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Pyogenic liver abscess: an unusual cause.

A Dinnoo1, L Barbier1, O Soubrane1

  • 1Chirurgie hépato-bilio-pancréatique, Hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy, France.

Journal of Visceral Surgery
|February 10, 2015
PubMed
Summary

A fishbone lodged in the liver pedicle caused a massive pyogenic liver abscess. Laparoscopic removal of the foreign body was successful after antibiotic treatment, highlighting the need for thorough investigation of liver abscesses.

Keywords:
Foreign bodyHepatic abscessPyogenic bacteria

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Surgical Pathology

Background:

  • Pyogenic liver abscesses (PLAs) are serious intra-abdominal infections requiring prompt management.
  • Percutaneous drainage and antibiotics are standard initial treatments for PLAs.
  • Unexplained or refractory PLAs necessitate a comprehensive etiological investigation.

Observation:

  • A 60-year-old female presented with a massive PLA initially treated with percutaneous drainage and antibiotics.
  • Computed tomography (CT) revealed a fishbone foreign body in the hepatic pedicle, near the right portal vein.
  • The patient underwent successful laparoscopic foreign body removal after 6 weeks of antibiotic therapy.

Findings:

  • A fishbone was identified as the causative agent of a massive pyogenic liver abscess.
  • Laparoscopic surgery effectively removed the foreign body, resolving the abscess.
  • This case underscores the importance of considering foreign bodies in PLA etiology.

Implications:

  • The presence of a foreign body, such as a fishbone, should be considered in the differential diagnosis of pyogenic liver abscesses.
  • Failure to resolve with standard treatment warrants advanced imaging to detect occult foreign bodies.
  • Early identification and removal of foreign bodies are crucial for successful PLA management and preventing complications.