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Bläckberg A, Jönsson A, Svensson E, Sunnerhagen T, Kiasat A, Ljungquist O. A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess. Open Forum Infect Dis 2023; 10:ofad352. [PMID: 37547858 PMCID: PMC10400158 DOI: 10.1093/ofid/ofad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pyogenic liver abscess (PLA) is a rare entity that is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.1-3.9]), malignancy (OR, 3.7 [95% CI, 1.9-7.1]), liver failure (OR, 6.3 [95% CI, 2.7-14.5]), and polymicrobial findings (OR, 3.8 [95% CI, 2.2-6.9]) were associated with death within 90 days (P < .05). Male sex (OR, 2.1 [95% CI, 1.2-3.6]), malignancy (OR, 2.1 [95% CI, 1.3-3.6]), age (64-74 years: OR, 2.5 [95% CI, 1.3-4.8]), and chronic liver disease (OR, 3.0 [95% CI, 1.4-6.5]) were associated with the risk of subsequent PLA (P ≤ .01). Conclusions Identifying different clinical variables associated with an unfavorable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.
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Affiliation(s)
- Anna Bläckberg
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden
| | - Ali Kiasat
- Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Ljungquist
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
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Malakar S, Mathur A, Elhence A, Ghoshal UC. Hepatogastric fistula: A rare complication of liver abscess. Indian J Gastroenterol 2023:10.1007/s12664-023-01347-7. [PMID: 37071374 DOI: 10.1007/s12664-023-01347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Sayan Malakar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226 014, Lucknow, India
| | - Akash Mathur
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226 014, Lucknow, India
| | - Anshuman Elhence
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226 014, Lucknow, India
- All India Institute of Medical Sciences, Raipur, 492 099, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 226 014, Lucknow, India.
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Tenewitz C, Harmon TS, Matteo M, Lamsal S, Matteo J. Fix the Flat: Applying the Principles of Tire Aerosol Repair to Prevent Exsanguination From a Hemorrhagic Intrahepatic Mass. Cureus 2021; 13:e19530. [PMID: 34934550 PMCID: PMC8668045 DOI: 10.7759/cureus.19530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Metastatic neoplasias often require increased blood supply for proliferation. Tumors that outgrow their blood supply can undergo necrosis, leading to the formation of mass-like abscesses. Depending on the location, these lesions can form fistulas with nearby organs resulting in poor patient outcomes. Interventional operators may use unconventional methods to the benefit of patients when resolving these complex lesions. The following case describes a patient with a large right hemorrhagic intrahepatic collection and formation of a duodenal fistula, resulting in acute blood loss anemia. Although there is not a standardized treatment for this complication, we present a novel therapeutic technique that incorporates similar principles analogous to the standard canned aerosol tire repair device.
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Affiliation(s)
- Chase Tenewitz
- Radiology, Mercer University School of Medicine, Savannah, USA
| | - Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Mika Matteo
- Radiology, University of Florida, Gainesville, USA
| | - Sanjay Lamsal
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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Mimery A, Ramly N, Das A, Rajkomar K. Malignant hepatogastric fistula with associated secondary liver abscess: a rare complication of an occult gastric adenocarcinoma. BMJ Case Rep 2021; 14:14/8/e240238. [PMID: 34353824 PMCID: PMC8719141 DOI: 10.1136/bcr-2020-240238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.
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Affiliation(s)
- Alexander Mimery
- Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Nicolas Ramly
- Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Amitabha Das
- Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kheman Rajkomar
- Upper Gastrointestinal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Lamba AS, Singh B, Gupta M, Dahiya S, Saini R. Hepato-Duodenal Fistula Complicating a Pyogenic Liver Abscess: An Unusual Presentation. Cureus 2020; 12:e12236. [PMID: 33500859 PMCID: PMC7819428 DOI: 10.7759/cureus.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An elderly male with type 2 diabetes mellitus was admitted to the emergency ward with fever and pain over the right hypochondrium since one month. An abdominal ultrasound revealed an ill-defined hypoechoic lesion with multiple air foci measuring 8 x 6 x 4 cm within the left lobe of the liver implicating segments III b and IV. A contrast-enhanced computed tomography (CECT) scan of the abdomen showed a similar lesion with leakage of oral contrast into the dependent areas of the collection from a rent in the antero-inferior aspect of the first part of the duodenum. Hepato-duodenal fistula or entero-hepatic fistula secondary to pyogenic liver abscess is an atypical and unusual complication requiring a high degree of suspicion for its diagnosis. Though optimal therapy for its management is still not known, early diagnosis with prompt initiation of therapy is imperative to reduce mortality.
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Affiliation(s)
- Amtoj Singh Lamba
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Bhavneet Singh
- Radiology, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Swati Dahiya
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Ruchika Saini
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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Kang MK, Kwon HJ, Kim MC. Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia. Yeungnam Univ J Med 2020; 37:246-249. [PMID: 32272010 PMCID: PMC7384915 DOI: 10.12701/yujm.2020.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022] Open
Abstract
Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.
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Affiliation(s)
- Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hee Jung Kwon
- Department of Pathology, Yeungnam University Hospital, Daegu, Korea
| | - Min Cheol Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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