[Pyogenic liver abscess in chronic alcoholic pancreatitis]

Area of Science:

• Hepatology
• Gastroenterology
• Infectious Diseases

Background:

• Pyogenic liver abscesses can arise from various causes, including biliary tract issues and systemic infections.
• Chronic pancreatitis presents a complex clinical challenge, with potential for severe complications.
• Distinguishing the etiology of liver abscesses, especially in patients with pancreatic disease, is crucial for effective management.

Observation:

• A patient with chronic pancreatitis developed a pyogenic liver abscess, initially treated successfully with antibiotics and drainage.
• Recurrence of the liver abscess prompted further investigation, revealing a pancreatico-hepatic fistula.
• Elevated pancreatic amylase levels in the abscess aspirate were key to identifying the fistula.

Findings:

• The study highlights a rare case of a pyogenic liver abscess secondary to a pancreatico-hepatic fistula.
• Endoscopic retrograde cholangiopancreatography (ERCP) successfully visualized the fistula.
• Combined treatment with naso-fistular drainage, irrigation, and antibiotics resolved both the fistula and abscess without recurrence.

Implications:

• This case underscores the importance of considering pancreatico-hepatic fistulas in patients with liver abscesses following pancreatitis.
• Measuring pancreatic amylase in abscess aspirates is a valuable diagnostic tool for identifying such rare fistulas.
• Early and accurate diagnosis of pancreatico-hepatic fistulas can lead to timely and effective treatment, preventing recurrence.