Salvage hepatectomy in refractory pyogenic liver abscess: a case report

Pyogenic liver abscess (PLA) is a rare but life-threatening condition. First-line management includes antimicrobial therapy and image-guided percutaneous drainage. Surgical resection is rarely required but remains an important method for definitive source control in selected cases. We report the case of a 65-year-old man with a large hepatic abscess that remained refractory to percutaneous drainage. Culture of the drain aspirate grew Klebsiella aerogenes and Candida albicans. Despite appropriate antimicrobial therapy, the patient's sepsis persisted, and imaging demonstrated inadequate resolution of the abscess. The patient underwent a hepatectomy and cholecystectomy. The post-operative course was complicated by a prolonged ileus, and the patient was well in his outpatient follow-up a few months after discharge. While uncommon in the modern era, hepatectomy remains a definitive treatment option for hepatic abscess when percutaneous drainage fails. Early recognition of treatment failure and timely escalation to surgery can be lifesaving.