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Prevotella species are Gram-negative anaerobic bacilli mainly involved in oral cavity infections. We report a rare case of bacteremia due to P. oris of probable hepatic origin. A 70-year-old man with a history of diabetes mellitus was admitted for general malaise, fever and dyspnea. The patient was admitted to the ICU due to septic shock. Two sets of blood cultures yielded a pure culture of an anaerobic microorganism identified as P. oris by MALDI-TOF MS. The same microorganism was isolated from a hepatic abscess drainage. Only resistance to penicillin was documented. Treatment with piperacillin-tazobactam and levofloxacin was administered, and the patient was discharged following his recovery.
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Bacteriemia , Prevotella , Idoso , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Humanos , Masculino , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por MatrizRESUMO
BACKGROUND: Hepatic abscess is a rare condition but comes with heavy consequences if not diagnosed and managed properly. Early detection of this pathology is challenging because of the variety and lack of specificity of symptoms but is necessary for accurate management. CASE REPORT: We report a case of pyogenic liver abscess secondary to the migration of an ingested fish bone in a 74-year-old female. We used laparoscopic surgery to drain the abscess, remove the foreign body responsible and look for the perforation site. Parenteral antibiotherapy was added to the surgical treatment. CONCLUSION: Early diagnosis of hepatic abscess caused by the migration of a foreign body remains a challenge. In our opinion, laparoscopic surgery associated with antibiotics is the safest and most effective therapeutic option.
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Migração de Corpo Estranho , Laparoscopia , Abscesso Hepático , Idoso , Animais , Osso e Ossos , Feminino , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Tomografia Computadorizada por Raios XRESUMO
Liver abscess (LA) is a serious infectious disease, but is relatively rare in the paediatric population, especially in developed countries. Mostly, hepatic abscesses are pyogenic, caused by Staphylococcus aureus, while in extremely rare cases can be caused by parasites, such as Ascaris lumbricoides. Antimicrobial therapy and percutaneous drainage are the treatments of choice, lowering the mortality caused by this infection. We report a case of a 3-year-old girl admitted to the hospital for abdominal pain and a low-grade fever, with abdominal ultrasonography revealing a hepatic lesion. Initial laboratory tests showed moderate anaemia, thrombocytosis, eosinophilia, high inflammatory markers, and normal liver function. A computed tomography scan revealed two liver abscesses located subdiaphragmatically, and a high immunoglobulin E (IgE) value (22,300 U/mL). After excluding other possible etiologies, the patient was tested for parasitic infections. IgE for Ascaris lumbricoides came slightly higher. In addition to empirical antibiotic treatment, the patient received albendazole and made an uneventful recovery, with the full remission of the abscesses and without the need for drainage. In certain cases, parasites such as Ascaris lumbricoides are capable of inducing a T helper 2 (Th2) dominated immune response, predisposing the host to eosinophilia, hyperIgE, and increased susceptibility to bacterial infections. Early diagnosis and treatment in these cases may lead to less invasive therapy options in order to obtain a full recovery. To the best of our knowledge, this is the only reported case in the literature of a paediatric patient with parasite-induced liver abscesses, with extremely high IgE values, minimal symptomatology, that made a fast, full recovery without the need of drainage.
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Abscesso Hepático , Parasitos , Infecções Estafilocócicas , Animais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Drenagem , Feminino , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológicoAssuntos
Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Tomografia Computadorizada por Raios X , Masculino , Feminino , Fígado/patologia , Fígado/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The duodenal-jejunal bypass liner (DJBL) is an endoscopic device designed to induce weight loss and improve glycemic control. The liner is licensed for a maximum implant duration of 12 months. It might be hypothesized that extension of the dwelling time results in added value. The goals of our study were to determine weight change, change in glycemic control, and safety in patients with an intended 24 months of DJBL dwelling time. METHODS: Patients were initially selected for a 12-month implantation period. When no physical complaints or adverse events (AEs) occurred, motivated patients who responded well were selected for extension of dwelling time to 24 months. Patients underwent a control endoscopy 12 months after implantation and visited the out-patient clinic every 3 months up to explantation. Patients agreed to remove the DJBL when complaints or AEs occurred that could not be treated conservatively. RESULTS: Implantation was extended in 44 patients, and 24 (55%) patients completed the full 24 months. Twenty patients required early removal due to AEs. During dwelling time, body weight decreased significantly (15.9 kg; TBWL 14.6%). HbA1c decreased non-significantly (4.9 mmol/mol). The number of insulin users and daily dose of insulin both decreased significantly. At 24 months after removal, glycemic control had worsened, while body weight was still significantly lower compared to baseline. In total, 68% of the patients experienced at least one AE. Two patients developed a hepatic abscess. CONCLUSIONS: DJBL treatment results in significant weight loss and improves glycemic control during implantation. The largest beneficial effects occur during the first 9-12 months after implantation. Extension of dwelling time to 24 months results only in stabilization of body weight and glycemic control. After explantation, weight improvements are maintained, but glycemic control worsens. As the cumulative risk of AEs increases with time, a maximal dwelling time of 12 months is advisable.
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Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/cirurgia , Duodeno/cirurgia , Jejuno/cirurgia , Obesidade/cirurgia , Próteses e Implantes , Adolescente , Adulto , Idoso , Cirurgia Bariátrica/instrumentação , Biomarcadores/sangue , Glicemia/metabolismo , Remoção de Dispositivo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Redução de Peso , Adulto JovemRESUMO
BACKGROUND/OBJECTIVES: Celiac axis stenosis (CAS) represents an uncommon and typically innocuous condition. However, when a pancreatic resection is required, a high risk for upper abdominal organs ischemia is observed. In presence of collaterals, such a risk is minimized if their preservation is realized. The aim of the present study is to systematically review the literature with the intent to address the routine management of collateral arteries in the case of CAS patients requiring pancreatoduodenectomy. METHODS: A systematic search was done in accordance with the PRISMA guidelines, using "celiac axis stenosis" AND "pancreatoduodenectomy" as MeSH terms. Seventy-four articles were initially screened: eventually, 30 articles were identified (nâ¯=â¯87). RESULTS: The main cause of CAS was median arcuate ligament (MAL) (nâ¯=â¯31; 35.6%), followed by atherosclerosis (nâ¯=â¯20; 23.0%). CAS was occasionally discovered during the Whipple procedure in 15 (17.2%) cases. Typically, MAL was divided during surgery (nâ¯=â¯24/31; 77.4%). In the great majority of cases (nâ¯=â¯83; 95.4%), vascular abnormalities involved the pancreatoduodenal arteries (i.e., dilatation, arcade, channels, aneurysms). Collateral arteries were typically preserved, being divided or reconstructed in only 14 (16.1%) cases, respectively. Severe ischemic complications were reported in six (6.9%) patients, 20.0% of whom were reported in patients with preoperatively unknown CAS (p-value 0.06). CONCLUSIONS: A correct pre-operative evaluation of anatomical conditions as well as a correct surgical planning represent the paramount targets in CAS patients with arterial collaterals. Vascular flow must be always safeguarded preserving/reconstructing the collaterals or resolving the CAS, with the final intent to avoid dreadful intra- and post-operative complications.
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PURPOSE: It has been reported that preoperative embolization or intraoperative reconstruction of the replaced right hepatic artery (rRHA) in order to secure the arterial blood flow to the liver and biliary tract are useful for patients who have undergone pancreaticoduodenectomy (PD) with concomitant rRHA resection. In this study, the feasibility of concomitant resection of rRHA in PD without preoperative embolization or intraoperative reconstruction were retrospectively evaluated with a particular focus on postoperative complications. METHODS: We retrospectively analyzed 323 consecutive patients who underwent PD. RESULTS: In 51 patients (15.8%), an rRHA was detected. Nine of 51 patients underwent combined rRHA resection during PD. Eight patients showed tumor abutment, and one patient had accidental intraoperative damage of the rRHA. Although there were no cases of bilioenteric anastomotic failure, a hepatic abscess occurred in one patient. This patient was treated with percutaneous transhepatic abscess drainage and was cured immediately without suffering sepsis. Postoperative complications of Clavien-Dindo classification ≥ IIIa were found in three patients, and R0 resection was achieved in six. Surgical outcomes showed no significant differences between the rRHA-resected and non-resected groups. Moreover, there were no significant differences in laboratory data related to liver functions between the rRHA-resected and non-resected groups before surgery and on postoperative days 1, 3, 5, and 7. CONCLUSIONS: Simple resection of the rRHA following an unintended or accidental injury during PD is not associated with severe morbidity and should be considered as an alternative to a technically difficult reconstruction.
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Embolização Terapêutica/métodos , Artéria Hepática/cirurgia , Pancreaticoduodenectomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Perda Sanguínea Cirúrgica/fisiopatologia , Estudos de Coortes , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
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.
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Osso e Ossos , Migração de Corpo Estranho/cirurgia , Laparoscopia , Abscesso Hepático Piogênico/cirurgia , Alimentos Marinhos , Adulto , Antibacterianos/administração & dosagem , Desbridamento , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Abscesso Hepático Piogênico/diagnóstico por imagem , Abscesso Hepático Piogênico/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora. CASE: The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up. CONCLUSIONS: The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.
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Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Abscesso Hepático/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus constellatus , Adulto , Antibacterianos/farmacologia , Ceftriaxona/farmacologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Humanos , Imunocompetência , Abscesso Hepático/tratamento farmacológico , Masculino , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus constellatus/efeitos dos fármacosRESUMO
PURPOSE: The left gastric artery (LGA) is commonly severed when the gastric tube is made for esophageal reconstruction. Sacrifice of the LGA can cause liver ischemic necrosis in patients with an aberrant left hepatic artery (ALHA) arising from the LGA. We experienced a case of life-threatening hepatic abscess after severing the ALHA. Therefore, the purpose of this study is to evaluate clinical outcomes of severing the ALHA. METHODS: We retrospectively enrolled 176 consecutive patients who underwent esophagectomy with gastric tube reconstruction. They were classified into the ALHA (N = 16, 9.1%) and non-ALHA (N = 160, 90.9%) groups. Univariate analysis was performed to compare the clinicopathological variables. Long-term survival was analyzed using the Kaplan-Meier method in matched pair case-control analysis. RESULTS: The postoperative morbidities were not statistically different between the two groups, although serum alanine aminotransferase levels on postoperative days 1 and 3 were significantly higher in the ALHA group (36 IU/L, 14-515; 32 IU/L, 13-295) than in the non-ALHA group (24 IU/L, 8-163; 19 IU/L, 6-180), respectively (p = 0.0055; p = 0.0073). Overall survival was not statistically different between the two groups (p = 0.26). CONCLUSIONS: Severe hepatic abscess occurred in 6.3% of the patients with the ALHA after esophagectomy, even though the results presented here found no statistical differences in morbidity or mortality with or without the ALHA. Surgeons should probably attempt to preserve the ALHA especially in patients with altered liver function while making a gastric tube for esophageal reconstruction.
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Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Artéria Hepática/anormalidades , Abscesso Hepático/etiologia , Complicações Pós-Operatórias/etiologia , Estômago/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Hepatic abscess is a rare but potentially fatal entity in neonates. The aim of this study was to provide valuable data for diagnosis, management and prevention of hepatic abscess in preterm infants. METHODS: A retrospective chart review was made for patients diagnosed with hepatic abscesses between 2012 and 2015. Methods included clinical and radiological review of records and evaluation of potential risk factors. RESULTS: A total of three infants with hepatic abscesses were identified. All of them had low birth weight and low gestational age. Predisposing factors included prematurity, late sepsis, umbilical catheterization, necrotizing enterocolitis and previous antibiotic therapy. Isolated organisms from blood included Staphylococcus spp. in two cases and Pseudomonas spp. in one case. To the best of our knowledge, this is the first preterm case of hepatic abscess caused by Pseudomonas aeruginosa in the literature. All patients responded well to antibiotic therapy alone, and no interventional drainage was required. CONCLUSION: We suggest evaluating all preterm neonates who have severe sepsis and/or necrotizing enterocolitis signs and who do not respond to prolonged antibiotic therapy with detailed abdominal ultrasound for possible hepatic abscesses as early diagnosis, and treatment favors prognosis.
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Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Antibacterianos/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido , Recém-Nascido Prematuro/sangue , Abscesso Hepático/diagnóstico por imagem , Masculino , Infecções por Pseudomonas/diagnóstico por imagem , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico por imagem , Resultado do Tratamento , UltrassonografiaRESUMO
INTRODUCTION: Amebiasis can mimic cecal tumors. Unless this infection is diagnosed in a timely manner, affected individuals may undergo extensive surgery. MATERIAL AND METHODS: We carried out a retrospective analytical study of the therapeutic approach to amebiasis in a second-level hospital in an area of central Mexico with a high prevalence of this infection. Records from 2005-2011 were reviewed. There were 261 cases of amebiasis. Twenty cases were diagnosed by the histopathologist or on the basis of serological results. Sixteen patients underwent surgery due to acute abdomen, and four received medical treatment with metronidazole. Three treatment groups were analyzed: 1. hemicolectomy, 2. appendicectomy and antiamebic therapy, and 3. antiamoebic therapy alone. In the non-surgical group, imaging studies showed improvement with medical therapy. RESULTS: Length of hospital stay was higher in the group undergoing extensive surgery (p < 0.0133). There were no statistically significant differences among the remaining variables. CONCLUSIONS: The incidence of ameboma in our environment is higher (7.6%) than that reported in the literature. We believe that, in endemic regions, ameboma should be ruled out in patients with a cecal mass. As part of the therapeutic approach, patients should be tested for amebiasis or receive antiamebic therapy with monitoring of the mass to avoid extensive resective surgery.
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Entamoeba histolytica , Entamebíase/cirurgia , Granuloma/cirurgia , Abdome Agudo/etiologia , Adulto , Idoso , Apendicectomia , Neoplasias do Ceco/diagnóstico , Colectomia/métodos , Terapia Combinada , Diagnóstico Diferencial , Doenças Endêmicas , Entamebíase/diagnóstico , Entamebíase/tratamento farmacológico , Entamebíase/epidemiologia , Feminino , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Granuloma/parasitologia , Humanos , Tempo de Internação , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Introduction: This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation: This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion: this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.
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Fasciola hepatica is a trematode causing acute and chronic infection. A 33-year-old Canadian woman with eosinophilic liver abscesses and no relevant travel was diagnosed with F hepatica infection. F hepatica is reported in livestock in Alberta. This is the first case of locally acquired fascioliasis in Canada in >100 years.
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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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A hepatic abscess is the collection of suppurative matter within the parenchyma of the liver. While most pyogenic liver abscesses (PLAs) are polymicrobial in nature, some rare cases are caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case of a 43 year-old male without evident exposures who presented with abdominal pain and via CT imaging was found to have monofocal MRSA hepatic abscess. An ultrasonography (US)-guided abscess drainage along with a pigtail catheter placement was performed along with antibiotic initiation. This article emphasizes the clinical manifestations of hepatic abscesses and employs literature reviews to offer a comprehensive approach to managing these patient populations.
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Parvimonas micra is a Gram-positive anaerobic coccus that typically colonizes the oral cavity and gastrointestinal tract in humans. Though P. micra is typically associated with periodontal abscesses, it can also be an unlikely cause of bacteremia. Here, we report a case of P. micra bacteremia in the setting of a hepatic abscess. Antibiotic treatment of the bacteremia was initiated, and the entry source of the infection was investigated using various imaging techniques in the inpatient setting. A hepatic abscess was suspected to be the origin of infection for the P. micra bacteremia. Successful antibiotic treatment was confirmed by negative repeat blood cultures and an improvement in the patient's symptoms and clinical picture.
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Metronidazole, a commonly used antiprotozoal agent, has been linked to neurotoxicity in a few individuals. We present the case of a 61-year-old gentleman diagnosed with a liver abscess, who received a total dose of 64 g of metronidazole over a four-week duration. He subsequently developed slurred speech, numbness, and tingling sensation in both feet. His neuroimaging revealed T2 hyperintensities in the bilateral dentate nuclei and withdrawal of the drug led to symptomatic improvement in the patient. Metronidazole is known to produce neurological manifestations with involvement of peripheral nerves and cerebellum commonly. In the present case, the cumulative dose impact of metronidazole on the dentate nucleus was evident.