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PubMed2003

Pyogenic cholangitis after inadvertent submucosal contrast injection in the papilla of Vater in a patient with cholestatic hepatitis.

Common bile duct stones and tumors constitute the leading cause of acute biliary tract obstruction and cholangitis. Septic complications after diagnostic endoscopic retrograde cholangiopancreatography (ERCP) are very unusual in unobstructed bile ducts. There are only three reported cases of patients without evidence of biliary tract disease who developed cholangitis and liver abscesses due to Pseudomonas aeruginosa. Biliary endoscopists believe that the inadvertent submucosal injection of contrast into the papilla of Vater is an innocent accident that has no serious consequences other than increasing the percentage of unsuccessful catheterizations of the common bile duct. Herein we describe a patient with drug-induced cholestatic hepatitis who developed pyogenic cholangitis after the inadvertent injection of submucosal contrast in the papilla of Vater.

Aged↗
PubMed1975

Pathogenecity of Yersinia enterocolitica for mice.

A laboratory infection of Yersinia enterocolitica in mice which closely resembles the naturally acquired human infection is described Intravenous inoculation of mice with small numbers of Y. enterocolitica gives rise to a systemic, pyogenic infection involving primarily the spleen, liver, and lungs. Massive neutrophil infiltration of these organs occurs early in the infection, eventually leading to large abscesses and pulmonary consolidation. Mice infected intragastrically show neutophil infiltration in the Peyer's patches of the distal ileum less than 24h postinfection. The Peyer's patches are unable to contain the infection which spreads to the mesenteric lymph node, causing large abscesses in the medullary regions. Soon after, the infection becomes systemic with abscesses forming in the liver, spleen, and lungs, and the total peripheral leukocyte count rises dramatically to over 30,000/mm2. A serological response, in the form of agglutinating antibody, begins to appear 2 weeks after infection. Possible causes of death and the usefulness of this infectious disease model are discussed.

Animals↗
PubMed1980

Recurrent pyogenic cholangitis: a necropsy study.

Forty-six necropsy cases of recurrent pyogenic cholangitis (RPC) among Chinese in Hong Kong were reviewed. Intrahepatic biliary pigment stones or bile sludge were present in all cases and liver abscesses were common (80%). Histologically the early lesion was marked by acute inflammation in portal tracts with frequent pylethrombophlebitis and the advanced chronic lesion by periductal fibrosis. Most patients died from chronic persistent hepatic suppuration or disseminated infection. The pathogenesis is not fully understood; the present study favours the view that a protein-deficient diet initiates intrahepatic stone or sludge formation with biliary obstruction; subsequent bacterial infection probably originates from the portal system.

Adult↗
PubMed1985

Ruptured amebic liver abscess.

Fifteen cases of extrahepatic rupture of amebic liver abscess have been reviewed. Five patients had thoracic rupture and ten had intra-abdominal rupture. Celiotomies were performed in five patients, with a preoperative diagnosis of acute appendicitis with perforation in four patients and generalized peritonitis of unknown origin in one patient. All 15 patients were treated with amebicides, including three patients with documented free intraperitoneal perforation who were not treated surgically. Twelve patients recovered uneventfully. Two patients with thoracic rupture developed secondary bacterial complications and in one case of free intraperitoneal rupture, a mistaken diagnosis of ruptured pyogenic abscess was made. Amebicidal therapy was delayed for four days. The patient died of multisystem organ failure. Amebicidal therapy is effective in the treatment of both unruptured and extrahepatic rupture of amebic liver abscess. Surgery should be required only for secondary bacterial complications.

Adult↗
PubMed1989

The CT appearance of cystic masses of the liver.

The authors here discuss twelve discrete pathologic entities that they found, in a review of over 500 abdominal CT scans, caused the appearance of a cystic lesion in the liver. The CT characteristics of the various lesions are illustrated, differential points in the patients' histories are noted, and gross and microscopic pathology specimens are correlated with the CT appearances to explain the CT findings. Lesions considered include: simple (bile duct) cyst, adult polycystic kidney disease, Caroli disease, pyogenic abscess, echinococcal cyst, amebic abscess, metastasis, biliary cystadenoma and cystadenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, biloma, and extrapancreatic pseudocyst.

Carcinoma, Hepatocellular↗
PubMed1993

[Ultrasonography in the diagnosis of liver abscesses. Apropos of 32 cases].

A retrospective series of 32 cases of hepatic abscess was collected in the radiology department of Ibn Roch University Hospital (Casablanca), over a period of 43 months (May 1989-September 1992). Among these 32 cases, 16 were amebic (based on the dysenteric syndrome and especially positive amebic serology) and 16 had pyogenic causes. All patients underwent ultrasound examinations. Only two cases had CT scan. The confirmation of the hepatic abscess was made by ultrasound guided percutaneous aspiration in 30 cases and laparotomy in 2 cases. The right lobe was concerned in all cases. The pyogenic abscesses were multiple in 62.5% cases, while the amebic abscesses were double in only one case. The amebic abscesses were larger than the pyogenic ones. The average volume was respectively 10.5 cm and 7 cm. Three ultrasound aspects were found. Hypoechogenic aspect was the most frequent (76% of amebic abscesses and 61% of pyogenic abscesses). The heterogenic aspect was found in 21% of amebic abscesses and in 36% of pyogenic abscesses. The anechogenic aspect was found in only one case of pyogenic abscess. A light and regular wall was found in 70% of amebic abscesses and in 51% of pyogenic abscesses. Referring to the literature, the various ultrasound signs of orientation towards an amebic or pyogenic etiology were found in this series, but we emphasize the very important role of ultrasound-guided percutaneous aspiration and amebic serology for the etiological diagnosis of hepatic abscess.

Adolescent↗
PubMed1992

An unrecognized etiology for pyogenic hepatic abscesses in normal hosts: dental disease.

Cryptogenic pyogenic hepatic abscesses are a diagnosis of exclusion. We have identified two patients with severe dental disease at the time of the diagnosis of their liver abscess. In both cases, oral flora was cultured from the abscess. Unlike a previous report, both patients were immunocompetent. When compared with a group of patients with liver abscesses and diverticulitis, two differences were found. In contrast to the single abscesses seen in 10 of 10 patients with diverticulitis, the patients with dental disease had multiple abscesses (p < 0.02). In addition, Fusobacterium nucleatum was cultured from both dental disease associated abscesses but only one of the diverticulitis associated liver abscesses (p < 0.05). If a liver abscess is thought to be cryptogenic, a thorough dental exam is recommended.

Aged↗
PubMed1986

Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage.

A retrospective review of 39 patients with pyogenic hepatic abscess treated from 1977 through 1984 included 23 patients who were surgically treated and 16 who underwent percutaneous drainage. The average age in each group was similar (about 55 years). The most common cause of abscesses in each group was biliary tract disease. Abscesses caused by portal seeding and local extension were more common in the surgical group, 14 of whom required additional surgical procedures at the time of surgical drainage. Of the 16 patients in the percutaneously drained group, seven were seen during the immediate postoperative period. Most of the abscesses occurred in the right lobe of the liver, but single abscesses in the left lobe (30%) and multiple abscesses (57%) were more common in the surgical group. Klebsiella enterobacter and group D streptococcus were most common in the surgically and percutaneously drained groups, respectively. All patients received antibiotics, with a mean length of treatment of 14 days. Mean time to defervescence was about four days in both groups, with a longer hospital stay for the percutaneously drained group (26 vs 46 days). Morbidity was high in both groups (surgical, 48%; percutaneous, 69%). Three of the percutaneously treated patients required surgical drainage because of highly viscous abscess contents. Mortality was 17% in the surgical group and 13% in the percutaneously drained group. Percutaneous drainage with computed tomography probably should be the initial drainage procedure in patients with pyogenic hepatic abscesses in whom no concomitant surgical procedure is planned. Regardless of treatment, the morbidity and mortality remain high.

Adult↗
PubMed1982

Hepatic structure and function in Papua New Guineans with leprosy.

Hepatic function, including plasma bromsulphthalein (BSP) clearance was studied in 20 Papua New Guineans with leprosy: 11 lepromatous (LL) (6 had erythema nodosum leprosum (ENL)) (group A), and 9 tuberculoid or borderline (BT or BB) (group B); 12 controls (group C) were also studied. Four of five with abnormal BSP results had significant complicating or additional factors (hepatic amyloidosis, pustular ENL, hepato-cellular carcinoma and a pyogenic abscess), compared with two of 15 with normal results (tuberculous osteitis and pyogenic osteomyelitis). In nine (five from group A, and four from group B) needle liver biopsy histology was assessed: foci of vacuolated phagocytes and histiocytes, and tuberculoid granulomata were the most frequent lesions; none had cirrhosis. Leprosy is not associated with impaired hepatocellular function unless a severe complication or coincident disease is concurrently present. In this limited study therapeutic agents were not associated with abnormal liver structure or function. When liver function is abnormal in leprosy, another cause (e.g. secondary amyloidosis, sepsis or malignancy) should be searched for.

Adolescent↗
PubMedDate not supplied

[Pyogenic hepatic abscesses: 16 years experience in its diagnosis and treatment].

BACKGROUND: The aim of the present was to know the epidemiologic characteristics and clinico-biological variables presented by pyogenic hepatic abscesses and to evaluate the different therapeutic alternatives with special emphasis on percutaneous drainage. METHODS: A historical retrospective review of the hepatic abscesses diagnosed and treated in the authors' hospital over a 16.5 year period was carried out. RESULTS: A total of 44 cases of pyogenic hepatic abscesses were collected representing a rate of 0.088% of the hospital admissions. The mean age of the patients was 61.8 years. Thirty-four percent were cryptogenetic, being followed in frequency by those of biliary, post abdominal surgery and venoportal origin. Fever and right hypochondrial pain were the most frequent clinical manifestations, accompanied by an elevation in VSG and leucocytosis being the most common analytical alterations. Ultrasonography and CAT were found to be valuable in the diagnosis and treatment. The microorganism responsible was identified in 48% of the cases, with enterobacteria being the greatest number isolated. Fifty-two percent of the abscesses were treated with percutaneous drainage (73% if only patients post 1984 are considered), with minimum complications and a reduction in the number of days of hospitalization in comparison with surgical treatment. CONCLUSIONS: The presentation of a pyogenic hepatic abscess may be unspecific. Imaging techniques (echography and CAT) provide the main support in both the diagnosis and treatment. Percutaneous drainage plus early empiric antibiotherapy are the treatment of choice in pyogenic hepatic abscesses.

Adolescent↗
PubMed1990

Diagnosis and percutaneous treatment of pyogenic hepatic abscesses.

Twelve patients with intrahepatic abscesses were examined with computed tomography and ultrasonography between 1979 and 1988. The median size of the lesions was 7 (1-12) cm. They were in 8 patients located only in the right liver lobe and in 3 in both liver lobes. On ultrasonography the echogenicity of the abscesses varied from hypo- to hyperechoic which is consistent with tumours. The final diagnosis of abscess was achieved by fine needle puncture and aspiration for bacterial culture. Nine patients were treated with percutaneous drainage. 3 of them with two catheters, and all received systemic antibiotic treatment. All patients survived the treatment.

Aged↗
PubMed1995

Imaging and intervention in patients with acute right upper quadrant disease.

Because of the high diagnostic yield, its widespread availability and the possibility of bedside examinations, US has become the imaging modality of choice in patients with acute right upper quadrant pain caused by inflammatory disorders such as liver abscesses, acute cholangitis and acute cholecystitis. Computed tomography (CT) can be reserved for more complex cases. US, often in combination with fluoroscopy, is also widely used to control interventions. In patients with liver abscesses the therapeutic strategy is determined by the size of the abscess, its uni- or multifocal presentation and the causative micro-organisms cultured after diagnostic percutaneous aspiration. Small-sized pyogenic abscesses (< 3 cm), most fungal and amoebic abscesses can be treated medically. Large-sized pyogenic abscesses should be drained percutaneously and can be cured in 75-90%. Surgery should be restricted to patients with prolonged sepsis after percutaneous drainage and patients with infected pre-existing hepatic lesions. In patients with acute cholangitis drainage of the infected bile is essential. Invasive imaging such as percutaneous or endoscopic cholangiography procedures such as nasobiliary drainage, stent placement and sphincterotomy has decreased mortality rates dramatically. Percutaneous drainage should be considered in patients in whom endoscopic procedures fail. Surgery may have a place in the treatment of bile duct obstruction which causes cholangitis. In patients with suspected acute cholecystitis, imaging modalities such as cholescintigraphy and CT can be reserved for patients with inconclusive sonographic studies and more complex cases. The contribution of percutaneous gallbladder aspiration and culture to diagnose acute cholecystitis seems limited. Percutaneous cholecystostomy is an effective procedure with a low morbidity and mortality for high-risk patients. The drainage catheter in the gallbladder does not interfere with cholecystectomy at a later stage in patients with calculous cholecystitis. In most patients with acalculous cholecystitis, percutaneous cholecystectomy provides a definitive treatment.

Acute Disease↗
PubMedDate not supplied

[Ultrasonographic changes in the gallbladder wall in non-gallbladder diseases].

Alterations of the gallbladder wall is a well known sonographic sign of acute cholecystitis. But thickening of the gallbladder wall is also found in patients without intrinsic gallbladder disease. We present our experience on this regard in patients with cirrhosis, acute viral hepatitis, infectious mononucleosis, halothane hepatitis, fulminant hepatic failure, malaria due to plasmodium falciparum, heart failure, severe malnutrition due to gastric obstruction, septicemia, pyogenic hepatic abscess, amoebic hepatic abscess and in a 14 years old patient with fracture of the skull-acute anemia-shock. Most of these diseases affected the liver directly or indirectly. Knowledge of these alterations of the gallbladder wall in these circumstances are important in order to avoid a the erroneous diagnosis of acute cholecystitis.

Acute Disease↗