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Perforated jejunal diverticulum with multiple hepatic abscesses
1Department of Surgery, Meharry Medical College, Nashville, Tenn. 37208.
Abstract:
We have described a patient with multiple hepatic abscesses caused by a perforated jejunal diverticulum with a presumed route of infection via the portal vein. Patients with hepatic abscesses and no known source of infection should be evaluated for a contained mesenteric perforation of the gastrointestinal tract. Finally, in patients who fail to respond promptly to percutaneous catheter drainage of a liver abscess, a continuing source of infection, such as perforation of a jejunal diverticulum, should be suspected.
Insights
A perforated jejunal diverticulum can cause multiple liver abscesses through portal vein infection. If liver abscesses lack a clear source, consider gastrointestinal perforation. Persistent infections may indicate ongoing diverticular issues.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Hepatic abscesses are serious infections requiring prompt diagnosis and treatment.
- Identifying the source of infection is crucial for effective management.
- Portal venous seeding is a recognized route for intra-abdominal infections to reach the liver.
Observation:
- A case of multiple hepatic abscesses was linked to a perforated jejunal diverticulum.
- The presumed route of infection was via the portal vein.
- The patient's condition suggested a contained mesenteric perforation.
Findings:
- Perforated jejunal diverticulum is a potential, often overlooked, cause of pyogenic liver abscesses.
- Portal vein involvement can lead to multifocal hepatic infection.
- Failure to respond to standard percutaneous drainage warrants suspicion of an unresolved intra-abdominal source.
Implications:
- Clinicians should consider gastrointestinal causes, particularly mesenteric perforation, in patients with unexplained hepatic abscesses.
- Evaluation for jejunal diverticular perforation is recommended for refractory liver abscesses.
- Early recognition and surgical intervention for perforated diverticula may improve outcomes in liver abscess patients.