Hepatic Resection for Liver Abscess – Case Report

Abstract

Background

Hepatic abscesses are confined masses of pus in the liver that generally form following liver trauma or abdominal infections. They can be classified by the causing organism as bacterial or amoebic (pyogenic abscesses), parasitic (hydatiform) or fungal. By location, most solitary abscesses form on the right lobe due to greater blood circulation, thus left sided abscesses are less commonly found. Intraabdominal inflammatory processes with bacterial infestation may use the the portal system to disperse the pathogen into the liver. Other mechanisms follow a more direct route. Acute cholangitis, or infection of the biliary tree can form a liver abscess per continuitatem. Risk factors for a liver abscess include all the risk factors for cholangitis or intraabdominal infections such as: appendicitis, cholecystitis, diverticulitis, bacteremia, endocarditis, biliary tract malformations, cysts and strictures or hepatocalculosis. Culprit pathogens include: E. Coli, Streptococcus, Staphylococcus, Klebsiella, E. Histolytica, but usually liver abscesses are multimicrobial. Liver metastases may also cause a liver abscess, which is not to be overlooked.

Case presentation

The patient is a 32 years old female who was transferred from a regional hospital. She had the complaints of abdominal pain of the right upper quadrant, high temperature (39-40°C) for three weeks. The patient was treated with a wide range of antibiotics, but no improvement was noted. An abdominal CT scan evidenced a large multi-cameral hepatic abscess involving segments VI-VII and VIII. The patient was transferred to the Intensive Care Department where she was resuscitated due to the severe septic state. She underwent the procedure of surgical drainage and resection of hepatic segments VI-VII. On the 10^th postoperative day she was discharged in good health.

Discussion

Size and location are important determining factors in the treatment strategy. For most of the cases of abscesses small and responsive to medical therapy the preferred route is the percutaneous drainage. However, it is in the surgeon’s discretion to decide whether an open approach is more beneficial for the patient.

Conclusion

Surgical drainage remains a cornerstone in the treatment of liver abscesses, especially those unresponsive to medical therapy. Patients with delayed diagnosis are more likely to need drainage or surgery. Our case underlines the importance the involvement of a multidisciplinary team and especially the surgeons in the treatment of patients with liver abscesses, as in advanced stages empiric medical therapy may be ineffective.

Keywords: General Surgery, Liver Abscess, Pyogenic Abscess, Liver Resection, Segmental Resection.

DOI: 10.7176/JEP/14-27-04

Publication date:September 30^th 2023