Manejo de un aneurisma infeccioso / Treatment of infected aneurysm

Resumen Introducción: Los aneurismas infecciosos constituyen una patología poco frecuente y se caracterizan por presentar infección de la pared del vaso implicado. El mejor tratamiento no está definitivamente establecido. Objetivo: Describir un caso de aneurisma infeccioso con manejo endovascular. Caso clínico: Presentamos un paciente de sexo masculino de 75 años que ingresa por cuadro compatible con abdomen agudo y que en el posoperatorio se pesquisa un aneurisma infeccioso del tronco celíaco, el cual se trata mediante una endoprótesis y manejo antibiótico. Discusión: El manejo tradicional del aneurisma infeccioso es la cirugía abierta que incluye la extirpación o exclusión del aneurisma y de su tejido perivascular infectado, pero conlleva gran morbimortalidad. Conclusión: El aneurisma infeccioso puede ser manejado de forma mínimamente invasiva con técnica endovascular, con baja morbilidad inmediata, pero con resultados a largo plazo aun no concluyentes.

Introduction: Infectious aneurysms are a rare disease and are characterized by infection of the involved vessel wall. The best treatment is definitely not established. Aim: To describe a case of infectious aneurysm with endovascular management. Case report: We present a 75-year-old male patient admitted to a table compatible with acute abdomen and that an infectious aneurysm of the celiac trunk is investigated in the postoperative period, treated with an endoprosthesis and antibiotic management. Discussion: The traditional management of the infectious aneurysm is open surgery that includes the removal or exclusion of the aneurysm and its infected perivascular tissue, but it leads to great morbidity and mortality. Conclusion: The infectious aneurysm can be managed minimally invasively with endovascular technique, with immediate low morbidity, but with long-term results that are still inconclusive.

Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis. .

Relapsing klebsiella pneumoniae liver abscesses in a non-asian diabetic man / Abcessos hepáticos recidivantes provocados por klebsiella pneumoniae num homem diabético não asiático

The Klebsiella pneumoniae invasive syndrome, first described in Asia, is being reported in other parts of the world. It causes liver abcsesses, with or without extrahepatic lesions. Diabetes mellitus is the most common hosts' underlying condition. It's frequent among asian people, even outside Asia, appearing to exist genetic factors, not yet established, increasing the risk. We present a case of a 55-year-old portuguese white diabetic man, who had a previous hospital admittion due to Klebsiella penumoniae pneumonia and a two-week latter diagnosis of liver abcsess. 4 years latter he was readmitted with nausea, chills, fever and myalgias. He had elevated inflammatory markers and the CT-scan showed 2 liver abscesses. Klebsiella pneumoniae was isolated in blood and antibiotics were given with complete clinical and imaging resolution. We present this case of relapsing Klebsiella pneumonia liver abscesses in a non-asian man emphasizing the growing incidence of this condition in Europe.

O síndrome invasivo provocado por Klebsiella pneumoniae, descrito pela primeira vez na Ásia, tem vindo a ser reportado em outras partes do mundo. Provoca abcessos hepáticos, com ou sem lesões extra-hepáticas associadas. A diabetes mellitus é a condição predisponente do hospedeiro mais comum. É frequente nos indivíduos asiáticos, mesmo fora da Ásia, parecendo existir factores genéticos, ainda não estabelecidos, que aumentam o risco da infecção. Apresentamos o caso de um homem português de 55 anos, diabético que tinha uma admissão prévia no hospital por pneumonia provocada por Klebsiella pneumoniae, com diagnóstico de abcesso hepático 2 semanas depois. 4 anos mais tarde, foi readmitido com um quadro clínico de nauseas, calafrios, febre e mialgias. Apresentava parâmetros inflamatórios elevados e a tomografia computorizada (TC) abdominal revelou 2 abcessos. Foi isolada Klebsiella pneumoniae em hemoculturas e foram administrados antibióticos com completa resolução clínica e imagiológica. Apresentamos este caso de abcessos hepáticos recidivantes por Klebsiella pneumoniae num homem não asiático, enfatizando a incidência crescente desta entidade na Europa.

A case of primary hepatic actinomycosis: an enigmatic inflammatory lesion of the liver

Primary hepatic actinomycosis is one of the chronic abscess-forming infections of the liver. Accurate diagnosis is frequently delayed due to its indolent course and nonspecific clinical and radiological manifestations. We report a case of a 57-year-old man presenting with asymptomatic multiple hepatic masses on follow-up abdominal computed tomography performed 1 year after stomach cancer surgery. Although a percutaneous liver biopsy procedure was conducted twice in order to obtain confirmative pathology, only a nonspecific organizing abscess with plasma cell infiltration was revealed, without identification of any organism in the tissue cultures. Ultimately, actinomycosis was diagnosed following the detection of sulfur granules on open surgical biopsied tissue. This case suggests that primary hepatic actinomycosis should be considered as one of the possible causes for enigmatic inflammatory lesions of the liver.

Clinical Features and Computed Tomography Characteristics of Non-Klebsiella pneumoniae Liver Abscesses in Elderly (>65 Years) and Nonelderly Patients

PURPOSE: To compare the clinical and computed tomography (CT) appearances of liver abscesses caused by non-Klebsiella pneumoniae bacterial pathogens in elderly and nonelderly patients. MATERIALS AND METHODS: Eighty patients with confirmed non-Klebsiella pneumoniae liver abscesses (non-KPLAs) were enrolled and divided into two age groups: elderly (age > or =65 years, n=42) and nonelderly (age <65 years, n=38). Diagnosis of non-KPLA was established by pus and/or blood culture. We compared clinical presentations, outcomes, and CT characteristics of the two groups, and performed multivariate analysis for significant variables and receiver-operating-characteristic analysis to determine the cutoff value of abscess diameter for predicting non-KPLA. RESULTS: Elderly patients with non-KPLA were associated with a longer hospital stay (p<0.01). Regarding etiology, biliary sources had a strong association in the elderly group (p<0.01), and chronic liver diseases were related to the nonelderly group (p<0.01). Non-KPLAs (52.5%) tended to show a large, multiloculated appearance in the elderly group and were associated with bile duct dilatation (p<0.01), compared with the nonelderly group. The abscess diameter (cutoff value, 5.2 cm; area under the curve, 0.78) between the two groups was predicted. In multivariate analysis, underlying biliary tract disease [odds ratio (OR), 3.58, p<0.05], abscess diameter (OR, 2.40, p<0.05), and multiloculated abscess (OR, 1.19, p<0.01) independently predicted elderly patients with non-KPLA. CONCLUSION: In the elderly patients with non-KPLA, a large, multiloculated abscess with a diameter greater than 5.2 cm was the predominant imaging feature.

Clinical Features and Computed Tomography Characteristics of Non-Klebsiella pneumoniae Liver Abscesses in Elderly (>65 Years) and Nonelderly Patients

PURPOSE: To compare the clinical and computed tomography (CT) appearances of liver abscesses caused by non-Klebsiella pneumoniae bacterial pathogens in elderly and nonelderly patients. MATERIALS AND METHODS: Eighty patients with confirmed non-Klebsiella pneumoniae liver abscesses (non-KPLAs) were enrolled and divided into two age groups: elderly (age > or =65 years, n=42) and nonelderly (age <65 years, n=38). Diagnosis of non-KPLA was established by pus and/or blood culture. We compared clinical presentations, outcomes, and CT characteristics of the two groups, and performed multivariate analysis for significant variables and receiver-operating-characteristic analysis to determine the cutoff value of abscess diameter for predicting non-KPLA. RESULTS: Elderly patients with non-KPLA were associated with a longer hospital stay (p<0.01). Regarding etiology, biliary sources had a strong association in the elderly group (p<0.01), and chronic liver diseases were related to the nonelderly group (p<0.01). Non-KPLAs (52.5%) tended to show a large, multiloculated appearance in the elderly group and were associated with bile duct dilatation (p<0.01), compared with the nonelderly group. The abscess diameter (cutoff value, 5.2 cm; area under the curve, 0.78) between the two groups was predicted. In multivariate analysis, underlying biliary tract disease [odds ratio (OR), 3.58, p<0.05], abscess diameter (OR, 2.40, p<0.05), and multiloculated abscess (OR, 1.19, p<0.01) independently predicted elderly patients with non-KPLA. CONCLUSION: In the elderly patients with non-KPLA, a large, multiloculated abscess with a diameter greater than 5.2 cm was the predominant imaging feature.

Hepatic abscess mimicking hepatocellular carcinoma in a patient with alcoholic liver disease

No abstract available.

A Case of Clostridium Liver Abscess with Sepsis / 대한소화기학회지

Clostridial septicemia usually occurrs in patients with immunocompromised diseases such as diabetes and malignancy. Clostridial liver abscess is very rare but highly fatal. We experienced a case of Clostridial septicemia due to liver abscess in a 73-year-old man. He was presented with fever and chills. On admission, abdominal CT scan showed about 35 mm sized hypoattenuated lesion with multiple central air-bubbles. After the diagnosis of liver abscess, the patient underwent prompt empirical antimicrobial therapy and percutaneous drainage. In spite of early therapy, the patient had gone into shock and death.

Edwardsiella tarda sepsis with multiple liver abscesses in a patient with Cushing's syndrome.

Edwardsiella tarda is very seldom a cause for gastroenteritis in humans. This organism can also cause extraintestinal infections, such as soft tissue infections, meningitis, peritonitis, osteomyelitis, endocarditis and hepatobiliary tract disease, particularly in the setting of compromised immunity. We describe, for the first time a case of E. tarda sepsis with multiple liver abscesses associated with Cushing's syndrome as a result of recreational aquatic exposure.

Ascariasis hepatobiliar con abscesos: a propósito de un caso en Honduras / Hepatobiliary ascariasis with abcesses: a case report from Honduras

Introducción: De las complicaciones menos frecuentes de la infección parasitaria por helminto intestinal Ascaris Lumbricoides, la ascaris hepática en niños es rara. Más rara aun es la ascaris hepatobiliar con abscesos. Caso clínico: se presenta el caso de una niña de 6 años de edad con sindrome de down, desnutrición proteico-calórica crónica grado II y nivel socieconómico bajo, que se presento con história de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y via biliar. la paciente desarrolló un bloque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones: La ascariasis hepatobiliar, aunque rara, tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños sospechen y diagnostiquen esta parasitosis para que con adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esa causa. Es necesario implementar medidas de prevención y control eficaces para la geohelmintiasis en Honduras...

Ascariasis hepatobiliar: informe de caso / Hepatobiliary ascariasis: a case report

Introducción. La ascariasis hepática es la complicación menos frecuente de la infección parasitaria por el helminto intestinal Ascaris lumbricoides. Sin embargo, el cuadro de ascariasis biliar complicada con abscesos hepáticos se observa en ciertas zonas endémicas como América Latina y el Sudeste Asiático, donde debe ser un diagnóstico a considerar en pacientes con sintomatología biliar obstructiva, principalmente en niños, ya que por el tamaño pequeño de sus órganos tienen mayor probabilidad de desarrollar obstrucción. Este gusano tiene la habilidad de entrar en ductos, como la vía biliar intra y extrahepática, y al morir dentro de la misma provoca serias complicaciones como obstrucción, colangitis y abscesos secundarios. Caso clínico. Se presenta el caso de una niña de 6 años de edad con antecedente de Síndrome de Down, desnutrición proteico-calórica crónica grado II y nivel socioeconómico bajo, que se presentó con historia de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. Se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y vía biliar. La paciente desarrolló un choque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones. La ascariasis hepatobiliar, aunque rara, es más común en países endémicos y tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños conozcan esta parasitosis para que con un adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esta causa. Es necesario implementar medidas de prevención y control eficaces para las geohelmintiasis en Honduras...

Liver abscess in a newborn leading to portal vein thrombosis.

We report a male neonate who had liver abscess that resolved with intravenous antibiotics and surgical drainage. However, the child developed complete thrombosis of portal vein with cavernous formation within 16 days of therapy and portal hypertension subsequently. The child is now 2½ years and has extra hepatic portal hypertension but is otherwise asymptomatic.

Papillon- lefevre syndrome with liver abscess.

An 8 year old boy presented with fever of unknown origin in whom the diagnosis of liver abscess was made. He also had palmoplantar keratoderma and premature loss of teeth, consistent with the diagnosis of Papillon Lefevre syndrome.

¿Es el absceso hepático de origen hídatídico un factor de riesgo para el desarrollo de complicaciones postoperatorias en pacientes intervenidos por hidatidosis hepática? / Liver abscess of hydatid origin as a risk factor for postoperative complications in hydatidosis

Background: Cyst infection and subsequent abscess formation is considered a complication of hepatic echinococcosis (HE). Aim: To determine whether liver abscess of hydatid origin (LAHO) is a risk factor for the development of postoperative complications (POC) in patients operated by HE. Material and Methods: Prospective cohort study. Patients consecutively operated by HE between 2000 and 2007 were studied. LAHO was considered as exposure and POC as outcome. Results: Fifty two patients with LAHO, aged 50 +/- 21 years (52 percent females) and 126 without LAHO, aged 48 +/- 20 years (56 percent females) were studied. Patients with LAHO had a higher frequency of coexistent cyst lesions and a lower frequency of biliary communications. The frequency of complications was 28.9 and 11.1 percent among patients with and without LAHO, respectively (p < 0.01, crude risk ratio of 2.6, 95 percent confidence intervals 1.4-5.0). Logistic regression showed a significant interaction of alkaline phosphatases with risk calculation. The risk ratio, adjusting by this variable, changed to 2.45 (95 percent confidence intervals 1.3-5.0). Conclusions: LAHO is a risk factor for the development of POC in patients operated by HE.

Introducción: La infección del quiste y subsiguiente formación de un absceso hepático de origen hidatídico (AHH) constituye una complicación evolutiva de la hidatidosis hepática (HH). Objetivo: Determinar si el AHH constituye un factor de riesgo (FR) para el desarrollo de complicaciones postoperatorias (CPO) en pacientes intervenidos por HH. Material y Método: Estudio de cohorte prospectiva. Se estudiaron pacientes intervenidos consecutivamente entre 2000 y 2007. La variable de exposición fue tener AHH y la variable resultado, el desarrollo de CPO (considerada de forma dicotómica). El tamaño de la muestra se calculó considerando nivel de significación de 5 por ciento, potencia de 80 por ciento, riesgo de CPO en pacientes con AHH de 24,4 por ciento y sin AHH de 6,5 por ciento; relación paciente con AHH: sin AHH de 1: 2; lo que determinó una muestra de 52 pacientes con AHH y 104 sin AHH. Se aplicaron análisis bivariados paramétricos y no paramétricos. Se calculó incidencia de CPO, riesgo relativo (RR) e intervalos de confianza del 95 por ciento (IC 95 por ciento); y se controló el efecto de variables clínicas, de laboratorio, evolutivas del parásito y quirúrgicas, aplicando modelos de regresión logística. Resultados: Las cohortes se conformaron por 52 pacientes con AHH y 126 sin AHH, con una mediana de edad de 45 años (59 por ciento de género femenino). La distribución de las variables categóricas fue similar en las cohortes en estudio, a excepción de "lesiones quísticas coexistentes" y "comunicaciones biliares". La incidencia de morbilidad fue 28,9 por ciento para la cohorte con AHH, y de 11,1 por ciento para la cohorte sin AHH (p = 0,0036; RR crudo de 2,6 [IC 95 por ciento 1,4 - 5,0]). El modelo de regresión logística permitió constatar que la variable "fosfatasa alcalina", interactuaba en la asociación en estudio (p = 0,018), razón por la que se controló por ésta, obteniéndose un RR ajustado de 2,45 con IC 95 por ciento de 1,3-5,0. Conclusión: Se...

A Case of Liver Abscess with Subcapsular Hematoma Mimicking Ruptured Hepatic Cholangiocarcinoma / 대한소화기학회지

Subcapsular hematoma is a very rare complication of liver abscess. We report a case of liver abscess with subcapsular hematoma mimicking ruptured hepatic cholangiocarcinoma. A 59-year old man presented with right upper quadrant pain and febrile sense. Computed tomography showed a low attenuated mass with extensive subcapsular hematoma on the right hepatic lobe. The initial impression was a hematoma caused by the rupture of cholangiocarcinoma. Hepatic arteriography was performed, but no active bleeding focus was found. After drainage of the subcapsular hematoma, a hematoma wall biopsy through the drainage catheter and a liver biopsy of the low attenuated mass were performed. The biopsies showed many neutrophils, macrophages, and granulation tissues consistent with an abscess, but no malignant cells were detected. After antibiotics therapy for 6 weeks, computed tomography was performed 4 months later, and revealed complete resolution of the hematoma and the low attenuated hepatic lesion.

A Case of Hepatocellular Carcinoma Combined with Liver Abscess / 대한소화기학회지

Hepatocellular calcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. It is important to diagnose HCC exactly before management is attempted. But, the clinical presentations and radiologic findings of liver abscess, HCC, and metastatic tumor to the liver may be quite similar, and procedures such as serum tumor marker assay, computerized tomography, and ultrasonography of the liver cannot make a specific diagnosis. We report a case of HCC successfully diagnosed by surgery which was misconceived as liver abscess and not improved by medical treatment.

Combined Hepatic and Splenic Abscesses in a Patient with Ulcerative Colitis

Liver abscesses are very rare complications of ulcerative colitis, and furthermore, there has been only one case of splenic abscess in a patient with ulcerative colitis reported in the English literature. We recently encountered a patient with ulcerative colitis accompanied by both hepatic and splenic abscesses. The patient was treated with abscess drainage as well as sulfasalazine and antibiotics. Follow-up sonography of the abdomen showed complete resolution of the lesions. To our knowledge, this is the first report of combined case of multiple liver abscesses combined with splenic abscess in a patient with ulcerative colitis.

Streptococcus intermedius liver abscesses and colon cancer: a case report / Abscesos hepáticos por Streptococcus intermedius y cáncer de colon: reporte de un caso

Certain species of bacteria are known to be associated with colorectal cancer. We report a case of adenocarcinoma of the colon with bacteraemia and liver abscesses due to Streptococcus intermedius. The isolation of this organism should prompt investigation for colorectal neoplasm, which may be present but asymptomatic, without metastases, and therefore at a curative stage.

Se sabe que ciertas especies de bacterias están asociadas con el cáncer colorectal. El presente trabajo reporta un caso de adenocarcinoma del colon acompañado de bacteriemia y abscesos hepáticos debidos a Streptococcus del grupo intermedius. El aislamiento de este organismo debe impulsar la investigación del neoplasma colorectal, el cual puede estar hallarse presente pero de forma asintomática, sin metástasis, y por consiguiente en una fase en que la cura es aún posible.