Multiloculated Klebsiella liver abscess successfully treated with early laparoscopic drainage after failed...

Klebsiella pneumoniae liver abscess is characterized by an aggressive clinical course with a high risk of metastatic complications. Early initiation of appropriate antibiotics and timely drainage are essential for successful management. However, large multiloculated Klebsiella pneumoniae liver abscesses are associated with a high risk of percutaneous drainage failure.

A 70-year-old man with a history of prediabetes and chronic kidney disease presented with a 2-week history of progressively worsening right upper quadrant abdominal pain. On presentation, he was tachycardic at 107 beats per minute. Physical examination revealed marked right upper quadrant tenderness and hepatic percussion tenderness. Laboratory testing demonstrated neutrophil-predominant leukocytosis and elevated alkaline phosphatase and gamma-glutamyl transferase levels. Contrast-enhanced abdominal computed tomography (CT) revealed an 11-cm multiloculated mass in the right hepatic lobe consistent with a liver abscess. Intravenous ceftriaxone and metronidazole were initiated, and percutaneous drainage was performed. Culture of the aspirated fluid grew Klebsiella pneumoniae. Despite percutaneous drainage, the patient continued to experience severe pain and persistent leukocytosis, and follow-up CT demonstrated a persistent hepatic abscess. He subsequently underwent laparoscopic partial liver resection with fenestration of the abscess cavity. Postoperative imaging showed marked improvement, with resolution of symptoms and leukocytosis.

This case underscores the importance of carefully evaluating morphology and causative organism of abscess when selecting a drainage strategy for pyogenic liver abscess. In patients with multiloculated Klebsiella pneumoniae liver abscess, clinicians should maintain a low threshold for considering early surgical drainage.