Step-up approach in emphysematous hepatitis: A case report.

Area of Science:

• Hepatology
• Infectious Diseases
• Surgical Gastroenterology

Background:

• Emphysematous hepatitis (EH) is a rare, rapidly progressive, gas-forming infection of the liver.
• This fulminant condition predominantly affects patients with diabetes mellitus.
• EH carries a high mortality rate, necessitating prompt recognition and intervention.

Observation:

• A case of EH was successfully managed using a comprehensive step-up treatment strategy.
• The treatment included aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage.
• Laparoscopic deroofing was performed as a subsequent step in the management.

Findings:

• The reported case demonstrates a successful outcome with the step-up approach.
• Compared to previous literature, where only 1 of 11 documented EH cases survived (via urgent laparotomy and debridement), this case highlights an alternative successful management pathway.
• This suggests that a tailored, multi-modal approach may improve survival rates in EH.

Implications:

• Timely diagnosis of emphysematous hepatitis is crucial for effective management.
• The described step-up treatment strategy offers a potentially life-saving alternative to aggressive surgical debridement.
• Further research into optimal management protocols for EH is warranted to improve patient outcomes.