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Category: Volume 08 Issue 09 September 2020
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Title: A Complicated Case of Recurrent Liver Abscess Requiring Right Hepatectomy

Authors: Dr Pramod Nichat, Dr Pravin Agarwal, Dr Priya Ahire, Dr Saad Shaikh, Dr Kushagra Rahul, Dr Geoffrey Kharmutee, Dr Dinesh Goswami, Dhiraj Kachare

 DOI: https://dx.doi.org/10.18535/jmscr/v8i9.15

Abstract

Abscess of the liver has been described since the time of Hippocrates (400 BCE), with the first published review by Bright appearing in 1936.In 1938, Ochsner's classic review heralded surgical drainage as the definitive therapy, as in most cases the abscess spares the biliary tree[1].

But few of the abscesses are invasive enough to involve the biliary tree where simple drainage can lead to the formation of a biliary fistula[2]. Such cases require extensive radiological elucidation and surgical management[2,3].

The authors here present a case of liver abscess which in spite of drainage with USG guided pigtail/aspiration and conservative management progressed into a non healing recurrent abscess involving the right biliary tree requiring right hepatectomy.

References

  1. Chiu CT, Lin DY, Wu CS, Chang-Chien CS, Sheen IS, Liaw YF. A clinical study on pyogenic liver abscess. Taiwan Yi Xue Hui Za Zhi. 1987;86:405–412. 
  2. Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. 1990;212(6):655–662. doi: 10.1097/00000658-199012000-00002.
  3. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39(11):1654–1659. doi: 10.1086/425616.
  4. Hope WW, Vrochides DV, Newcomb WL, et al. Optimal treatment of hepatic abscess. Am Surg. 2008;74(2):178–182. 
  5. Lee KT, Wong SR, Sheen PC. Pyogenic liver abscess: an audit of 10 years' experience and analysis of risk factors. Dig Surg. 2001;18(6):459–465. doi: 10.1159/000050194.
  6. Branum GD, Tyson GS, Branum MA, Meyers WC. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. 1990;212:655–662.
  7. Baek SY, Lee MG, Cho KS, Lee SC, Sung KB, Auh YH. Therapeutic percutaneous aspiration of hepatic abscesses: effectiveness in 25 patients. AJR. 1993;160:799–802.
  8. Endoscopic Retrograde Cholangiopancreatography (ERCP) Technique Updated: May 30, 2019 Author: Ahmad Malas, MD; Chief Editor: Kurt E Roberts, MD [medscape.com/article/1829797.
  9. Biliary Stenting-Updated: Sep 30, 2019-Author: Philip L Johnson, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR [com/article/1828072-overview]
  10. Blumgart LH, Belghiti J. Surgery of the liver, biliary tract, and pancreas. 4th ed. Philadelphia, PA: Saunders Elsevier, 2007.
  11. Sharp KW, Locicero RJ. Abdominal packing for surgically uncontrollable haemorrhage. Ann Surg. 1992;215:467–475. 
  12. Rau HG, Duessel AP, Wurzbacher S. The use of water-jet dissection in open and laparoscopic liver resection. HPB (Oxford). 2008;10:275-280.
  13. Bertel CK, van Heerden JA, Sheedy PF., 2nd Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage. Arch Surg. 1986;121:554–558.
  14. Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess. Modern treatment. Arch Surg. 1991;126:991–996.
  15. Farges O, Leese T, Bismuth H. Pyogenic liver abscess: an improvement in prognosis. Br J Surg. 1988;75(9):862–865. doi: 10.1002/bjs.1800750910. 

Corresponding Author

Dr Geoffrey Kharmutee

Resident under General Surgery, General Surgery, Grant Government Medical College Mumbai Maharashtra India