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Tang ZQ, Zhao DP, Dong AJ, Li HB. Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function: A case report. World J Clin Cases 2023; 11:6515-6522. [PMID: 37900233 PMCID: PMC10600992 DOI: 10.12998/wjcc.v11.i27.6515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/06/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Non-liquefied multiple liver abscesses (NMLA) can induce sepsis, septic shock, sepsis-associated kidney injury (SA-AKI), and multiple organ failure. The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines, exacerbating organ damage, and potentially causing immunosuppression and T-cell exhaustion. Therefore, the search for additional effective treatments that complement antibiotic therapy is of great importance. CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital's intensive care unit with intermittent vomiting, diarrhea, and decreased urine output. The patient exhibited a temperature of 37.8 °C. Based on the results of liver ultrasonography, laboratory tests, fever, and oliguria, the patient was diagnosed with NMLA, sepsis, SA-AKI, and immunosuppression. We administered antibiotic therapy, entire care, continuous renal replacement therapy (CRRT) with an M100 hemofilter, and hemoperfusion (HP) with an HA380 hemofilter. The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors. In addition, the treatment stimulated the expansion of the cluster of differentiation 8+ (CD8+) T-cells and led to the complete recovery of renal function. The patient was discharged from the hospital. During the follow-up period of 28 d, she recovered successfully. CONCLUSION Based on the entire therapeutic regimen, the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections, reduce inflammatory responses, and improve CD8+ T-cell immune function.
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Affiliation(s)
- Zhi-Qiang Tang
- Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Dan-Ping Zhao
- Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - A-Jing Dong
- Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Hai-Bo Li
- Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Zavidić T, Dejhalla E, Zahirović D, Lovrinić Đ. Piogenic liver abscess–A challenge for cooperation between family medicine and clinics. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2022. [DOI: 10.29333/jcei/12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kogo H, Yamamoto K, Yoshida H. A case of transverse colon cancer with a large liver abscess that could be treated with a radical operation after infection control. Int J Surg Case Rep 2020; 77:182-186. [PMID: 33166816 PMCID: PMC7652707 DOI: 10.1016/j.ijscr.2020.10.122] [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: 09/21/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Advanced colorectal cancer is known to be associated with liver abscesses. A strategy to treat liver abscesses as early as possible is necessary to ensure high surgical curability before the cancer progresses and to prevent worsening nutritional status of the patient during surgery. PRESENTATION OF CASE An 82-year-old woman was hospitalized due to fever. A 10 cm in diameter liver abscess and advanced colon cancer were diagnosed. After conservative treatment of the liver abscess with antibiotics and puncture drainage, colorectal cancer surgery was performed on a standby basis. DISCUSSION We propose that empiric antibiotic therapy should be administered early in cases of liver abscesses that may require early colorectal surgery. Abscess drainage should be performed promptly if the abscess is of a size that can be punctured easily. CONCLUSION In patients with advanced colorectal cancer complicated by liver abscesses that required early surgery, prompt drainage of the liver abscesses is mandatory.
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Affiliation(s)
- Hideki Kogo
- Department of Surgery, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
| | | | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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Pickens RC, Jensen S, Sulzer JK, Baimas-George M, Baker EH, Vrochides D, Martinie JB, Ocuin LM, Iannitti DA. Minimally Invasive Surgical Management as Effective First-Line Treatment of Large Pyogenic Hepatic Abscesses. Am Surg 2019. [DOI: 10.1177/000313481908500830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (<3 cm), PD for type II (≥3, unilocular), and surgical intervention (minimally invasive drainage or resection, when possible) for type III (≥3 cm, multilocular). Outcomes were compared between patients who received first-line treatment following the algorithm versus alternate therapy. Of 330 patients with PHA, 201 met inclusion criteria. Type III abscesses had significantly lower failure following algorithmic approach with surgery compared with PD (4% vs 28%, P = 0.018). Type II abscesses failed first-line PD in 27 per cent (13/48) with 11 patients requiring surgical rescue, whereas first-line surgery failed in only 13 per cent (2/15). No deaths occurred after any surgical intervention, and there was no statistical difference in major complications between first-line surgical intervention and PD for type II or III abscesses. These results support the algorithmic approach and demonstrate that minimally invasive surgical intervention is a safe and effective modality for large PHA. We recommend that select patients with large, complex abscesses should be considered for a first-line minimally invasive surgical approach depending on surgical experience and available resources.
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Affiliation(s)
- Ryan C. Pickens
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - Stephanie Jensen
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jesse K. Sulzer
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - Maria Baimas-George
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - Erin H. Baker
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - John B. Martinie
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - Lee M. Ocuin
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
| | - David A. Iannitti
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina and
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Sato K, Banshodani M, Nishihara M, Nambu J, Kawaguchi Y, Shimamoto F, Dohi K, Sugino K, Ohdan H. Sessile serrated adenoma/polyp leading to acute appendicitis with multiple pyogenic liver abscesses: A case report. Int J Surg Case Rep 2017; 42:38-43. [PMID: 29216529 PMCID: PMC5725155 DOI: 10.1016/j.ijscr.2017.11.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/27/2023] Open
Abstract
Appendicitis with liver abscess and sessile serrated adenoma/polyp is rare. Ileocecal resection was performed for an inflammatory mass in the ileocecum. The patient was successfully treated with a combination of surgery and antibiotics.
Introduction Although appendicitis is a common disease, appendicitis concurrent with liver abscesses and sessile serrated adenoma/polyp (SSA/P) is rare. Presentation of case A 69-year-old man presented with symptoms of abdominal pain and fever. Computed tomography (CT) revealed multiple liver abscesses and an enlarged appendix with a pseudotumoral appearance, which suggested acute appendicitis. In the emergency operation, ileocecal resection was performed for the perforated appendicitis with an inflammatory mass in the ileocecum. On macroscopic examination, the torose lesion was localized at next to the appendiceal orifice. The tumor was diagnosed as SSA/P based on the microscopic finding. The postoperative course was uneventful, and the liver abscesses were cured by antibiotic therapy. The patient was discharged 17 days after the surgery. Discussion In this case, SSA/P localization at next to the appendiceal orifice was suggested as the cause of the perforated appendicitis with multiple liver abscesses. The patient was successfully treated with a combination of surgery and antibiotic therapy. Conclusion This is the first reported case of a patient with SSA/P that led to acute appendicitis with multiple pyogenic liver abscesses.
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Affiliation(s)
- Koki Sato
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
| | - Masahiro Nishihara
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Junko Nambu
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yasuo Kawaguchi
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Department of Pathology, Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Kiyohiko Dohi
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Keizo Sugino
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Torres US, Grassi PG, Portela-Oliveira E, Gual F, Braojos FDC, Criado DAB. Sonographic "Bull's Eye" pattern of multiple liver lesions: atypical presentation of pyogenic abscesses. Surg Infect (Larchmt) 2013; 14:480-2. [PMID: 23991651 DOI: 10.1089/sur.2013.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ulysses S Torres
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School , São José do Rio Preto, São Paulo, Brazil
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Ishigami S, Arigami T, Uenosono Y, Uchikado Y, Kita Y, Sasaki K, Okumura H, Kurahara H, Kijima Y, Nakajo A, Maemura K, Natsugoe S. A case of sudden onset septicemia in recurred gastric cancer following s1 plus docetaxel treatment. J Gastric Cancer 2013; 13:126-8. [PMID: 23844329 PMCID: PMC3705134 DOI: 10.5230/jgc.2013.13.2.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/20/2022] Open
Abstract
Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.
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Affiliation(s)
- Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
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Abstract
Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3 cm), Abscess Type II (large >3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and χ2 used for comparison with a P < 0.05 considered significant. Our study consisted of 107 patients with pyogenic liver abscess. The success rate for small abscesses treated with antibiotics was 100 per cent. The success rate with antibiotics and percutaneous drainage for large, unilocular abscesses was 83 per cent and for large, multiloculated abscesses was 33 per cent. None of the 27 patients who had surgical therapy for large, multiloculated abscesses had recurrences. Surgical treatment for large (>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P ≤ 0.01). The mortality rate for the percutaneous drainage plus antibiotic group was not significantly different from the primary surgical group (4.2% versus 7.4%, P = 0.40). We propose a treatment algorithm with small abscesses being treated with antibiotics alone; large, uniloculated abscess with percutaneous drainage plus antibiotics; and large, multiloculated abscessed treated with surgical therapy.
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Affiliation(s)
- William W. Hope
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Dennis V. Vrochides
- Departments of Surgery, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | - William L. Newcomb
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - William W. Mayo-Smith
- Departments of Diagnostic Imaging, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | - David A. Iannitti
- Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, North Carolina
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