ABSTRACT
BACKGROUND: Adult liver recipients (ALR) differ from the general population with pyogenic liver abscess (PLA) as they exhibit: reconstructed biliary anatomy, recurrent hospitalizations, poor clinical condition and are subjected to immunosuppression. The aim of this study was to identify risk factors associated with PLA in ALR and to analyze the management experience of these patients. METHODS: Between 1996 and 2016, 879 adult patients underwent liver transplantation (LT), 26 of whom developed PLA. Patients and controls were matched according to the time from transplant to abscess in a 1 to 5 relation. A logistic regression model was performed to establish PLA risk factors considering clusters for matched cases and controls. Risk factors were identified and a multivariate regression analysis performed. RESULTS: Patients with post-LT PLA were more likely to have lower BMI (p = 0.006), renal failure (p = 0.031) and to have undergone retransplantation (p = 0.002). A history of hepatic artery thrombosis (p = 0.010), the presence of Roux en-Y hepatojejunostomy (p < 0.001) and longer organ ischemia time (p = 0.009) were independent predictors for the development of post-LT PLA. Five-year survival was 49% (95%CI 28-67%) and 89% (95%CI 78%-94%) for post-LT PLA and no post-LT PLA, respectively (p < 0.001). CONCLUSION: history of hepatic artery thrombosis, the presence of hepatojejunostomy and a longer ischemia time represent independent predictors for the development of post-LT PLA. There was a significantly poorer survival in patients who developed post-LT PLA compared with those who did not.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cholangiopancreatography, Endoscopic Retrograde , Drainage , Liver Abscess, Pyogenic/therapy , Liver Transplantation/adverse effects , Adolescent , Adult , Aged , Anti-Bacterial Agents/adverse effects , Argentina , Arterial Occlusive Diseases/mortality , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/mortality , Cholangiopancreatography, Magnetic Resonance , Databases, Factual , Drainage/adverse effects , Drainage/mortality , Female , Humans , Jejunostomy/adverse effects , Jejunostomy/mortality , Liver Abscess, Pyogenic/diagnostic imaging , Liver Abscess, Pyogenic/microbiology , Liver Abscess, Pyogenic/mortality , Liver Transplantation/mortality , Male , Middle Aged , Multidetector Computed Tomography , Operative Time , Retrospective Studies , Risk Assessment , Risk Factors , Thrombosis/mortality , Time Factors , Treatment Outcome , Young AdultABSTRACT
Sao analisados 26 doentes submetidos à estomia na vigência de peritonite por abdome agudo nao traumático. A faixa etária variou de 25 a 83 anos, com média de idade de 51 anos. Nao houve predomínio quanto ao sexo. O abdome agudo obstrutivo (AAO) foi a causa mais freqüente de peritonite (11 casos), seguido do abdome agudo perfurativo (AAP) em 8, abdome agudo vascular (AAV) em 5 e inflamatório (AAI) em 2. Na maioria dos doentes (65 por cento) foi realizada ileostomia à Brooke. Em apenas 4 praticou-se jejunostomia, observando-se má evoluçao. A mortalidade global foi de 54 por cento. A realizaçao de estomia ou anastomose primária na presença de peritinite constitui um tema com muitas controvérsias. Nesta artigo sao discutidas as indicaçoes e os problemas envolvendo a exteriorizaçao intestinal na urgência.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Peritonitis/surgery , Abdomen, Acute/etiology , Peritonitis/etiology , Aged, 80 and over , Jejunostomy/mortality , Ostomy , Ileostomy/mortality , Risk Factors , Abdomen, Acute/mortality , Anastomosis, Surgical , Postoperative Complications/mortality , Surgical Wound Dehiscence/mortalityABSTRACT
Twenty-six patients showing peritonitis due to nontraumatic acute abdomen were submitted to ostomy. Mean age was 51 years (range 25-83), being 13 males and 13 females. Bowel obstruction (BO) was the most frequent cause of peritonitis (11 cases), followed by intestinal perforation (IP) (8 cases), acute mesenteric infarction (AMI) (5 cases), and acute abdomen of inflammatory/infectious origin (AAIO) (2 cases). Brook's ileostomy was performed on 65% of the patients. Jejunostomy was performed only in 4 patients, leading to a bad evolution. Overall mortality was 54%. Primary ostomy or anastomosis in cases of peritonitis constitute a highly controversial theme. Indications and problems involving the intestinal exteriorization in emergency surgery urgency are herein discussed.