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A case of amoeboma of the ascending colon with multiple amoebic liver abscess is being presented; which was mistakenly diagnosed as carcinoma of ascending colon with multiple secondaries in liver. Awareness of this previously unreported association is important because it adds to our knowledge of the spectrum of intestinal amoebiasis.
Two imported cases of amebic liver abscess are discussed with regard to laboratory, diagnostic and therapeutic peculiarities. The diagnostic role of ultrasonography and especially of specific serology is stressed, whereas in therapeutic terms, the efficacy of medical approach alone is emphasized even when complications until yesterday surgically treated occur.
Forty-eight patients were treated for amoebic liver abscess, 27 with metronidazole (Flagyl; Maybaker) and 21 with tinidazole (Fasigyn; Pfizer). Although 4 patients treated with tinidazole and 2 treated with metronidazole required a second course of therapy, both drugs were highly effective and resulted in rapid clinical improvement. The only side-effect was oral candidiasis, which developed in 2 patients in each drug group.
The authors submit the case-history of a 39-year-old patient with elective cholecystectomy where the immediate postoperative course was complicated by a liver abscess. The authors discuss aetiological factors, diagnosis and treatment of liver abscesses. In the conclusion they submit a proposal of ATB prophylaxis in severe inflammations of the gallbladder and biliary pathways. In the department of the authors ATB prophylaxis is not used before elective cholecystectomy.
32 CT-guided percutaneous drainages of bacterial liver abscesses in 25 patients accomplished definitive sanitation in 18 of them (72%). In 7 cases surgical revision was required. Percutaneous drainage of abscesses was able to achieve a temporal improvement in these cases and therefore was an effective pre-surgical measure. There were no complications primarily due to the method itself. The average dwell-time of catheters during drainage of curative percutaneous drainage was 22.5 days. The new therapy concept has proven to be of little discomfort and complications together with high therapeutic effectiveness.
This is a report of a rare case of bilateral exudative retinal detachment occurring in a young Nigerian male with pyogenic liver abscess. Detailed ocular and clinical examination with biochemical, haematological and microbiological studies of the blood and liver aspirate were done. Ocular and abdominal scan plus surgical drainage of abscess were also done. The main features were febrile illness with hepatomegaly and sudden loss of eyesight. Visual acuity was light perception in both eyes. The cardiovascular and renal systems were normal. Ocular scan showed bilateral bullous retinal detachment while abdominal ultrasound revealed multiple liver abscess cavities. HIV and HBsAg tests were negative. Pyogenic liver abscess should be regarded as possible cause of exudative retinal detachment and has a potential blinding complication.
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An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.
A case is presented of a patient with a psychiatric illness and pica who developed a pyogenic liver abscess due to perforation of the duodenum by a pen. This report emphasizes the importance of ultrasound and computed tomography in making a rapid diagnosis. The relative superiority of ultrasound was revealed because an anaesthetic was not required for scanning, and in addition to the liver abscess, the precise location of the perforating foreign body was demonstrated.
A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.
INTRODUCTION AND IMPORTANCE: Pyogenic liver abscess (PLA) has traditionally been considered prevalent in Asia. However, its incidence is increasing in Europe. Klebsiella pneumoniae (Kp) has emerged as the leading causative pathogen, and hypervirulent strains pose a higher risk of invasive disease and metastatic complications, such as endogenous endophthalmitis (EE). CASE PRESENTATION: The case describes a 77-year-old woman who presented with fever and right upper quadrant abdominal pain. She was diagnosed with a second episode of PLA within 3 months, caused by Kp. Despite prompt antimicrobial therapy and percutaneous transhepatic drainage, the patient developed acute vision loss in the left eye during hospitalization. Ophthalmologic assessment confirmed EE secondary to bacteremia. Whole-genome sequencing identified the isolate as hypervirulent Kp (hvKp) sequence type 23 (ST23). While the liver abscess resolved following treatment, the patient sustained permanent loss of vision in the affected eye despite aggressive medical and surgical management. CLINICAL DISCUSSION: This case illustrates the invasive nature of hvKp and its potential for recurrence and metastatic complications. Improved recognition through targeted virulence testing is essential to avoid underdiagnosis. CONCLUSION: This case highlights the aggressive nature of hvKp. Early recognition of systemic and ocular symptoms, prompt ophthalmologic evaluation, and timely source control are essential. Optimal management requires multidisciplinary collaboration and the use of molecular diagnostics, including whole-genome sequencing, to identify hypervirulent lineages and support surveillance.
Hepatic tuberculosis is one of the uncommon forms of extrapulmonary tuberculosis. We report a 78-year-old woman who developed tuberculous liver abscesses with splenic abscess not associated with pulmonary foci. Ultrasonography and computed tomography of the abdomen showed the low-density lesions in the liver and spleen. Histopathology of specimens obtained by percutaneous needle biopsy revealed coagulation necrosis and epithelioid cells but not tumor cells, suggesting tuberculosis infection in the liver and spleen. Systemic chemotherapy with anti-tuberculous agents led to the improvement of the lesions in the liver as well as spleen. Although tuberculous liver abscess is a very rare case, it should be included in the differential diagnosis of unknown hepatic mass lesions.
The presenting features, modes of treatment and clinical course were reviewed for 55 patients with pyogenic liver abscess, seen at Duke University Medical Center over a 15-year period. Thirty-three patients had a solitary abscess and 22 had multiple abscesses. Most patients were between the ages of 40 and 60 years. Males predominated, 2.4:1. Major underlying conditions included biliary tract disease, malignancy and colonic disease. Eight patients, each with a solitary abscess, had no identifiable underlying condition. Symptoms and signs were nonspecific: fever, chills, focal abdominal tenderness and hepatomegaly were common. A raised serum alkaline phosphatase level was the most consistent abnormal laboratory finding. CT with contrast enhancement, radioisotope scanning and ultrasonography all accurately defined solitary hepatic abscesses. However, CT scan was more successful than other imaging techniques in detecting multiple abscesses. In seven patients the diagnosis was made only at laparotomy. Overall, a diagnosis of liver abscess was made in 50 living patients (91%). Microorganisms were recovered from pus and/or blood cultures of 44 patients (80%). Most common were enteric gram-negative facultative rods, anaerobic gram-negative rods, and microaerophilic streptococci. Single abscesses were more likely than multiple abscesses to contain more than one organism. All patients received antibiotics; the choice of antibiotic does not appear to be critical provided the regimen has a broad spectrum including activity against anaerobes. Surgical or percutaneous drainage was successful when attempted in all patients with a single abscess, but the outcome was less favorable in those with multiple abscesses. Percutaneous drainage is currently replacing open operative drainage as the method of choice. Overall mortality in patients with single abscesses was 15% (5/33) and in those with multiple abscesses 41% (9/22).
We report on a case of a three year old boy, suffering from chronic granulomatosis disease, which led to repeated bacterial infections and finally to multiple liver abscesses. Diagnosis was based on the nitroblue-tetrazolium-test and histology. Antibiotic therapy over many weeks was not successful in spite of an adequate choice of medication against staphylococcal microorganisms and of good intracellular penetration, applicated parenterally. Only treatment by chloramphenicol after previous surgical drainage of the abscesses led to a dramatic clinical improvement and regression of the liver abscesses. The subsequent chemoprophylaxis with trimethoprim/sulfamethoxazole for at lest two years left the patient without clinical symptoms.
PURPOSE: Pyogenic liver abscess after hemorrhoidectomy is extremely rare. Only two such cases have been previously reported; the diagnosis in each was made intraoperatively. We report two additional cases of hepatic abscess after hemorrhoidectomy, both treated nonoperatively with a successful outcome. METHODS: The two cases were analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: In both cases, the patients presented within one week of the hemorrhoidectomy. Treatment with broad-spectrum intravenous antibiotics was successful in achieving significant clinical improvement. The liver function test values reverted back to normal and follow-up computed tomography (CT) scans of the liver revealed marked improvement of the abscesses. Laparotomy was avoided in both of the patients. CONCLUSIONS: Increased awareness of this serious complication will afford earlier diagnosis. In addition, proper aerobic and anaerobic bacterial isolation techniques will allow appropriate nonoperative therapy, decreasing the high morbidity and mortality rates associated with this complication.
An unusual case of a toothpick perforating the stomach, then penetrating the liver, and thereafter forming a liver abscess is reported. A 48-year-old woman who had ingested a toothpick 1 month earlier was admitted to our hospital because of severe epigastralgia which had progressively worsened. A laparotomy was performed because a granulomatous abscess in the liver due to this ingested foreign body was suspected. We found a granulomatous abscess in the liver due to the penetration of the toothpick through the stomach. The toothpick had become completely embedded about 2 cm deep in the left lobe of the liver. When dissecting the tumor, a 5.5-cm toothpick was removed, and a partial lateral resection of the liver was performed. The histological diagnosis was a hepatic abscess with granulomatous change. This was a rare case of a migration of an ingested toothpick into the liver through the stomach.
Hepatic ultrasonography not only can be used to detect amebic liver abscess, but can follow its resolution. Twenty-five patients with 32 abscesses had hepatic sonography performed repeatedly. Sonography clearly demonstrated abscesses of 1-22 cm; 19 patients (76%) had abscesses only in the right lobe of the liver, and 22 (88%) had solitary abscesses. Resolution time ranged from 2 months for the smallest abscess to 20 months for the largest. Four abscesses initially had a heterogenous partially solidified pattern. All abscesses healed completely, leaving normal hepatic sonographic patterns.
We report the case of a 17-year-old boy with gp91phax-deficient chronic granulomatous disease who developed a liver abscess due to Staphylococcus aureus. Despite treatment with appropriate antibiotics and gamma interferon for three months as well as incision and drainage, the abscess persisted unchanged in size. After surgical debridement, the abscess cavity was filled with two pedunculated greater omentum flaps as a direct feeder road of granulocytes to the infectious focus. An average of 48.5 x 10(9) granulocytes a day harvested from G-CSF-prestimulated donors were transfused for a total of 8 days without side effects. Ultrasound 3 months later showed no residual abscess. Combination of greater omentum flaps and transfusion of G-CSF-prestimulated granulocytes may be the optimal treatment for liver abscesses refractory to conventional therapy.