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Successful hepatectomy for hepatic abscess with chronic granulomatous disease: a case report
Ryo Muranushi1, Makoto Suzuki2, Kenichiro Araki3
1Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Gunma University, 3-39-33, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Insights
Surgical resection of hepatic abscesses is a viable option for patients with Chronic Granulomatous Disease (CGD) when medical treatments fail. This case demonstrates successful hepatectomy in a CGD patient, offering a potential management strategy.
Area of Science:
- Hepatology
- Immunology
- Surgical Gastroenterology
Background:
- Chronic Granulomatous Disease (CGD) is a rare inherited immune disorder affecting phagocytic cell function.
- Hepatic abscesses are common in CGD patients, but optimal management remains unclear.
- This study focuses on a specific case to explore surgical intervention for hepatic abscess in CGD.
Purpose of the Study:
- To present a case of successful surgical management of a hepatic abscess in an adolescent with Chronic Granulomatous Disease.
- To highlight hepatectomy as a potential treatment option when medical therapy is ineffective for CGD-related hepatic abscesses.
Main Methods:
- A case presentation of an adolescent diagnosed with CGD presenting with persistent fever and a hepatic abscess.
- Computed tomography (CT) scan confirmed a multilocular hepatic mass.
- Anatomic liver resection (segments S4a+S5) and cholecystectomy were performed due to treatment failure with antibiotics and gamma-globulin.
Main Results:
- The patient's fever and inflammatory markers persisted despite medical management.
- Surgical resection of the hepatic abscess was performed.
- The postoperative course was uneventful, with no residual abscess noted on follow-up CT scans.
Conclusions:
- Hepatic abscess in CGD patients can be effectively managed with surgical intervention when medical treatments are unsuccessful.
- Hepatectomy is a feasible and potentially curative option for complex hepatic abscesses in CGD.
Background:
Chronic granulomatous disease (CGD), a rare inherited disorder, is characterized by impaired ability of phagocytic cells to kill certain bacteria and fungi. Although liver abscess is a common manifestation of CGD, its optimal management in these patients is unknown. Here, we present a case of successful hepatectomy for hepatic abscess in a patient with CGD.
Case Presentation:
An adolescent patient with previously diagnosed CGD presented to the pediatrics department of our institution with fever. Blood tests showed high concentrations of inflammatory markers. A computed tomography (CT) scan showed a multilocular mass measuring 52 mm × 34 mm in hepatic segment 4 (S4). Blood cultures were negative. Despite administration of antibiotics and γ-globulin, his fever and high concentrations of inflammatory markers persisted and the mass did not change on CT scan images. Because the medications had proved ineffective and percutaneous drainage would have been difficult because of the honeycombing in the abscess, we performed hepatic S4a + S5 anatomic resection and cholecystectomy. Culture of the excised specimen was negative. The patient's postoperative course was uneventful. On day 62, CT showed no abscess around the resection stump. On day 81, he was transferred to undergo bone marrow transplantation.
Conclusions:
Surgical treatment for hepatic abscess can be effective when medical treatment has failed.
