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Cut it out: Managing hepatic abscesses in patients with chronic granulomatous disease
Li Ern Chen1, Robert K Minkes, Penelope G Shackelford
1St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA.
Insights
For chronic granulomatous disease (CGD) patients, primary hepatic resection is a safe and definitive treatment for liver abscesses, avoiding recurrence and prolonged hospitalization associated with drainage procedures.
Area of Science:
- Hepatology
- Immunology
- Surgical Management
Background:
- Chronic granulomatous disease (CGD) predisposes patients to hepatic abscesses due to persistent bacterial challenges in the liver.
- Management strategies for liver abscesses in CGD patients require careful consideration.
Purpose of the Study:
- To investigate the efficacy of drainage versus hepatic resection in managing liver abscesses in patients with CGD.
- To compare outcomes, including recurrence rates and hospitalization duration, between drainage and resection.
Main Methods:
- Retrospective review of medical records for CGD patients diagnosed with hepatic abscesses between 1990 and 2001.
- Analysis of treatment approaches, including antibiotic therapy, drainage procedures, and hepatic resection.
Main Results:
- Six CGD patients with hepatic abscesses were identified; all received antibiotics.
- Four patients underwent multiple drainage procedures before resection, while two had primary resection.
- Resection resulted in no recurrences (mean follow-up 4.3 years) and significantly shorter hospital stays compared to drainage.
Conclusions:
- Drainage procedures for hepatic abscesses in CGD patients are linked to higher recurrence rates and extended hospitalizations.
- Primary hepatic resection offers a safe, definitive, and more efficient management strategy for liver abscesses in CGD.
Background:
Hepatic abscesses develop in patients with chronic granulomatous disease (CGD) because the liver is a site of constant bacterial challenge. The authors investigated the roles of drainage and hepatic resection in the management of liver abscesses in CGD patients.
Methods:
Medical records of CGD patients with hepatic abscesses from 1990 to 2001 were reviewed.
Results:
There were 6 patients. Mean age of initial abscess was 7.2 years (range, 3 weeks to 18.9 years). All abscesses involved the right lobe of the liver (2 single, 4 multiple). All patients received appropriate antibiotics. Four patients were treated with one to 6 drainage procedures over one to 4 admissions before ultimately undergoing resection. The other 2 patients underwent primary resection without preliminary drainage. Of the 6 resections, 4 were nonanatomic, and 2 were anatomic. There was one major postoperative complication (bleeding) requiring reoperation. There were no recurrences after resection (mean follow-up 4.3 yr). Mean total days in hospital for the treatment of liver abscess was 49 in the preliminary drainage group and 8.5 in the primary resection group. Three patients required admission into the intensive care unit, one after a drainage procedure and 2 after resection.
Conclusions:
For CGD patients with hepatic abscesses, drainage procedures are associated with recurrence and prolonged hospitalization. Primary hepatic resection removing all involved tissue is safe and definitive for the management of this problem.