BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage...BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.展开更多
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to ...AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europ...BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.展开更多
We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case,...We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.展开更多
A 40-year-old woman without any clinical history was admitted for fever and discomfort in her right upper abdomen for 2 weeks.She denied headaches,recent travel,recent dental procedures,and recreational drug use.She w...A 40-year-old woman without any clinical history was admitted for fever and discomfort in her right upper abdomen for 2 weeks.She denied headaches,recent travel,recent dental procedures,and recreational drug use.She was noted to have dental caries.Physical examination revealed tenderness in the right upper abdomen and percussion pain in the hepatic area.The white cell count was 15.7×10^(9)/L,with 83.1%neutrophils.Abdominal plain computed tomography(CT)revealed that the liver was full of multiple low-density cysts.Enhanced CT revealed no enhancement of the central necrotic areas but revealed uneven enhancement of the cystic walls(yellow arrows)and edema of the surrounding liver parenchyma(Figure 1A).展开更多
BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefor...BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.展开更多
Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily...Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.展开更多
Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases.In some countries,its use is restricted to radiologists,limiting access for other clinicians,su...Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases.In some countries,its use is restricted to radiologists,limiting access for other clinicians,such as gastroenterologists.Endoscopic ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive diseases.However,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.展开更多
BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The c...BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.展开更多
BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiolog...BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.展开更多
BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecula...BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.展开更多
BACKGROUNDParagonimiasis is a typical food-borne zoonotic disease. Hosts acquire Paragonimusinfection through the ingestion of raw or undercooked crayfish and crab.The clinical manifestations of the disease are varied...BACKGROUNDParagonimiasis is a typical food-borne zoonotic disease. Hosts acquire Paragonimusinfection through the ingestion of raw or undercooked crayfish and crab.The clinical manifestations of the disease are varied, and it is often misdiagnosedor missed. The diagnosis of paragonimiasis should be considered comprehensively.Praziquantel is the first choice for treatment, and albendazole can beused in combination with repeated courses in severe cases.CASE SUMMARYWe report a case of liver paragonimiasis that was misdiagnosed as an abscess. Thepatient presented with fatigue and poor appetite for 2 months, and was diagnosedwith liver abscess in the local hospital. After 6 months, the patient visited ourhospital because of recurrent abdominal pain and was diagnosed with liverparagonimiasis based on epidemiological history, clinical presentations, andlaboratory findings. He was treated with praziquantel (25 mg/kg) three times aday for 3 days;however, the symptoms still presented after treatment. He wastreated with oral praziquantel and albendazole for one further course. Follow-upsuggested that the treatment was effective and the symptoms improved.CONCLUSIONThe combination of albendazole and praziquantel may improve the therapeuticefficacy of paragonimiasis.展开更多
BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis synd...BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.展开更多
BACKGROUND Thrombocytopenia is a common complication of invasive liver abscess syndrome(ILAS)by Klebsiella pneumoniae(K.pneumoniae)infection,which indicates severe infection and a poor prognosis.However,the presence o...BACKGROUND Thrombocytopenia is a common complication of invasive liver abscess syndrome(ILAS)by Klebsiella pneumoniae(K.pneumoniae)infection,which indicates severe infection and a poor prognosis.However,the presence of leukopenia is rare.There are rare reports on leukopenia and its clinical significance for ILAS,and there is currently no recognized treatment plan.Early and broad-spectrum antimi-crobial therapy may be an effective therapy for treating ILAS and improving its prognosis.CASE SUMMARY A 55-year-old male patient who developed fever,chills,and abdominal distension without an obvious cause presented to the hospital for treatment.Laboratory tests revealed thrombocytopenia,leukopenia,and multiple organ dysfunction.Imaging examinations revealed an abscess in the right lobe of the liver and thromboph-lebitis,and K.pneumoniae was detected in the blood cultures.Since the patient was diabetic and had multi-system involvement,he was diagnosed with ILAS accom-panied by leukopenia and thrombocytopenia.After antibiotic treatment and sys-temic supportive therapy,the symptoms disappeared,and the patient’s condition almost completely resolved.CONCLUSION Leukopenia is a rare complication of ILAS,which serves as an indicator of adverse prognostic outcomes and the severity of infection.展开更多
Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has incre...Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.展开更多
BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare malignant tumor and has non-specific clinical manifestations and imaging characteristics,making preoperative diagnosis challenging.Here,we report a case of PHL p...BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare malignant tumor and has non-specific clinical manifestations and imaging characteristics,making preoperative diagnosis challenging.Here,we report a case of PHL presenting primarily with fever,with computed tomography imaging showing a thick-walled hepatic lesion with low-density areas,resembling liver abscess.CASE SUMMARY The patient was a 34-year-old woman who presented with right upper abdominal pain and fever over 4 days before admission.Based on the patient’s medical history,laboratory examinations,and imaging examinations,liver abscess was suspected.Mesenchymal tumor was diagnosed by percutaneous liverbiopsy and partial hepatectomy was performed.Postoperative pathology revealed PHL.The patient is currently undergoing intravenous chemotherapy with the AD regimen and shows no signs of recurrence.CONCLUSION When there is a thick wall and rich blood supply in the hepatic lesion with a large proportion of uneven low-density areas,PHL should be considered.展开更多
Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,am...Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,amebic liver abscesses are more prevalent in tropical and developing nations.Most liver abscesses heal without complications.However,various vascular complications can occur in these patients,including compression of the inferior vena cava,thrombosis of the portal vein and/or hepatic veins,hepatic artery pseudoaneurysm,direct rupture into major vessels or the pericardium,and biliovascular fistula.These compli-cations can present significant clinical challenges due to the potential for hae-morrhage,ischemia,and systemic embolism,thereby increasing the risk of morbidity and mortality.Mechanical compression,flow stasis,inflammation,endothelial injury,and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess.For the diag-nosis,thorough assessment,and therapeutic planning of vascular complications,more sophisticated imaging techniques such as multidetector computed tomo-graphy angiography or magnetic resonance angiography may be necessary.Although most vascular complications resolve with abscess treatment alone,additional interventions may be required based on the nature,severity,and course of the complications.This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses,offering insights into their pathogenesis,diagnosis,and management strategies.展开更多
BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We re...BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.展开更多
BACKGROUND Klebsiella variicola(K.variicola)is a member of the Klebsiella genus and is often misidentied as Klebsiella pneumoniae.In this report,we present a rare case of invasive liver abscess caused by K.variicola.C...BACKGROUND Klebsiella variicola(K.variicola)is a member of the Klebsiella genus and is often misidentied as Klebsiella pneumoniae.In this report,we present a rare case of invasive liver abscess caused by K.variicola.CASE SUMMARY We report a rare case of liver abscess due to K.variicola.A 57-year-old female patient presented with back pain for a month.She developed a high-grade fever associated with chills,and went into a coma and developed shock.The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K.variicola complicated by intracranial infection and septic shock.The patient successfully recovered following early percutaneous drainage of the abscess,prompt appropriate antibiotic administration,and timely open surgical drainage.CONCLUSION This is a case of successful treatment of invasive liver abscess syndrome caused by K.variicola,which has rarely been reported.The findings of this report point to the need for further study of this disease.展开更多
BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventio...BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.展开更多
文摘BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.
基金Supported by The National Natural Science Foundation of China, No. 30872482 and No. 81072051
文摘AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
文摘We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.
基金supported by National Key Research and Development Program of China(grant number 2021YFC2501800).
文摘A 40-year-old woman without any clinical history was admitted for fever and discomfort in her right upper abdomen for 2 weeks.She denied headaches,recent travel,recent dental procedures,and recreational drug use.She was noted to have dental caries.Physical examination revealed tenderness in the right upper abdomen and percussion pain in the hepatic area.The white cell count was 15.7×10^(9)/L,with 83.1%neutrophils.Abdominal plain computed tomography(CT)revealed that the liver was full of multiple low-density cysts.Enhanced CT revealed no enhancement of the central necrotic areas but revealed uneven enhancement of the cystic walls(yellow arrows)and edema of the surrounding liver parenchyma(Figure 1A).
文摘BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.
文摘Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.
文摘Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases.In some countries,its use is restricted to radiologists,limiting access for other clinicians,such as gastroenterologists.Endoscopic ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive diseases.However,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.
文摘BACKGROUND Human cystic echinococcosis(CE)is a life-threatening zoonosis caused by the Echinococcus granulosus(sensu lato).Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality in the world.The coexistence of CE and HCC is exceedingly rare,and only several well-documented cases have been reported.In addition to this coexistence,there is no report of the coexistence of CE,HCC,and liver abscess to date.Herein,we aimed to report a case of coexistence of liver abscess,hepatic CE,and HCC.CASE SUMMARY A 65-year-old herdsman presented to the department of interventional therapy with jaundice,right upper abdominal distension and pain for 10 d.Laboratory test showed that he had positive results for HBsAg,HBeAb,HBcAb,and echino-coccosis IgG antibody.The test also showed an increased level of alpha fetopro-tein of 3400 ng/mL.An abdominal computed tomography(CT)scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver.In addition,CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images,the diagnoses of hepatic CE(CE4 subtype)and HCC were established.Initially,transarterial chemoembolization was performed for HCC.In the follow-up,liver abscess occurred in addition to CE and HCC;thus,percutaneous liver puncture drainage was performed.In the next follow-up,CE and HCC were stable.The liver abscess was completely resolved,and the patient was discharged with no evidence of recurrence.CONCLUSION This is the first reported case on the coexistence of liver abscess,hepatic CE,and HCC.Individualized treatment and multidisciplinary discussions should be performed in this setting.Therefore,treatment and diagnosis should be based on the characteristics of liver abscess,hepatic CE,and HCC,and in future clinical work,it is necessary to be aware of the possibility of this complex composition of liver diseases.
文摘BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.
基金supported by Hunan Province Key Research and Development Program(2020SKC2004).
文摘BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.
文摘BACKGROUNDParagonimiasis is a typical food-borne zoonotic disease. Hosts acquire Paragonimusinfection through the ingestion of raw or undercooked crayfish and crab.The clinical manifestations of the disease are varied, and it is often misdiagnosedor missed. The diagnosis of paragonimiasis should be considered comprehensively.Praziquantel is the first choice for treatment, and albendazole can beused in combination with repeated courses in severe cases.CASE SUMMARYWe report a case of liver paragonimiasis that was misdiagnosed as an abscess. Thepatient presented with fatigue and poor appetite for 2 months, and was diagnosedwith liver abscess in the local hospital. After 6 months, the patient visited ourhospital because of recurrent abdominal pain and was diagnosed with liverparagonimiasis based on epidemiological history, clinical presentations, andlaboratory findings. He was treated with praziquantel (25 mg/kg) three times aday for 3 days;however, the symptoms still presented after treatment. He wastreated with oral praziquantel and albendazole for one further course. Follow-upsuggested that the treatment was effective and the symptoms improved.CONCLUSIONThe combination of albendazole and praziquantel may improve the therapeuticefficacy of paragonimiasis.
文摘BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.
基金Supported by the 2022 Nanjing Health Science and Technology Development Special Fund Support Project,No.YKK22240.
文摘BACKGROUND Thrombocytopenia is a common complication of invasive liver abscess syndrome(ILAS)by Klebsiella pneumoniae(K.pneumoniae)infection,which indicates severe infection and a poor prognosis.However,the presence of leukopenia is rare.There are rare reports on leukopenia and its clinical significance for ILAS,and there is currently no recognized treatment plan.Early and broad-spectrum antimi-crobial therapy may be an effective therapy for treating ILAS and improving its prognosis.CASE SUMMARY A 55-year-old male patient who developed fever,chills,and abdominal distension without an obvious cause presented to the hospital for treatment.Laboratory tests revealed thrombocytopenia,leukopenia,and multiple organ dysfunction.Imaging examinations revealed an abscess in the right lobe of the liver and thromboph-lebitis,and K.pneumoniae was detected in the blood cultures.Since the patient was diabetic and had multi-system involvement,he was diagnosed with ILAS accom-panied by leukopenia and thrombocytopenia.After antibiotic treatment and sys-temic supportive therapy,the symptoms disappeared,and the patient’s condition almost completely resolved.CONCLUSION Leukopenia is a rare complication of ILAS,which serves as an indicator of adverse prognostic outcomes and the severity of infection.
文摘Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.
基金Supported by the Lishui City Key Research and Development Project,No.2022ZDYF08.
文摘BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare malignant tumor and has non-specific clinical manifestations and imaging characteristics,making preoperative diagnosis challenging.Here,we report a case of PHL presenting primarily with fever,with computed tomography imaging showing a thick-walled hepatic lesion with low-density areas,resembling liver abscess.CASE SUMMARY The patient was a 34-year-old woman who presented with right upper abdominal pain and fever over 4 days before admission.Based on the patient’s medical history,laboratory examinations,and imaging examinations,liver abscess was suspected.Mesenchymal tumor was diagnosed by percutaneous liverbiopsy and partial hepatectomy was performed.Postoperative pathology revealed PHL.The patient is currently undergoing intravenous chemotherapy with the AD regimen and shows no signs of recurrence.CONCLUSION When there is a thick wall and rich blood supply in the hepatic lesion with a large proportion of uneven low-density areas,PHL should be considered.
文摘Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,amebic liver abscesses are more prevalent in tropical and developing nations.Most liver abscesses heal without complications.However,various vascular complications can occur in these patients,including compression of the inferior vena cava,thrombosis of the portal vein and/or hepatic veins,hepatic artery pseudoaneurysm,direct rupture into major vessels or the pericardium,and biliovascular fistula.These compli-cations can present significant clinical challenges due to the potential for hae-morrhage,ischemia,and systemic embolism,thereby increasing the risk of morbidity and mortality.Mechanical compression,flow stasis,inflammation,endothelial injury,and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess.For the diag-nosis,thorough assessment,and therapeutic planning of vascular complications,more sophisticated imaging techniques such as multidetector computed tomo-graphy angiography or magnetic resonance angiography may be necessary.Although most vascular complications resolve with abscess treatment alone,additional interventions may be required based on the nature,severity,and course of the complications.This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses,offering insights into their pathogenesis,diagnosis,and management strategies.
文摘BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.
文摘BACKGROUND Klebsiella variicola(K.variicola)is a member of the Klebsiella genus and is often misidentied as Klebsiella pneumoniae.In this report,we present a rare case of invasive liver abscess caused by K.variicola.CASE SUMMARY We report a rare case of liver abscess due to K.variicola.A 57-year-old female patient presented with back pain for a month.She developed a high-grade fever associated with chills,and went into a coma and developed shock.The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K.variicola complicated by intracranial infection and septic shock.The patient successfully recovered following early percutaneous drainage of the abscess,prompt appropriate antibiotic administration,and timely open surgical drainage.CONCLUSION This is a case of successful treatment of invasive liver abscess syndrome caused by K.variicola,which has rarely been reported.The findings of this report point to the need for further study of this disease.
文摘BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.
