A Case of Hypermucoviscosity Phenotype of Klebsiella pneumoniae Liver Abscess Saved by Damage Control Strategy.

Liver abscess caused by the Hypermucoviscosity phenotype of Klebsiella pneumoniae (HKp) is characterized by high tissue invasiveness and multiple systemic infections. This leads to sepsis, multiple organ failure, and coagulopathy. An 80 year old man came to our hospital with a complaint of malaise and went into hemorrhagic shock after percutaneous transhepatic drainage of a liver abscess caused by HKp. An emergency laparotomy was performed, but the patient suffered from severe coagulopathy and underwent damage control surgery. HKp liver abscesses must be operated on in the presence of multiple organ failure and disseminated intravascular coagulation (DIC) complications when medical treatment is refractory. In these situations, a two-stage damage control strategy should be considered: hemostasis and infection control at the initial surgery and hepatic resection.

Factor Analysis Influencing Postoperative Hospital Stay and Medical Costs for Patients with Definite, Suspected, or Unmatched Diagnosis of Acute Cholecystitis according to the Tokyo Guidelines 2013.

Purpose. To identify significant independent preoperative factors influencing postoperative hospital stay (PHS) and medical costs (MC) in 171 patients who underwent cholecystectomy for benign gallbladder diseases and had definite, suspected, or unmatched acute cholecystitis (AC) diagnosis according to the Tokyo Guidelines 2013 (TG13). Methods. The 171 patients were classified according to the combination of diagnostic criteria including local signs of inflammation (A), systemic signs of inflammation (B), and imaging findings (C): A+ B+ C (definite diagnosis, n = 84), A+ B (suspected diagnosis, n = 25), (A or B) + C (n = 10), A (n = 41), and B (n = 11). Results. The A+ B + C and (A or B) + C groups had equivalent PHS and MC, suggesting that imaging findings were essential for AC diagnosis. PHS and MC were significantly increased in the order of severity grades based on TG13. Performance status (PS), white blood cell count, and severity grade were identified as preoperative factors influencing PHS by multivariate analysis, and significant independent preoperative factors influencing MC were age, PS, preoperative biliary drainage, hospital stay before surgery, albumin, and severity grade. Conclusion. PS and severity grade significantly influenced prolonged PHS and increased MC.