Pyogenic Liver Abscess Following Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) and Robot-Assisted...

Pyogenic liver abscess is a potentially life-threatening condition primarily caused by bacterial spread from the gastrointestinal or biliary tract to the liver. As endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy becomes more common in the treatment of choledocholithiasis, the risk of developing pyogenic liver abscess increases, with Klebsiella pneumoniae continuing to emerge as a more commonly identified pathogen in North America. Our case describes this unique presentation of a 54-year-old female diagnosed with Klebsiella liver abscess (KLA) following multiple diagnostic and therapeutic interventions: ERCP, biliary sphincterotomy with stent placement, and robot-assisted cholecystectomy. Prophylactic antibiotics, meticulous aseptic techniques during procedures, and close postoperative monitoring are key strategies that may mitigate the risk of KLA. In addition, clinical vigilance for potential bacterial colonization in these high-risk patients may further reduce the incidence of such complications. Importantly, this study highlights the gaps in science and the need for further investigation of endoscopic interventions as potential underlying risk factors associated with pyogenic liver abscess, particularly KLA.