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

ABSTRACT

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.