Morphological characteristics of liver abscesses according its etiology / Características morfológicas de los abscesos hepáticos según su etiología

Although infrequent in the diagnostics areas, liver abscesses are of significant relevance, which is related to the high morbidity and mortality figures they can cause if they are not detected and treated in time. Although multiple operational classifications are described, the one most recognized for its usefulness is that related to its causative agent (pyogenic or bacterial infection, hydatid origin or secondary to infected hydatidosis, and amoebic or by invasive amebiasis). The objective of this article was to generate a study report regarding the morphological characteristics of liver abscesses, characterizing them according to their etiology, as well as describing their study and the latest recommended treatments.

Los abscesos hepáticos son entidades nosológicas de baja frecuencia, pero de significativa relevancia, la que se relacionada con las elevadas cifras de morbilidad y mortalidad que pueden causar si no son detectados y tratados a tiempo. Si bien se describen múltiples clasificaciones operacionales, aquella más reconocida por su utilidad es la relacionada a su agente causal (piógenos o bacterianos, hidatídicos o secundarios a hidatidosis infectada, y amebianos o por amebiasis invasora). El objetivo de este artículo fue generar un documento de estudio respecto de las características morfológicas de los abscesos hepáticos, caracterizándolos de acuerdo con su etiología, así como describir su estudio y tratamiento recomendado de acuerdo con el estado del arte.

Microabscesos hepáticos en una paciente con síndrome antifosfolipidos. Reporte de caso / Liver microabscesses in a patient with antiphospholipid syndrome. Case report

Los abscesos hepáticos en la actualidad se siguen considerando un reto diagnóstico. Estos pueden dividirse en tres categorías principales según las condiciones subyacen­ tes: infecciosas, malignas e iatrogénicas. Incluyen aquellos secundarios a la extensión directa de una infección local, bacteriemia sistémica e infecciones intraabdominales procedente de la porta, Sin embargo, a lo largo de los años, con los estudios diagnósti­ cos la lista de factores de riesgo aumento, obligando a mas investigaciones para su en­ tendimiento; logrando su pronto reconocimiento y tratamiento eficaz con el fin de obtener buenos resultados. Se presenta un caso de femenino con antecedentes de sín­ drome antifosfolípidos con dolor abdominal asociado a intolerancia a la vía oral. Image­ nología abdominal muestra lesiones compatibles con microabscesos hepáticos siendo imposible la toma de muestra, requiriendo cubrimiento antibiótico de amplio espectro con resolución clínico radiológico completa. Tac de abdomen que muestra lesiones hepáticas múltiples con discreta colestasis intrahepática, lesiones compatibles con mi­ croabscesos múltiples.

Liver abscesses are currently still considered a diagnostic challenge. These can be divi­ ded into three main categories according to the underlying conditions: infectious, malig­ nant and iatrogenic. They include those secondary to the direct extension of a local infection, systemic bacteraemia and intra­abdominal infections from the portal, however, over the years, with diagnostic studies the list of risk factors increased, forcing more re­ search for its understanding; achieving its prompt recognition and effective treatment in order to obtain good results. A case of a female with a history of antiphospholipid syn­ drome with abdominal pain associated with oral intolerance is presented. Abdominal imaging shows lesions compatible with hepatic microabscesses, the sampling being im­ possible, requiring broad­spectrum antibiotic coverage with complete radiological clini­ cal resolution. Abdominal tac showing multiple liver lesions with discrete intrahepatic cholestasis, lesions compatible with multiple microabscesses.

Actinomicosis de pared abdominal con infiltración hepática simulando una neoplasia maligna: reporte de un caso / Abdominal wall actinomycosis with hepatic infiltration mimicking a malignant neoplasm: case report

La infección por Actinomices (actinomicosis), es una entidad poco frecuente y que puede crear dificultades diagnósticas y terapéuticas; principalmente cuando por su presentación se asemeja a neoplasias malignas. El objetivo de este estudio fue reportar un caso de actinomicosis de pared abdominal con infiltración hepática y revisar la evidencia existente. Se trata de una paciente sexo femenino, de 33 años de edad, sin antecedentes quirúrgicos ni de utilización de dispositivos intra-uterinos. Consultó por dolor abdominal y masa palpable a nivel epigástrico. Se estudió con imágenes, las que permitieron verificar una masa de pared abdominal con trayecto fistuloso al hígado. Se realizó una exéresis amplia de la lesión antes descrita. Una vez extirpado el espécimen, se fue a estudio histopatológico, que reveló gránulos de azufre consistentes con actinomices. La paciente evolució de forma satisfactoria, sin inconvenientes. Presentamos un caso poco común de actinomicosis de pared abdominal con infiltración hepática. Cuando se encuentra una gran masa intraperitoneal, la actinomicosis debe incluirse en el proceso de diagnóstico diferencial.

Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses.

Rotura hepática asociada a hipertensión arterial crónica y preeclampsia sobreañadida / Liver rupture associate with chronic hypertension and overadded preeclampsia

Se describe el caso clínico de una paciente de 29 años de edad con gestación de 24 semanas y antecedentes de hipertensión arterial crónica, que acudió al Servicio de Urgencias del Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba, por presentar cifras tensionales elevadas, cefalea, epigastralgia y vómitos. Se diagnosticó una preeclampsia sobreañadida y, por los signos de agravamiento, se decidió efectuar laparotomía. Se halló hemoperitoneo y una rotura en lóbulo derecho hepático, de modo que se realizó taponamiento hepático, que luego se retiró. La paciente requirió cuidados intensivos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres y la evaluación de un equipo multidisciplinario debido a la aparición de complicaciones: síndrome de insuficiencia respiratoria aguda, absceso de pared abdominal, absceso hepático y presunta trombosis ileofemoral. La evolución fue favorable y egresó viva.

The case report of a 29 year-old patient is described with a pregnancy of 24 weeks and a history of chronic hypertension, so that she went to the emergency Department of Tamara Bunke Bider Teaching Gynecological and Obstetrical Hospital in Santiago de Cuba, due to her high values, migraine, epigastralgia and vomits. A overadded preeclampsia was diagnosed and, because of the worsening signs, it was decided to make a laparotomy. A hemoperitoneo and a rupture in hepatic right lobe were found, thus, a hepatic tamponing was carried out which was then retired. The patient required intensive cares in Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital and the evaluation of a multidisciplinary team due to the emergence of complications: acute respiratory failure syndrome, abdominal wall abscess, hepatic abscess and presumed ileofemoral thrombosis. Her clinical course was favorable and she was discharged alive.

Enhanced Resolution of Eosinophilic Liver Abscess Associated with Toxocariasis by Albendazole Treatment / 대한소화기학회지

BACKGROUND/AIMS: Visceral larva migrans, caused by Toxocara canis and Toxocara cati, has emerged as a significant cause of eosinophilic liver abscess (ELA). Differentiation of ELA associated with toxocariasis (ELA-T) from metastasis or primary liver malignancy is sometimes difficult. However, the role of albendazole treatment remains uncertain in this condition. The aim of this study was to evaluate whether albendazole can enhance the radiologic resolution of ELA-T. METHODS: We retrospectively reviewed the medical records of the patients diagnosed with ELA-T at our institution between January 2008 and December 2011. ELA-T was diagnosed based on the imaging findings on computed tomography or magnetic resonance imaging and the presence of positive serum IgG antibody for Toxocara canis. Among a total of 163 patients, 32 patients received albendazole (albendazole group) and 131 did not (control group). Baseline characteristics and fate of liver nodules were compared between the two groups. RESULTS: Baseline characteristics (age, sex, number and maximal size of lesions, eosinophil count) were similar between the two groups. Median duration for achieving radiologic resolution in the albendazole group was significantly shorter than in the control group (207 days [range 186-228] vs. 302 days [range 224-380], p=0.023). In Cox regression analysis of the cumulative rates of radiologic resolution, the hazard ratio for albendazole treatment was 1.99 (95% confidence interval, 1.22-3.23). CONCLUSIONS: Radiologic resolution of ELA-T can be accelerated with albendazole treatment. Hence, inconvenience associated with long-term follow-up and unnecessary worries among patients can be eliminated with albendazole treatment.

Liver Abscess in Advanced Hepatocellular Carcinoma after Sorafenib Treatment / 대한소화기학회지

Hepatocellular carcinoma (HCC) is a critical global health issue and the third most common cause of cancer-related deaths worldwide. The majority of patients who present HCC are already at an advanced stage and their tumors are unresectable. Sorafenib is a multi-kinase inhibitor of the vascular endothelial growth factor pathway and was recently introduced as a therapy for advanced HCC. Furthermore, studies have shown that oral sorafenib has beneficial effects on survival. However, many patients experience diverse side effects, and some of these are severe. Liver abscess development has not been previously documented to be associated with sorafenib administration in HCC. Here, we report the case of a HCC patient that developed a liver abscess while being treated with sorafenib.

Absceso hepático piógeno por hueso de pescado: reporte de un caso / Pyogenic liver abscess due to fish bone: case report

Se informa el caso de un hombre residente en la ciudad de Bogotá, Colombia, quien consultó al servicio de urgencias del Hospital el Tunal de dicha ciudad por dolor abdominal progresivo de seis días de evolución, localizado en el cuadrante superior derecho, asociado a ictericia y fiebre, sin antecedentes relevantes. Al ingreso tenía deterioro marcado del estado general, por lo que requirió atención en la unidad de cuidados intesivos; se le hicieron estudios de imágenes diagnósticas que documentaron una colección multiseptada en el lóbulo hepático izquierdo, y un cuerpo extraño. En la laparotomía se encontró un hueso de pescado como causa del absceso. Con el drenaje y la terapia antibiótica la evolución fue favorable.

We report the case of a man who consulted the emergency department of Hospital el Tunal in Bogotá, Colombia, because of six days of progressive abdominal pain in the upper right quadrant, associated with jaundice and fever; there was no relevant information in his medical history. On admission he was found in poor general condition and required management in the intensive care unit; diagnostic imaging studies documented a multiseptate collection in the left hepatic lobe, and a foreign body. He was submitted to laparotomy in which a fish bone was found as the cause of the abscess. After drainage of the collection and with antibiotic therapy evolution was favorable.

A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver / 대한소화기학회지

Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.

Hepatobiliary fascioliasis in non-endemic zones: a surprise diagnosis

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Because of population migration and international food trade, human fascioliasis is being an increasingly recognised entity in nonendemic zones. In most parts of Asia, hepatobiliary fascioliasis is sporadic. Human hepatobiliary infection by this trematode has two distinct phases: an acute hepatic phase and a chronic biliary phase. Hepatobiliary infection is mostly associated with intense peripheral eosinophilia. In addition to classically defined hepatic phase and biliary phase fascioliasis, some cases may have an overlap of these two phases. Chronic liver abscess formation is a rare presentation. We describe a surprise case of hepatobiliary fascioliasis who presented to us with liver abscess without intense peripheral eosinophilia, a rare presentation of human fascioliasis especially in non-endemic zones

Abscesso hepático de origem hematogênica em paciente com febre de origem indeterminada / Hematogenic hepatic abscess in a patient presenting fever of unknown origin / Absceso hepático de origen hematogénico en paciente con fiebre de origen indeterminado

OBJETIVO: Descrever uma apresentação atípica de abscesso hepático em paciente pediátrico e realizar uma revisão da literatura no que diz respeito às diferenças observadas na etiopatogenia do quadro, quando considerados os países desenvolvidos e aqueles em desenvolvimento. DESCRIÇÃO DO CASO: Paciente de 13 anos, do sexo masculino, foi trazido ao pronto-socorro pediátrico devido à febre diária e à perda de peso, sem alterações ao exame físico. Na investigação realizada, o ultrassom abdominal evidenciou área heterogênea nodulariforme relativamente definida, compatível com abscesso hepático. Foi realizada drenagem cirúrgica e antibioticoterapia. No material da drenagem houve crescimento de Staphylococcus aureus sensível à oxacilina. COMENTÁRIOS: O caso demonstra a importância de o pediatra conhecer as principais causas da febre de origem indeterminada, saber desenvolver a abordagem investigativa e, frente ao diagnóstico de abscesso hepático, aferir a possibilidade de o agente etiológico ser o Staphylococcus aureus, principalmente quando houver relato de rotura da pele.

OBJECTIVE: To describe the clinical presentation of an atypical liver abscess in the pediatric setting and to conduct a review of the literature concerning ethiopathogenic differences between developed and developing countries. CASE DESCRIPTION: A 13-year-old male patient was admitted to the emergency room due to daily fever and weight loss, without abnormalities in his physical examination. After undergoing an investigation, the patient was found to have a well-defined heterogeneous nodular area in the abdominal ultrasonography exam, which was compatible with liver abscess. He was subsequently submitted to surgical drainage and started on antibiotics. The drainage material culture turned positive to methicillin-sensible Staphylococcus aureus. COMMENTS: The present case report shows that the pediatrician needs to be aware of the common causes of fever of unknown origin in order to systematically develop an investigative approach. In face of the diagnosis of a liver abscess, the possibility of Staphylococcus aureus, especially with a previous history of skin rupture, should be considered.

OBJETIVOS: Describir una presentación atípica de absceso hepático en pacientes pediátricos y realizar una revisión de la literatura en lo que se refiere a las diferencias observadas en la etiopatogenia del cuadro, cuando considerados los países desarrollados y en desarrollo. DESCRIPCIÓN DEL CASO: Paciente de 13 años, varón, fue traído a la emergencia pediátrica debido a la fiebre diaria y pérdida de peso, sin alteraciones al examen físico. En la investigación realizada, el ultrasonido abdominal evidenció área heterogénea nodulariforme relativamente definida, compatible con absceso hepático. Se realizó drenaje quirúrgico y antibioticoterapia. En el material drenado hubo crecimiento de Staphylococcus aureus sensible a la oxacilina. COMENTARIOS: El caso demuestra la importancia del pediatra en conocer las principales causas de fiebre de origen indeterminado, en saber desarrollar un acercamiento investigativo y, frente al diagnóstico de absceso hepático, estimar la posibilidad de que el agente etiológico sea el Staphylococcus aureus, principalmente cuando haya relato de rotura de la piel.

Cryptococcal liver abscess in HIV-negative individual.

Opportunistic fungal infections in immunocompromised patients are usually caused by candida, aspergillus, cryptococcus or zygomycetes. Rarely, fungal infections may occur in immunocompetent indivivals and are usually caused by cryptococcus or aspergillus. When infected by cryptococcus, the usual sites of infection include respiratory tract, central nervous system, or skin. Uncommon sites are liver, spleen, prostate, and bone marrow. When it involves liver, it can present with micro-abscesses, cholangitis, or hepatitis. Here we report a case of cryptococcal infection of liver in a HIV-negative patient presenting with micro-abscesses.

Prevalencia de abscesos hepáticos en el Hospital General del Oeste: período 2008-2010 / Prevalence of liver abscess in the General Hospital West: period 2008-2010

Introducción: Los abscesos hepáticos tienen múltiples etiologías, siendo los amebianos endémicos en los países en desarrollo, con una incidencia de 21 en 100.000 habitantes, generalmente son únicos y se ubican en el lóbulo derecho. Son más prevalentes en el sexo masculino, entre la tercera y quinta década de la vida. La mortalidad depende de la diferenciación entre el absceso piógeno, que es de alta mortalidad (hasta 40%) y que con frecuencia requiere drenaje, y el amebiano que es de nula mortalidad, el cual requerirá drenaje, dependiendo de su tamaño y de algunas localizaciones críticas. El objetivo de nuestro trabajo fue determinar la prevalencia y características ultrasonográficas de los abscesos hepáticos en el servicio de gastroenterología del Hospital General del Oeste. Métodos: Se realizó una revisión retrospectiva de los hallazgos ultrasonográficos en pacientes con diagnóstico de absceso hepático, que acudieron al servicio de Gastroenterología del Hospital General del Oeste, entre el año 2008 y el año 2010. Resultados: Se incluyeron un total de 58 pacientes. De los cuales el 72.4% fueron del sexo masculino y 27.5% del sexo femenino. Con una edad promedio de 37.6 años. El principal hallazgo ultrasonográfico fue absceso hepático único en 86.7%, de tamaño mediano (43.1%), con ubicación en el lóbulo derecho (84.4%). El 100% de los pacientes recibió tratamiento médico basado en antibioticoterapia, en 87.93% sólo se indico tratamiento médico, 5.17% drenaje percutáneo y 6.89% drenaje quirúrgico. Conclusión: Los abscesos hepáticos en nuestro centro son más frecuentes en el sexo masculino, siendo el hallazgo ultrasonográfico más común la presencia de abscesos medianos, únicos y ubicados en lóbulo derecho. En cuanto al tratamiento, la totalidad de los pacientes recibió antibioticoterapia oral o endovenosa, siendo bajo el porcentaje de pacientes que ameritó el drenaje de los mismos.

Introduction: Liver abscesses have multiple etiologies, with the amoebic form as a endemic in developing countries, with an incidence of 21 in 100,000 people, they are unique and are usually located in the right lobe. They are more prevalent in males between the third and fifth decade of life. Mortality depends on the differentiation between pyogenic abscess, which is a high mortality (up to 40%) and often requires drainage, and amebic which is no mortality, which require drainage, depending on their size and some locations criticism. The aim of our study was to determine the prevalence and ultrasonographic features of liver abscesses in the department of gastroenterology at the Hospital General del Oeste. Methods: We conducted a retrospective review of ultrasound findings in patients with liver abscess, who attended the Gastroenterology Service of the Western General Hospital, between 2008 and 2010. Results: A total of 58 patients. Of which 72.4% were male and 27.5% female. With an average age of 37.6 years. The main finding was ultrasonographic liver abscess in 86.7% single, medium-sized (43.1%), with location in the right lobe (84.4%). 100% of the patients received medical treatment based on antibiotic therapy in only 87.93% indicated medical treatment, 5.17% percutaneous drainage and 6.89% surgical drainage. Conclusión: Liver abscesses in our hospital are more frequent in males, being the most common ultrasonographic finding: abscesses medium, unique and located in the right lobe. As for treatment, all patients received oral or intravenous antibiotics, with low percentage of patients that required draining them.

Abscesso-Colonic Fistula Following Radiofrequency Ablation Therapy for Hepatocellular Carcinoma; A Case Successfully Treated with Histoacryl Embolization / 대한소화기학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Although surgical resection still remains the treatment of choice for HCC, radiofrequency ablation (RFA) has emerged as reliable alternatives to resection. It is less invasive and can be repeated after short intervals for sequential ablation in case of multiple lesions. The most common complication of RFA is liver abscess, and bile duct injury such as bile duct stricture has been reported. This is a case report of a rare complication of abscesso-colonic fistula after RFA for HCC. The case was treated by percutaneous abscess drainage and antibiotics and occlusion of abscesso-colonic fistula with n-butyl-2-cyanoacrylate embolization.

A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.

Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.

Endoscopic removal of chicken bone that caused gastric perforation and liver abscess.

A 40-yr-old gentleman presented with abdominal pain, nausea and vomiting since 3 weeks. CT scan of the abdomen showed a liver abscess but also a bone penetrating the left lobe of the liver. A 5-cm-long chicken bone was removed endoscopically. He was discharged on day 8 and was asymptomatic 12 months later. Endoscopic retrieval of an extraluminal foreign body causing liver abscess has not been reported previously.

Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates.

Liver abscess is a rare condition in neonates and its diagnosis requires a high degree of suspicion. CT scan and ultrasound are the most sensitive diagnostic modalities for detecting hepatic abscess. Portal vein thrombosis and cavernoma formation are rare complications following neonatal liver abscess and sepsis. We describe the case of two neonates with hepatic abscess following umblical vein catheterisation, with rare complications of portal vein thrombosis and portal vein cavernoma formation. Therefore, unreserved caution should be exercised in performing umbilical cannulation in neonates due to the inherent risks involved with this procedure.