describe la coexistencia de estas dos afecciones.

Abstract: Paroxysmal nocturnal hemoglobinuria is an acquired disorder of hematopoietic stem cells characterized by episodes of intravascular hemolysis. Although it is a rare disease, it mostly affects young adults, regardless of sex. We present the case of a 32-year-old man with acute symptoms of paleness, jaundice, hemoglobinuria and pain in the right hypochondrium. The study of flow cytometry of bone marrow reported the absence of CD55 and CD59 markers, diagnostic indicators of nocturnal paroxysmal hemoglobinuria in addition to a hypodense tomographic image in the liver compatible with abscess. In the medical literature, this is the first case in which the coexistence of these two medical conditions is described.

A Study of Management of Hepatic Abscess by Percutaneous Catheter Drainage

Background: Aim and Objectives: To distinguish the efficacy of percutaneous catheter drainage (PCD) approaches in the management of hepatic abscess. Methods: In this study, 60 cases of liver abscess were taken with age group between 25-60 years. Study was done in surgery department of government hospital Sikar from October 2014 to September 2016. All cases were registered satisfied the inclusion criteria and exclusion criteria. Group A was given conservative treatment and Group B was given percutaneous catheter drainage. Results were analyzed statistically. Results: ‘it was revealed in this study that mostly males were there, 55 out of 60 cases. The most frequent complaint was abdominal pain and tenderness in right hypochondrium in 85% of the cases. The average hospital stay for patients in group B was 5 days as compared to 7 days in group A. Pain relieved in just 4 days in group B as compared to group A, it was 6 days. Conclusions: Percutaneous catheter drainage is a successful option of treatment in hepatic abscess as compared to conservative management.

Comparative Study In Management Of Hepatic Abscess Drainage Using Ultrasound Guided Needle Aspirations Versus Pigtail Catheter Placement.

Objective: The aim of this study was to compare the effectiveness of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the management of hepatic abscess. Methods: The current study includes prospective randomized comparative study of 60 patients admitted in emergency and indoor department at tertiary health care centre, randomized into two groups- Percutaneous needle aspiration (PNA) & Pigtail catheter drainage (PCD). The effectiveness of hepatic abscess is based early recovery period, duration of hospital stay, and clinical improvement status. Results: The recovery rate was significantly improved in catheter drainage group. The analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of early recovery, clinical improvement and days to achieve a 50% reduction in abscess cavity size. Conclusion: Both PNA and PCD are safe methods of draining hepatic abscesses. However, PCD is more effective than PNA because it facilitates a higher success rate, reduces the time required to achieve clinical relief and supports a 50% reduction in abscess cavity size. However, among successfully treated patients, the outcomes of PNA are comparable with those of PCD.

Laparoscopic Treatment of Hepatic Abscess Caused by an Ingested Foreign Body

Pyogenic hepatic abscess caused by an ingested foreign body is extremely uncommon, and reports on the laparoscopic treatment for it are very rare. We report here on a case of hepatic abscess caused by an ingested chicken bone which was treated with a laparoscopic approach. A 61-year-old man visited an emergency room with the chief complaints of high fever. He was diagnosed with pyogenic liver abscess that contained a sharp calcified foreign body seen on a CT-scan. At first, percutaneous transhepatic drainage of the abscess was performed to achieve recovery of the patient's condition. Subsequent laparoscopic exploration found and removed the foreign body in the lesser sac. The foreign body turned out to be an ingested chicken bone. The patient was discharged on the 10th day after surgery.

Diagnosis,treatment and etiology of hepatic infarction and abscess after pancreaticoduodenal surgery / 中国实用外科杂志

OBJECTIVE: To explore the causes and treatment of hepatic infarction and abscessafter pancreaticoduodenal surgery.METHODS: The clinical data of 11 cases of hepatic infarction or abscess after pancreaticoduodenal surgery in Peking Union Medical College Hospital between January 2012 and December 2018 were analyzed retrospectively.RESULTS: A total of 11 patients were diagnosed of hepatic infarction or abscess after PD.The overall mortality rate was27.3%(3 of 11 patients).54.5%(6/11)had biliary fistula.Of the 11 patients,7 had proper hepatic artery and right accessory hepatic artery occlusion or stenosis,1 had abdominal trunk root stenosis before operation,and 3 had PV stenosis.Enterococcus and Klebsiella were the organisms most frequently cultured,and fungi were also the common pathogens.Antibiotics and selective percutaneous drainage were the main means of treatment.CONCLUSION: Ischemia of hepatic artery and portal vein after PD is the main cause of liver infarction and liver abscess.Biliary fistula and multiple pathogenic bacteria are often associated with high mortality.

Síndrome de larva migrans visceral y absceso hepático: Reporte de un caso / Visceral larva migrans syndrome and hepatic abscess: A case report

La infección por T oxocara canis o catis es una zoonosis diseminada en el ser humano. La toxocariasis puede coexistir con otras parasitosis endémicas. El hombre actúa como huésped no natural y adquiere la infección a través de la ingesta de huevos del geohelminto. Estos pueden localizarse en la tierra, los patios y los juegos de los niños, y son eliminados, principalmente, por perros o gatos. Existen distintos espectros en la presentación clínica; algunos de ellos son toxocariasis ocular, larva migrans visceral, toxocariasis encubierta y neurotoxocariasis. Se presenta el caso de un paciente de 2 años y 3 meses de edad, con antecedente de síntomas respiratorios, fiebre prolongada y hepatomegalia, con resultados de laboratorio que informa hipereosinofilia, hipergammaglobulinemia y serología positiva para toxocariasis (ensayo por inmunoabsorción ligado a enzimas). Se plantea el diagnóstico de síndrome de larva migrans visceral.

Toxocariasis canis or catis is a zoonotic infection disseminated in humans. Human beings can act as non-natural hosts in which the parasite can survive for long periods of time and they become infected by the ingestion of geohelminth eggs. These can be located on the ground, playgrounds and children's games, and are mostly eliminated by dogs or cats. There are different spectra in the clinical presentation of this infection, which can vary from an asymptomatic host to the production of serious organic lesions; some of them are ocular toxocariasis, visceral larva migrans, covert toxocariasis and neurotoxocariasis. In this case report a patient who presents with a history of respiratory problems, prolonged fever, and hepatomegaly. Laboratory analyses show hypereosinophilia, hypergammaglobulinemia and serodiagnosis is positive for toxocariasis. Preliminary diagnosis: Visceral Larva Migrans Syndrome.

The application value of whole-lesion method measuring hepatic abscess lesions in ADC map:a pilot study / 实用放射学杂志

Objective To explore the value of whole-lesion method measuring hepatic abscess lesions in ADC map.Methods 13 cases with hepatic abscess were measured by using three methods,drawing the outline of the lesion by manual operation,and placing the round ROI in the central area and the peripheral area in ADC map,respectively.The differences of the ADC values measured by the three methods were compared.The Friedman test was used for the mean of ADC values.The value differences of the groups were compared by the Bonferroni test.Results Among the 17 lesions,6 lesions located in the anterior segment of right lobe of liver,7 lesions in the posterior segment of right lobe of liver,1 lesion in the caudate lobe,1 lesion in the junction zone between the anterior segment of right lobe and the medial segment of left lobe,1 lesion in the medial segment of left lobe and 1 lesion in the lateral segment of left lobe of liver.The mean values from the three methods(×10-3 mm2/s) and the 95％ confidence intervalwere:1.27±0.33,1.23± 0.84,1.29±0.44 and (1.21,1.34),(1.06,1.40),(1.20,1.38),respectively.The results of the Friedman test were x2=2.176,P=0.337,and there was no statistical significance between the differences.There were also no statistical significance by the Bonferroni test (P values ＞0.05/3=0.017).The 95 ％ confidence interval of the whole-lesion method was the narrowest,and the accuracy was the highest.The 95％ confidence interval of the central method was the widest,and the accuracy was the lowest.Conclusion The whole-lesion measurement may be used as an analytical method for hepatic abscess in ADC map.

Absceso hepático piógeno secundario a cuerpo extraño / Pyogenic hepatic abscess secondary to a foreign body

El absceso hepático piógeno es una enfermedad secundaria a un foco primario cuyas vías básicas de infección son: vía biliar y el sistema portal. Se presenta el caso de un paciente de 23 años que presenta dolor a nivel de hemiabdomen superior que refiere haber ingerido un alambre en forma de gancho. Sobre la base de los antecedentes y exámenes complementarios se interpreta la posibilidad de un absceso hepático secundario a un cuerpo extraño. Se realizó drenaje del absceso y yeyunotomía para extracción del cuerpo extraño endoluminal. Actualmente, el paciente se encuentra totalmente recuperado(AU)

Pyogenic hepatic abscess is a disease secondary to a primary focus whose basic pathways of infection are the bile duct and the portal system. The case is presented of a 23-year-old patient with pain at the level of the upper hemiabdomen and who reported having ingested a wire in the shape of a hook. Upon the basis of the antecedents and complementary examinations the possibility is interpreted for a hepatic abscess secondary to a foreign body. Drainage of the abscess and jejunostomy were performed to remove the foreign body from the endoluminal system. Currently, the patient is fully recovered(AU)

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)

Gastrointestinal Fistulization in Amebic Liver Abscess.

Background: Liver abscess is a common deep seated abscess in children; amebic liver abscess is associated with more local complications. Case characteristics: We report two preschool children presenting with short history of pain, fever and right upper quadrant pain. The abscess communicated with gastro-intestinal tract (ascending colon in case 1 and duodenum in case 2), and diagnosis of amebic liver abscess was confirmed by DNA PCR. Outcome: Both children were successfully managed with intravenous antibiotics and catheter drainage. Message: Gastrointestinal fistulization may be rarely seen in amebic liver abscess. Conservative management with antibiotics, catheter drainage and supportive care may suffice.

Absceso hepático a Klebsiella pneumoniae

Se presenta caso de varón, diabético, con fiebre prolongada, ictericia y hepatoesplenomegalia. Por ecografía se constata absceso hepático y esplénico. Fue tratado exitosamente con antibiótico y drenaje percutáneo del absceso hepático. Se aisló Klebsiella pneumoniae en sangre y líquido drenado del hígado.

This is the case of a diabetic man with prolonged fever, ictericia and hepatosplenomegaly. Ultrasonography confirms hepatic and splenic abscesses. Patient was successfully treated with antibiotics and percutaneous drainage of the hepatic abcess. Klebsiella pneumoniae was isolated from blood and liquid drained from liver.

Onfalopileflebitis con absceso hepático en un neonato asociado con cateterización umbilical / Onfalopileflebitis with hepatic abscess associated with umbilical catheterization in a newborn

La onfalopileflebitis es la inflamación conjunta con trombosis séptica de la vena porta o de alguna de sus tributarias. Ésta se presenta como una complicación de la colocación del un catéter umbilical. El diagnóstico es difícil, debido a lo inespecífico del cuadro; los hallazgos de este padecimiento suelen realizarse durante una intervención quirúrgica o en forma incidental mediante estudios de imagen o estudios anatomopatológicos. Se reporta el caso de un neonato que tuvo un desenlace fatal por esta entidad con formación de absceso hepático, el cual requirió de un drenaje quirúrgico abierto y antibioticoterapia. Se discutió su condición rara y no comunicada, además de sus características etiopatogénicas, clínicas, diagnósticas y terapéuticas.

Omphalopylephlebitis is the inflammation with septic thrombosis of the portal vein or one of its tributaries as a complication of umbilical catheter placement. Diagnosis is difficult because of non specific findings of the picture and are usually performed during a surgery, or incidentally by imaging studies or pathology. We report the case of a newborn with fatal outcome for this entity with liver abscess formation which required open surgical drainage and antibiotic therapy. We discuss rare condition, besides unreported etiopathogenic characteristics, clinical, diagnostic and therapeutic.

Progression of hepatic aspergillosis following second renal transplantation in a patient with recurrent glomerulonephritis.

Invasive aspergillosis is a serious complication in renal transplant recipients. Hepatic involvement, although seen in liver transplant recipients, has not been reported following renal transplantation. We describe here an interesting occurrence of hepatic Aspergillus infection in a renal transplant recipient. The infection responded to anti-fungal therapy, but there was re-activation following a second renal transplant. In addition, the patient had recurrence of the underlying membrano-proliferative glomerulonephritis following both transplants. The relevant existing literature relating to these problems has been reviewed.

Abscessos hepáticos secundários a espinha de peixe: relato de caso / Liver abscess secondary to a fishbone: case report

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi relatar e discutir a experiência clínica de uma doença comum, porém de etiologia pouco frequente com risco de óbito na falta do diagnóstico precoce. RELATO DO CASO: Paciente do sexo feminino, 25 anos, foi admitida no hospital com dor abdominal, febre e calafrios. O exame físico revelou anemia e dor epigástrica. Os dados do laboratório mostraram leucocitose e função hepática alterada. A tomografia computadorizada (TC) de abdômen revelou abscessos no lobo direito e esquerdo do fígado. A laparotomia exploratória foi realizada e uma espinha de peixe de 2,8 cm de comprimento foi encontrada perfurando o duodeno e penetrando no lóbulo esquerdo do fígado formando um abscesso hepático. A drenagem do abscesso hepático com remoção da espinha de peixe e fechamento simples da perfuração foi realizada. A paciente evoluiu bem e recebeu alta hospitalar. CONCLUSÃO: O diagnóstico de abscesso hepático secundário à perfuração do trato gastrintestinal por um corpo estranho é de difícil reconhecimento uma vez que há uma variedade de sintomas inespecíficos e porque os pacientes muitas vezes desconhecem a ingestão. Mesmo assim, na presença de abscessos hepáticos, a etiologia deve ser insistentemente investigada, principalmente quando não responde à terapia inicial. A presença de um corpo estranho deve ser lembrada como possível causa de um abscesso hepático, mesmo que raro, para evitar que se protele o tratamento adequado.

BACKGROUND AND OBJECTIVES: The aim of this study was to discuss the clinical experience of a common disease of infrequent etiology where as death can occur without early diagnosis. CASE REPORT: Female patient, 25 years-old, was admitted with abdominal pain, fever and chills. Physical examination revealed anemia and epigastric pain. Laboratory data showed leukocytosis and abnormal liver function. Computed tomography (CT) of abdomen showed abscesses in the right and left lobe of the liver. Exploratory laparotomy was performed and a fish bone 2.8 cm in length was found perforating the duodenum and penetratingin to the left lobe of the liver forming a liver abscess. The drainage of liver abscess with removal of fish bones and simple closure of perforation was performed. The patient recovered well and was discharged. CONCLUSION: The diagnosis of liver abscess secondary to perforation of the gastrointestinal tract by a foreign body is difficult to recognize since there are a variety of nonspecific symptoms and because patients often unaware of ingestion. Still, in the presence of liver abscess, etiology should be investigated urgently, particularly when not responding to initial therapy. The presence of aforeign body should be remembered as a possible cause of liver abscess, even though rare, to avoid delays the proper treatment.