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Hepatic abscess after biliary tract procedures.

J B Matthews¹, P Gertsch, H U Baer

¹Department of Visceral and Transplantation Surgery, University of Berne, Switzerland.

Surgery, Gynecology & Obstetrics

|June 1, 1990

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Hepatic abscesses following biliary surgery present indolently, often misdiagnosed. Surgical drainage may offer better outcomes than percutaneous methods for these complex cases.

Area of Science:

Hepatobiliary Surgery
Gastroenterology
Infectious Disease

Background:

Hepatic abscesses typically present acutely, but those post-biliary surgery can be indolent.
Patients may receive prolonged oral antibiotics for misdiagnosed non-suppurative cholangitis.

Purpose of the Study:

To describe the clinical presentation and management of hepatic abscesses after biliary tract operations.
To compare outcomes of different drainage techniques and identify factors influencing recurrence.

Main Methods:

Retrospective analysis of seven patients with hepatic abscess post-biliary surgery over two years.
Detailed investigation of the biliary tree to identify underlying biliary pathology.
Review of surgical and percutaneous drainage procedures and subsequent management.

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Main Results:

Presentations were indolent, with delayed diagnosis in several patients.
Associated biliary pathologies included strictures and iatrogenic bile duct injuries.
Recurrence occurred after both percutaneous and surgical drainage, requiring further intervention.

Conclusions:

Hepatic abscesses post-biliary surgery require thorough biliary tree investigation.
Operative drainage may be superior to percutaneous drainage for definitive management of associated biliary pathology.
Recurrence necessitates addressing underlying biliary issues, potentially via drainage of excluded ducts or fistulojejunostomy.