Objective To formulate an evidence-based treatment plan for a patient with suspected pyogenic liver abscess. Methods Based on the clinical questions raised by a patient with suspected pyogenic liver abscess, we searched The Cochrane Library (Issue 4, 2007), MEDLINE (1996 to January 2008), ACP Journal Club (1991 to January 2008), and Chinese Journal Full-text Database (1994 to January 2008) for systematic reviews, randomized controlled trials (RCTs) and case-control studies. The quality of the included studies was assessed. Results We did not find any systematic reviews or large-scale RCTs involving a comparison between laparoscopic drainage and surgical drainage in the treatment of pyogenic liver abscess. Four clinical retrospective studies closely related to our questions were found and assessed. These studies concluded that laparoscopic drainage for liver abscesses was a safe alternative for patients requiring surgical drainage. Based on the current evidence, as well as our clinical expertise and the patient’s values, laparoscopic drainage was not used for this patient and surgical drainage was applied. The patient was recovered and discharged. Conclusion Current evidence showed that laparoscopic drainage might be effective and safe for liver abscesses but high-quality large-scale randomized controlled trials are still required.
Objective To analyze the treatment and effect of bacterial liver abscess over the past two decades in one single center. Methods The total 198 patients with bacterial liver abscess during the last twenty years were studied retrospectively. They were divided into three groups according time: 1989-1995 group, 1996-2002 group and 2003-2008 group. Gender and age of patient, location, number and size of abscesses, treatment, hospital days, morbidity of complications and mortality among the groups were compared. Results There were 54, 69, 75 cases in 1989-1995, 1996-2002 and 2003-2008 group respectively. No significant differences were found in gender and age of patient, location, number and size of abscess among three groups （Pgt;0.05）. In 1989-1995 group, 35 cases (64.8%) were treated with laparotomy, 8 cases (14.8%) with laparoscope, and 11 cases (20.4%) with percutaneous treatment (needle aspiration or catheter drainage). In 1996-2002 group, 15 cases (21.8%) were treated with laparotomy, 21 cases (30.4%) with laparoscope, 31 cases (44.9%) with percutaneous treatment (needle aspiration or catheter drainage), and 2 cases (2.9%) were treated with antibiotherapy. In 2003-2008 group, 5 cases (6.7%) were treated with laparotomy, 13 cases (17.3%) with laparoscope, 54 cases (72.0%) with percutaneous treatment (needle aspiration or catheter drainage), and 3 cases (4.0%) were treated with antibiotherapy. The constituent ratio of treatment was significantly different among three groups (P＜0.05). The hospital days was (18.5±12.2) d, (16.4±12.8) d and (20.1±14.6) d, the morbidity of complications was 9.3% (5/54), 4.3%(3/69) and 4.0%(3/75), the mortality was 3.7%(2/54), 1.4%(1/69) and 1.3% (1/75) respectively, but there were no significant differences of three indexes among three groups. Conclusion With the development of surgical techniques, effective antibiotic therapy and percutaneous treatment (needle aspiration or catheter drainage) have been the main therapeutic methods, and laparoscopy and laparotomy are necessary supplement.
ObjectiveTo investigate the clinical characteristics and treatment to improve the prognosis of liver abscess after liver transplantation. MethodsEight cases of liver abscess after liver transplantation who were treated in our hospital from Apr. 1999 to Sep. 2013 were retrospectively analyzed, including clinical presentation, predisposing factors, treatment, and prognosis of outcomes. ResultsIn our group, the incidence of liver abscess after liver transplantation was 2.07% (8/387), and main predisposing factors included biliary complications, hepatic artery complications, and so on. The treatments included sensitive antibiotics therapy, reducing or deactivating immunosuppressant, aspiration and drainage of abscess by the ultrasound guiding, balloon valvuloplasty for biliary stenosis, percutaneous transhepatic cholangial drainage (PTCD), indwelling biliary stents, endoscopic nasobiliary drainage (ENBD), and hepatic resection. All of the 8 cases were followed-up for 3-59 months (median of 23 months), during the follow-up period, 4 cases were cured, 1 case improved, and 3 cases died. ConclusionsHepatic arterial and biliary complications are the most common predisposing factors for liver abscess after liver transplantation. Active prevention and treatment of biliary and hepatic arterial complications after liver transplantation are the key to reduce the occurrence of liver abscess and improve the prognosis of it.
ObjectiveTo evaluate the significance of the accessory left hepatic artery during the procedure of laparoscopic radical gastrectomy for gastric cancer. MethodsClinical data and imaging data of 120 patients with gastric cancer who underwent laparoscopic radical gastrectomy between January 2014 and June 2015 were retrospectively collected, to summarize the significance of accessory left hepatic artery in laparoscopic radical gastrectomy for gastric cancer, and to summarize the main points during the operation. ResultsNine patients (7.5%) had the accessory left hepatic artery in the whole group of 120 patients. Ligation was performed at the beginning of the distal left gastric artery or each branch near the stomach. All patients recovered well postoperatively. There was no significant difference in the total bilirubin, glutamic-pyruvic transaminase, and glutamic-oxalacetic transaminase on 3 days before surgery, 1, 3, and 7 days after surgery (P > 0.05). In addition, there was no occurrence of liver abscesses and intrahepatic biloma. ConclusionsThe incidence of accessory left hepatic artery variation is at a high incidence rate in clinical patients. It needs to be paid attention to protect the accessory left hepatic artery during the laparoscopic radical gastrectomy for gastric cancer, in order to avoid the occurrence of liver abscess and intrahepatic biloma.
Objective To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Methods The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured. Conclusions The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).
Objective To investigate the iron regulated locus in Klebsiella pneumoniae isolates from blood culture of liver abscess patients in Sichuan Provincial People’s Hospital. Methods From January to December of 2015, a total of 10 isolates of Klebsiella pneumoniae were collected from blood culture of liver abscess patients from Sichuan Provincial People’s Hospital. The genomic DNA was extracted to identify the genes of iroB, iroC, and iroD by PCR, and data was further analyzed by Graphpad Prism 5 software. Results Among the 10 Klebsiella pneumoniae clinical strains, 9 strains were iroB positive strains, 9 strains were iroC positive strains, and 10 strains were iroD positive strains, 9 strains were iroB/C/D triple positive. Conclusion The current study suggests that the frequency of triple positive of iroB/C/D in Klebsiella pneumoniae is high in isolates from liver abscess patients, the triple positive of iroB/C/D may contribute to liver abscess.