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Hepatic abscesses after adhesiolysis
J Antonsen1, R Balachandran1, F Helgstrand1
1Køge Sygehus, Dept. of Surgery, Lykkebækvej 1, 4600 Køge, Denmark.
Introduction:
Hematogenous spread of bacteria from the bowel due to bacterial translocation has been postulated in animal and trauma studies. This case presents a patient with possible hematogenous bacterial spreading after acute laparotomy.
Case Presentation:
A 57-year old woman was admitted with abdominal pain. A computed tomography showed mechanical small bowel obstruction. A laparotomy was performed showing no contamination, and no bowel resection was performed. The patient was not given any antibiotics during this time. The patient was re-admitted 24h after discharge with fever, elevated white count and abdominal pain. A computed tomography showed newly developed intrahepatic abscesses. These were treated with antibiotics, and the patient was discharged with follow-up ultrasound showing diminished abscesses.
Discussion:
This case discusses the possible pathophysiology behind the development of intrahepatic abscesses after small bowel obstruction.
Conclusion:
Febrilia and pain in upper right quadrant of the abdomen days after a simple operation for bowel obstruction could be caused by translocation of intestinal bacteria and subsequent formation of hepatic abscesses.
Insights
Bacterial translocation from the bowel after surgery may cause liver abscesses. This case highlights a patient who developed intrahepatic abscesses following a laparotomy for small bowel obstruction, underscoring potential post-operative complications.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Bacterial translocation from the bowel is a proposed mechanism for hematogenous bacterial spread.
- This phenomenon has been observed in animal and trauma studies.
- This case explores its potential role in a patient following acute laparotomy.
Purpose of the Study:
- To present a case of intrahepatic abscess formation after laparotomy for small bowel obstruction.
- To discuss the possible pathophysiology of bacterial translocation leading to hepatic abscesses in this context.
Main Methods:
- A 57-year-old woman underwent laparotomy for mechanical small bowel obstruction without intraoperative contamination or bowel resection.
- The patient was not administered antibiotics perioperatively.
- Post-discharge, she developed fever, elevated white blood cell count, and abdominal pain, leading to the diagnosis of intrahepatic abscesses via computed tomography.
Main Results:
- Computed tomography revealed newly developed intrahepatic abscesses 24 hours after discharge.
- Abscesses were successfully treated with antibiotics.
- Follow-up ultrasound indicated diminished abscess size.
Conclusions:
- Intestinal bacterial translocation following small bowel obstruction and subsequent laparotomy may lead to the formation of intrahepatic abscesses.
- Fever and right upper quadrant pain after such procedures could indicate this complication.
- This case underscores the importance of considering bacterial translocation in the differential diagnosis of post-operative hepatic abscesses.
