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Background: Intrahepatic and perihepatic abscess (IPHA) is a severe yet understudied complication that can occur after hepatectomy. This multicenter study aimed to elucidate the clinical features, risk factors, and outcomes of IPHA after hepatectomy for hepatocellular carcinoma (HCC), and to develop a novel prediction model for personalized risk assessment., Methods: This was a multicenter cohort study of HCC patients who underwent curative-intent hepatectomy. IPHA was defined as an imaging-confirmed abscess located in the hepatic or perihepatic space within 30 days after surgery. A nomogram-based prediction model was developed using preoperative and intraoperative variables, and its performance was evaluated by the concordance index (C-index)., Results: Among the 4621 patients identified, 154 (3.3 %) developed IPHA. IPHA was associated with significantly prolonged hospital stays (median: 16 vs. 11 days, P < 0.001), increased 30-day readmission rates (33.0 % vs. 3.1 %, P < 0.001), and higher 90-day mortality (11.7 % vs. 2.8 %, P < 0.001). Multivariate analysis identified obesity, diabetes mellitus, portal hypertension, major hepatectomy, open surgery, and intraoperative diaphragmatic incision as independent risk factors. The prediction model demonstrated robust discrimination (C-index: 0.747) and calibration., Conclusions: IPHA significantly impacts postoperative outcomes following HCC resection. The novel prediction model aids in preoperative risk assessment to improve patient outcomes., (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

BACKGROUND Crohn disease is a chronic inflammatory bowel disease known for causing fistulous tracts, abscesses, and bowel perforation. Enterohepatic fistulas, a rare but significant complication, are scarcely reported. This article presents the case of a hepatic abscess due to an enterohepatic fistula in a patient with long-term Crohn disease and reviews the existing literature on this phenomenon. CASE REPORT A 59-year-old female patient with a known history of Crohn disease and previous ileocolic resection due to enteroenteric fistulas presented to our Emergency Department with right-sided abdominal pain persisting for 10 days. Diagnostic investigations, including imaging, revealed an enterohepatic fistula with a 3-4 cm hepatic abscess in segment V of the liver. Initial management involved conservative treatment with radiological drainage and antibiotics, leading to the patient's discharge. An elective laparotomy was scheduled 1 month later. The patient underwent resection of the ileocolic anastomosis with ileotransverse re-anastomosis and catheter removal. Postoperative management included treatment for paralytic ileus. She was discharged in good condition on postoperative day 11. CONCLUSIONS This report highlights the range of complications that can occur in patients with Crohn disease and presents the rare association between Crohn disease and enterohepatic fistula and abscess formation. Only 2 other case reports of enterohepatic fistula due to Crohn disease exist in the literature. Given the scarcity of evidence, no standardized guidelines are available, necessitating an individualized treatment approach. Initial conservative management can be effective; however, close monitoring is crucial to determine the need for subsequent surgical intervention.

BACKGROUND Hepatic lesion in a young woman can lead to multiple diagnostic hypotheses, mainly infection and tumor. Crohn's disease (CD) is hardly evoked by clinicians but is reportedly associated with liver damage, especially diffuse granulomas and aseptic abscess. IgA deficiency has been associated with celiac disease or inflammatory bowel disease, including CD. In this report, we present the diagnosis of CD in a fit 23-year-old woman following detection of aseptic liver abscess associated with a previously unknown selective IgA deficiency. CASE REPORT A young 23-year-old woman with no previous medical history other than appendicitis 1 year ago was hospitalized with persistent fever for 2 weeks associated with C-reactive protein increase (142 mg/L). Abdominal computed tomodensitometry and MRI showed a 4-cm liver abscess (segment IV). Biopsy revealed an aseptic epithelioid gigantocellular granuloma with caseous-free necrosis and granulomas rich in eosinophilic polynuclei. Furthermore, colonoscopy detected an inflammation in the colonic and ileal mucosa, with focal ulcerations, suggestive of CD. Immunological assessment led to the diagnosis of selective IgA deficiency. Anti-TNF and immunosuppressor therapies led to a rapid recovery and regression of hepatic lesions. CONCLUSIONS CD should be considered in aseptic liver abscess cases. Considering the association between IgA deficiency and CD, IgA (and IgG/IgM) should be assessed in patients with CD. Further research is necessary to confirm if specific manifestations such as aseptic liver abscess frequently occur in patients with CD related to IgA deficiency.

A 61-year-old female with diabetes and stage 5 chronic kidney disease on hemodialysis since 3 years via left brachiocephalic arteriovenous fistula presented with uncontrolled sugars, weight loss, and dysphagia. On evaluation, she was found to have an oral thrush with leucocytosis. Initial blood and urine cultures were sterile, and ultrasonography revealed hypoechoic lesions in the left lobe of the liver. She had high-grade fever followed by seizures on postadmission Day 10. Brain imaging and serum electrolytes were normal. Cerebrospinal fluid analysis was noncontributory, and urine culture revealed Candida non-albicans with elevated white blood cell counts. She was started on fluconazole; however, her clinical condition deteriorated, with hemodynamic instability. Repeat abdominal computerized tomography revealed increasing hypodense lesions in the left lobe of the liver with elevated beta D glucan levels. Percutaneous drainage of the abscess revealed no fungal elements. In view of clinical deterioration, amphotericin B was started, which resulted in clinical improvement. Clinician should have high index of suspicion for fungal etiology in hemodialysis patients presenting with liver abscess., (© 2024 International Society for Hemodialysis.)

Purpose: To estimate the risk of hepatobiliary infection, including endoTIPSitis, liver abscesses, and cholangitis, after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with prior biliary intervention., Materials and Methods: This multi-institution, retrospective study identified 76 patients (n = 48 males; mean age, 54.9 years; mean Model for End-stage Liver Disease [MELD] score, 13.2; n = 45 for ascites and n = 23 for varices; n = 31 with prior liver transplantation) among 2,130 (3.6%) undergoing TIPS creation who had prior biliary intervention (n = 19 bilioenteric anastomoses, n = 35 sphincterotomies, n = 28 internal plastic stent placements, n = 4 internal metal stent placements, and n = 6 percutaneous biliary drain placements). The baseline risk of post-TIPS creation hepatobiliary infection was estimated from a control group of 1,202 TIPS creation procedures in patients without prior biliary intervention., Results: Eleven (14.5%) of 76 patients developed hepatobiliary infection after TIPS creation, including 7 with endoTIPSitis, 4 with hepatic abscesses, and 2 with cholangitis. The 30-day risk of infection was 10.9% (95% confidence interval [CI], 3.5%-17.8%), significantly higher than the 0.4% risk (95% CI, 0.1%-0.8%) observed in patients without prior biliary intervention (hazard ratio [HR], 25.56; 95% CI, 8.36-78.13; P < .001). All types of biliary intervention were associated with increased risk of infection, with bilioenteric anastomoses conferring the highest risk. Paradoxically, among patients with prior biliary intervention, use of postprocedural antibiotic prophylaxis was associated with an increased infection risk (HR, 19.85; 95% CI, 2.44-161.50; P = .005). Microbial culture data showed high rates of Enterococcus, Klebsiella, and Candida species., Conclusions: Prior biliary intervention was associated with a 10.9% risk of hepatobiliary infection, including endoTIPSitis, liver abscess, and cholangitis, within 30 days after TIPS creation., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)

The presence of an intraperitoneal source of infection, e.g., a liver abscess, can be an obstacle to performing an abdominal aortic surgery with a midline laparotomy because graft infection is one of the most critical complications of aortic surgery. We report the successful Y-grafting of a pararenal abdominal aortic aneurysm through a retroperitoneal approach in a 67-year-old male undergoing liver abscess drainage. The retroperitoneal approach to the abdominal aorta may be useful for abdominal aortic surgery in patients with a localized intraperitoneal infection., Competing Interests: No potential conflict of interest relevant to this article was reported.

Background and Study Aims: Drug-eluting bead transarterial chemoembolization (DEB-TACE) causes serious complications, including liver abscess and biloma formation. This study aimed to investigate the frequency and risk factors of liver abscess and biloma formation after dug-eluting bead transarterial chemoembolization for unresectable intrahepatic cholangiocarcinoma (ICC)., Patients and Methods: 152 unresectable ICC patients received 241 DEB-TACE procedures from February 2018 to November 2022 were studied retrospectively. Patients were evaluated for the presence of liver abscess and biloma formation after DEB-TACE. The medical records, including baseline demographic data, preoperative imaging data, DEB-TACE details, and postoperative management, were reviewed to search for risk factors of liver abscess and biloma formation., Results: Liver abscesses developed in 11 cases, with an incidence rate of 7.2 % (11/152) per patient and 4.6 % (11/241) per procedure. In the 11 patients with abscesses, the incidence of biloma formation was 36.4 % (n = 4). The binary logistic regression analysis showed that diabetes mellitus (OR 7.967, 95 % CI 1.491-42.571, p = 0.015), bilioenterostomy or biliary stent implantation (OR 18.716, 95 % CI 1.006-348.049, p = 0.049) and grade 1 arterial occlusion (OR 9.712, 95 % CI 1.054-89.484, p = 0.045) were independent risk factors for liver abscess and biloma formation., Conclusion: Liver abscesses and biloma formation induced by DEB-TACE are associated with various factors. Diabetes mellitus, bilioenterostomy or biliary stent implantation, and grade 1 artery occlusion were all associated with liver abscess and biloma formation after DEB-TACE for unresectable ICC. In patients with these risk factors, the DEB-TACE procedure should be finely designed and manipulated with more caution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

A 46-year-old man underwent endoscopic ultrasound (EUS)-guided transgastric drainage with subsequent direct endoscopic necrosectomy (DEN) for an infected walled-off pancreatic necrosis (WOPN). Following treatment, he improved clinically with resolution of fever and substantial reduction in size of the WOPN. He was discharged with indwelling plastic stents which were to be removed after complete resolution of the WOPN. Follow-up CT and EUS 1 months later showed spontaneous stents dislodgement and a residual pancreatic fluid collection (PFC) measuring 4.0×2.3cm, for which re-intervention was technically demanding due to the small size. As he was asymptomatic, a decision was made to manage him expectantly for spontaneous resolution of the residual PFC. However, against our expectation, 1 year later he presented with recurrent fever to 40.1 °C. An hepatic abscess was identified on CT scan, which also revealed the residual PFC, though it was further reduced in size. After one month of antibiotic treatment, follow-up CT revealed that the hepatic abscess had resolved. Concurrently, complete resolution of residual PFC was also observed. EUS-guided drainage/debridement is a first-line therapy for WOPN. Remnant PFC due to premature stent dislodgement may persist as an insidious source of infection in which dormant pathogens may become reactivated sometime and culminate in a flare-up. Since the venous drainage of the pancreatic region ends up in the portal vein, occurrence of the hepatic abscess in the presence of the residual PFC should be considered as causal rather than coincidental. At least we couldn't help arousing a high suspicion of their cause-and-effect relationship. Therefore, despite its being technically challenging, timely reintervention with measures such as EUS-guided needle puncture and irrigation so as to thoroughly eradicate the residual PFC burden should be advocated to reduce the likelihood of late on-set local or distant infection.

Purpose: To analyze the safety of combination treatment comprising drug-eluting bead transarterial chemoembolization (DEB-TACE) and immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC)., Method: In total, 208 HCC patients receiving DEB-TACE were enrolled for this retrospective single-institution study. Among them, 50 patients who received ICIs at an interval less than one month from DEB-TACE were categorized into the DEB-ICI group; the remaining 158 patients were categorized into the DEB group. Albumin-bilirubin (ALBI) score before and at three months after DEB-TACE were recorded to evaluate liver function changes. Adverse events within three months after DEB-TACE were considered TACE-related and were compared between the two groups., Results: The DEB-ICI group had significantly higher incidence of liver abscess than the DEB group (14.0 % versus 5.1 %, p-value = 0.0337). No significant difference in the other TACE-related adverse events and change of ALBI score between the groups. Univariate logistic regression confirmed that combination with ICIs was an independent risk factor for liver abscess after DEB-TACE (odds ratio = 3.0523, 95 % confidence interval: 1.0474-8.8947, p-value = 0.0409); other parameters including subjective angiographic chemoembolization endpoint scale and combined targeted therapy were nonsignificant risk factors in this study population. In the DEB-ICI group, patients who received ICIs before DEB-TACE exhibited a trend toward liver abscess formation compared with those who received DEB-TACE before ICIs (23.8 % versus 6.9 %, p-value = 0.0922)., Conclusions: Combination treatment involving DEB-TACE and ICIs at an interval less than one month increased the risk of liver abscess after DEB-TACE. Greater caution is therefore warranted for HCC patients who receive ICIs and DEB-TACE with this short interval., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

A woman in her 70s was hospitalized and was diagnosed with liver abscess and managed with antibiotics in a previous hospital. However, she experienced altered consciousness and neck stiffness during treatment. She was then referred to our hospital. On investigation, we found that she had meningitis and right endophthalmitis concurrent with a liver abscess. Klebsiella pneumoniae was detected from both cultures of the liver abscess and effusion from the cornea. A string test showed a positive result. Therefore, she was diagnosed with invasive liver abscess syndrome. Although she recovered from the liver abscess and meningitis through empiric antibiotic treatment, her right eye required ophthalmectomy. In cases where a liver abscess presents with extrahepatic complications, such as meningitis and endophthalmitis, the possibility of invasive liver abscess syndrome should be considered, which is caused by a hypervirulent K. pneumoniae.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) caused imminent acute infection of respiratory tract known as Coronavirus disease 2019 (COVID-19). Complications of hepatobiliary system especially liver often found in post-acute COVID-19 patients. However, there are only few studies specifically discussing about liver abscess in patients who had history of contracted COVID-19. We present a case of a 54-years-old gentleman with no previous medical illness and no history of vaccination, who was presented with ruptured liver abscess post COVID-19 infection Category 4 (symptomatic with lung infection and the need of oxygen supplementation). Percutaneous drainage was performed to drain the abscess and collections.

The authors present minimally invasive surgical treatment of recurrent liver abscess caused by migration of fish bone from the upper gastrointestinal tract. Two-stage treatment implied small-caliber transparietal drainage of abscess with evacuation of purulent detritus at the first stage. At the second stage, primary percutaneous approach was transformed into access of sufficient diameter for flexible or rigid optics for visually controlled bone extraction. Foreign body removal through the drainage tube with endoscopic capture under visual control is preferable regarding safety compared to removal under ultrasound and/or X-ray control. Indeed, endoscopic approach is valuable for optimal positioning of the object and prevention of damage to liver parenchyma during extraction.

A woman in her 40s presented to hospital with cholangitis. A magnetic resonance cholangiopancreatography showed a moderately dilated common bile duct and mild intrahepatic duct dilatation with sludge. She underwent a successful endoscopic retrograde cholangiopancreatography (ERCP) and sphincteroplasty. She subsequently developed recurrence of fevers and abdominal pain with rising inflammatory markers. Initial investigations and imaging were unremarkable. A positron emission tomography scan demonstrated multiple fluorodeoxyglucose (FDG)-avid hepatic lesions, and subsequent imaging confirmed multifocal liver abscesses without a drainable collection. The patient was managed with intravenous co-amoxiclav initially before switching to oral antibiotics, however, represented 1 week later with similar symptoms. Her antibiotic coverage was broadened to intravenous pipercillin-tazobactam, and she was discharged on this with follow-up in clinic. This case report highlights the rare complication of hepatic abscesses following ERCP and the importance of considering this as a differential in patients who present with sepsis following the procedure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Dr. Manuel Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic and M.I.Tech.

Liver injuries after blunt abdominal trauma are very common. Non-operative approaches to management are now the standard of care for many patients with up to and including grade V liver injuries. However, the long-term complications associated with coil embolization can be challenging to manage. We present the case of a 29-year-old male who presented with a chronic liver abscess which contained the coils following embolization of a grade IV liver injury and the subsequent transhepatic embolization of the pseudoaneurysm. In addition, the patient developed a fistula draining the abscess through the previously placed drain site that traversed the diaphragm. A multidisciplinary discussion was held between trauma surgery, hepatobiliary surgery, thoracic surgery, and interventional radiology to discuss the best treatment plan. The patient subsequently underwent liver resection, fistula tract resection, and diaphragm repair. This case presents a definitive management strategy for these complex patients.

We present the case of a 64-year-old male with a history of chronic liver disease due to hepatitis C virus, with a sustained viral response after oral antiviral treatment and without follow-up for 5 years. He was admitted after a one-month history of constitutional symptoms, low-grade fever, abdominal pain and a palpable epigastric tumor. Analysis showed marked elevation of acute phase reactants (48,000 leukocytes and C-reactive protein of 19mg/dl) and dissociated cholestasis. Two lesions were identified by abdominal CT.

Purpose: To investigate risk factors associated with post-microwave ablation (MWA) abscess development., Materials and Methods: A retrospective case-control analysis was conducted to identify hepatic MWA performed at a single tertiary medical center between January 2010 and January 2022. Case and control patients were defined as those who did or did not develop intrahepatic abscess within 3 months following MWA, respectively. Correlations between risk factors and post-MWA abscess development were assessed by Fisher's exact test., Results: Between 2010 and 2022, 253 patients underwent 376 MWA sessions with post-ablation abscess complication rate of 1.1% (4/376). Complications associated with intrahepatic abscess included bacteremia, empyema, pleural abscess, subcutaneous abscess, cholangitis, bile leak, biliocutaneous and arterio-biliary fistulae, and pseudoaneurysm. One patient expired from septic shock 5 days post-ablation. All abscesses were treated by percutaneous drainage and antibiotics. One patient required concomitant placement of a biliary stent and embolization of a biliocutaneous tract. History of Sphincter of Oddi manipulation (p < 0.01), cholangiocarcinoma (p < 0.05), transarterial radioembolization (TARE) to the index lesion (p < 0.05), and abnormal serum alkaline phosphatase levels (p < 0.05) were significantly correlated with post-MWA abscess. The risk of developing post-MWA abscesses for patients with a history of cholangiocarcinoma or a history of Sphincter of Oddi manipulation were 20.0% and 27.2%, respectively., Conclusion: Patients with prior Sphincter of Oddi manipulation, cholangiocarcinoma, or TARE are at greater risk of developing post-MWA abscess., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

A bronchobiliary fistula (BBF) is an uncommon but severe complication after radiofrequency ablation (RFA). However, the definitive salvage methods are controversial. We herein report a patient with hepatocellular carcinoma with hepatic abscess and BBF following RFA. We also review previous reports of BBF after RFA. The patient was a man in his 70s who underwent RFA for recurrent hepatocellular carcinoma in the subphrenic area. Despite percutaneous transhepatic abscess drainage, bilioptysis persisted. Finally, the BBF was occluded with an endobronchial Watanabe spigot under fiber-optic bronchoscopy. Placing an endobronchial Watanabe spigot should be considered as a salvage therapy for refractory BBF following RFA.

COVID-19 infection has been associated, particularly in severely ill patients requiring hospitalization, with a hypercoagulable state. The case presented herein was a 66-year-old man with SARS-CoV-2 infection who did not have any respiratory symptoms. He presented with the following clinical manifestations: portal vein and hepatic artery thrombosis, liver infarction, and a superimposed abscess of the liver. In this case, early detection and the administration of anticoagulants and antibiotics led to a significant improvement within weeks of the diagnosis. We encourage physicians to be aware of COVID-19-associated hypercoagulable state and its potential complications, regardless of the acuity of the presentation or the absence of respiratory symptoms.

Metronidazole (MNZ) is a widely used drug for protozoan and anaerobic infections. The continuous use of MNZ causes various neurological symptoms, such as cerebellar ataxia, visual disturbance, vestibulocochlear symptoms, gait disturbance, dysarthria, and epileptic seizures of unknown cause, named MNZ-induced encephalopathy (MIE), in rare cases. MIE is a reversible disease that often improves within a few days of MNZ discontinuation, but irreversible neurological symptoms rarely remain. Herein, we report a case of MIE that developed during MNZ administration for a liver abscess, causing prolonged unconsciousness and death even after drug discontinuation. An 85-year-old female patient complained of fever, elevated liver enzymes, and a multifocal abscess in the right hepatic lobe, as seen on computed tomography. Percutaneous transhepatic abscess drainage and antibiotic therapy were initiated. The causative agent of the liver abscess could not be identified, thus meropenem was started, which demonstrated no inflammation improvement, thus oral MNZ was added. The inflammation recurred when MNZ was discontinued, and the patient continued taking MNZ. Vomiting, upper limb tremors, consciousness disturbance, and convulsions appeared on day 46 (total dose of MNZ 73.5mg), and the patient was hospitalized. T2-weighted, diffusion-weighted, and FLAIR head magnetic resonance imaging (MRI) revealed symmetrical abnormal high-signal areas in the cerebellar dentate nucleus, corpus callosum, cerebral white matter, and periventricular areas. MIE was diagnosed based on the patient's course and MRI images, and MNZ was discontinued. The patient continued to suffer from impaired consciousness and convulsions after MNZ discontinuation and died due to aspiration pneumonia. Suggestively, MIE development is related to long-term MNZ administration, poor nutrition, liver disease, underlying diseases (such as advanced cancer), and serious complications. A systematic review of MIE cases revealed that 4.8-5.9% of the patients demonstrated little improvement of symptoms after MNZ discontinuation, and some deaths were reported. Patients with poor prognosis were often suffering from impaired consciousness and convulsions. Furthermore, impaired consciousness was the most common residual symptom. Abnormal signals in characteristic areas, such as the dentate nucleus cerebri and corpus callosum, on head MRI are useful for MIE diagnosis, especially in patients with abnormal findings in the cerebral white matter, which is associated with a poor prognosis. We should pay close attention to the onset of MIE when MNZ is administered.

Umbilical venous catheterisation is a common bedside procedure in the neonatal intensive care unit (NICU). Complications including thrombus formation, thromboembolism, vessel perforation, haemorrhage, and central line-associated bloodstream infection can be seen after the procedure. Pyogenic liver abscess is a rare but life-threatening complication of umbilical venous catheterisation. A male infant with cyanotic congenital heart disease was admitted to NICU. An umbilical venous catheter (UVC) was inserted. Abdominal X-ray showed an improperly positioned UVC, it was removed and replaced with a newer one. On the seventh day, the infant had abdominal distension and his clinical condition deteriorated. Abdominal ultrasonography (US) revealed a hepatic abscess. US-guided percutaneous abscess drainage was performed. Empiric antibiotic treatment was initiated and culture revealed Staphylococcus. The patient was followed by serial US and the lesion was completely resolved after three weeks. In conclusion, clinical worsening associated with gastrointestinal symptoms in a cyanotic infant with UVC should raise suspicion for liver abscess. Key Words: Neonate, Hepatic abscess, Umbilical venous catheter, Cyanotic heart disease.

We present a case of hepatic abscess caused by a fish puncture through the gastric wall and the development of Slackia exigua infection., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Liver abscesses are a bacterial infection, which occurs because of entry, via portal vein, of pyogenic bacteria into the hepatic parenchyma. Liver abscesses are a polymicrobial infection; however, Fusobacterium necrophorum, a ruminal bacterium, is the primary etiologic agent. Ruminal acidosis disrupts the protective barrier function of the ruminal epithelium and facilitates entry and colonization of F. necrophorum in the ruminal wall and subsequent entry into the portal circulation. Virulence factors of F. necrophorum contribute to the evasion of host defense mechanisms and cause tissue damage to set up an infection in the liver. The potential role of the hindgut in pathogenesis remains to be investigated., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose : We describe our experience with the development of hepatobiliary infection in patients with prior surgical, percutaneous, or endoscopic biliary interventions who are receiving transarterial radioembolization (TARE) with yttrium-90 ( 90 Y) for primary or metastatic hepatobiliary lesions. Methods : Records of 15 patients with a history of prior biliary intervention and liver malignancy subsequently treated with TARE at the participating medical center from November 2009 to September 2015 were reviewed. The primary endpoint was the development of a hepatic abscess or cholangitis in a patient after radioembolization. Results : A total of 15 patients comprising 9 men and 6 women, with a median age of 49 years (range 30-73), underwent 17 TARE with 90 Y procedures. Of the 15 patients, 2 (13.3%) of them developed a hepatobiliary infection. A single patient (6.6%) developed a hepatobiliary abscess. Conclusion : Our study shows a low incidence rate of hepatic abscess following TARE in patients with prior biliary intervention.

Rationale: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC., Patient Concerns: A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital., Diagnosis: Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess., Interventions: Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed., Outcomes: Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37., Lessons: We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC., Competing Interests: There are no funding or conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Late-onset biliary complications (LBC) after pancreatoduodenectomy (PD) can be serious. This study aimed to clarify the frequency and risk factors of severe LBC after PD., Methods: We defined LBC as biliary complications occurring 3 months after PD and severe LBC as cases that required intensive care. A total of 318 patients who underwent PD between 2010 and 2018 with at least 1 year of postoperative follow-up were evaluated., Results: Hospitalization for severe LBC was required in 59 patients (19%), of whom 20 had liver abscesses (6.3%); 18, acute cholangitis (5.7%); 12, biliary stones (3.8%); and 21, biliary strictures (6.6%). Interventional radiological or endoscopic treatment was required in 32 patients (10%), of whom 9 had a benign primary disease with biliary stones and/or strictures. Thirteen of the remaining 23 patients with a malignant primary disease had liver abscesses and cholangitis. Significant independent risk factors for severe LBC in patients with malignant primary disease were recurrence around the hepaticojejunostomy (odds ratio 6.5, P = 0.013) and chemotherapy (odds ratio 13.5, P < 0.001)., Conclusions: Severe LBC after PD may occur regardless of whether the primary disease is benign or malignant. The course of severe LBC differs according to the primary disease, and therefore, appropriate follow-up and optimal treatment should be recommended according to the condition of the patient and the disease state., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Competing Interests: Competing interests: None declared.

A 60-year-old male with cStage IVB lung cancer was treated with pembrolizumab. However, after five courses of pembrolizumab, he developed pembrolizumab-related cholangitis. Imaging studies showed enlargement and diffuse wall thickening of the gallbladder and mild dilation of the bile ducts without any obvious obstruction. As the patient experienced severe abdominal pain, we suspected bile stasis and performed biliary drainage. However, his condition did not improve, and he developed multiple liver abscesses and died during immunosuppressive therapy. Our case suggests that in ir-cholangitis, the indication and method of endoscopic retrograde cholangiopancreatography should be carefully judged., (© 2022. Japanese Society of Gastroenterology.)

Introduction: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis and is among the most frequently done procedures in United States. Spillage of gallstones occurs in up to 30 percent of these procedures and is associated with rare but important complications including abscess formation., Case Description: We present a case of 44-year-old man with a peri-hepatic abscess developed three years after a laparoscopic cholecystectomy. Multiple percutaneous drainages and antibiotic courses had failed to provide a definitive resolution. CT scan showed signs of a developing abscess but no stones. A diagnostic laparoscopy was performed, and multiple retained stones were visualized. It was converted to open laparotomy and the abscess was drained along with resection of portions of liver and diaphragm. The patient remained vitally stable with no fever spikes following the procedure., Discussion: Spillage of gallstones should be seriously considered in all patients presenting with peri-hepatic abscess with a history of previous LC, even if the imaging studies do not provide evidence of stones. Percutaneous drainage and antibiotics may provide temporary relief, but a surgical intervention is often the definitive management., (Copyright© South Dakota State Medical Association.)

Background and Study Aims: A full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention., Patients and Methods: 11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed., Results: The incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes., Conclusion: PTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Clostridium perfringens causes pyogenic liver abscesses, which are rare but rapidly fatal infections. These abscesses often occur in patients with immunodeficiency due to malignancy, liver cirrhosis, diabetes mellitus, or organ transplantation. The identification of gram-positive bacilli in septicemia, the presence of gas-forming liver damage and intravascular hemolysis are manifestations of Clostridium perfringens infection. Clostridioides toxin A hydrolyzes phospholipids in erythrocyte membranes, causing spherocytosis and subsequent intravascular hemolysis, resulting in rapid deterioration and a high mortality rate. A 62-year-old man with recurrent hepatocellular carcinoma complained of a high fever and abdominal pain one day after microwave ablation. Abdominal computed tomography revealed gas-containing lesions in the liver. His condition was complicated with massive hemolysis. Laboratory examinations revealed low hemoglobin, high serum lactate dehydrogenase, and elevated indirect bilirubin levels, suggesting massive intravascular hemolysis. Although aggressive treatment was applied, he died within 16 hours after onset of the infection. After the patient died, a blood culture indicated Clostridium perfringens positivity. Clostridium perfringens-induced septicemia with massive hemolysis is rare but rapidly leads to a severe prognosis. It is important to identify Clostridium perfringens infection early and initiate effective treatment, especially abscess aspiration, which should be performed as soon as possible., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Jiang Guo, Changqing Li, Xuesong Gao.)

Background: Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare., Case Presentation: A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications., Conclusions: Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract., (© 2022. The Author(s).)

A 76-year-old Japanese man was admitted to our hospital with chills and fever. Computed tomography revealed a 10-cm cystic tumor with peripheral ring enhancement in the left lobe of the liver and several small low-density areas with early peripheral enhancement in both lobes. The large liver mass was diagnosed as a pyogenic abscess and treated with antibiotics. However, elevation of the tumor marker, PIVKA-II, raised the possibility of hepatocellular carcinoma. A fine-needle aspiration biopsy was performed, and malignant hepatic cells were identified. The patient underwent left hepatectomy. Histological analyses of the resected surgical specimen confirmed necrotic liver abscess and residual hepatocellular carcinoma with massive lymphoid cell infiltration. Immunohistochemical analyses revealed that the lymphoid cells were positive for CD3 and CD8. The PIVKA-II level returned to normal after surgery and the hepatic lesions disappeared within 10 months. These findings suggest that the liver abscess stimulated cancer immunity, resulting in the proliferation of cytotoxic T lymphocytes and, subsequently, tumor regression.

Objective: To investigate the incidence and risk factors for liver abscess formation after treatment with drug-eluting bead chemoembolization (DEB-TACE) in patients with metastatic hepatic tumors (MHT)., Methods: The current study is a retrospective analysis of the clinical data of 137 patients with metastatic hepatic tumors who received DEB-TACE treatment in our institute (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology) between June 2015 and September 2020. Patients were evaluated for the presence or absence of post-DEB-TACE liver abscess. Univariate and multivariate analyses were used to identify risk factors for liver abscess formation., Results: The incidence of liver abscess formation after the DEB-TACE procedure was 8.76% per patient and 5.53% per procedure. Univariate analysis showed that larger maximum tumor diameter ( p = 0.004), Grade 1 artery occlusion ( p < 0.001) and systemic chemotherapy within 3 months before the DEB-TACE procedure ( p < 0.001) were all associated with liver abscess formation. However, only systemic chemotherapy within 3 months before the DEB-TACE procedure (OR 5.49; 95% CI 0.34-13.54; p < 0.001) was identified by multivariate analysis to be an independent risk factor., Conclusions: Tumor size, Grade 1 artery occlusion and recent systemic chemotherapy may all be associated with increased risk of liver abscess formation following DEB-TACE treatment in patients with metastatic hepatic tumors., Advances in Knowledge: Identification of risk factors for liver abscess formation following DEB-TACE in patients with MHT. These findings suggest the need for caution and consideration of the aforementioned risk factors on the part of interventional radiologists when designing DEB-TACE strategies and performing post-procedure patient management.

Competing Interests: The authors declared no potential conflicts of interest.

Hepatic artery pseudoaneurysm (HAP) is mostly encountered secondary to trauma or iatrogenic causes. HAP associated with cholangitic liver abscess is a rare complication. We present a case of gallstone disease and choledocholithiasis who developed moderate cholangitis and a liver abscess. A small HAP was detected incidentally on a biphasic CT done to evaluate the biliary system. Repeat CT after management with endoscopic retrograde cholangiopancreatography and antibiotics showed resolution of cholangitic abscess with spontaneous thrombosis of HAP., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Liver abscesses caused by Candida species are mainly found in immunocompromised hosts, associated with conditions (such as neutropenia and mucositis) that facilitate the spreading of microorganisms from the gastrointestinal tract., Case Report: We present the case of a non-immunocompromised 72-year-old woman with a liver abscess caused by Candida haemulonii var. vulnera, in whom potential associated conditions could be polycystic kidney disease and renal replacement therapy. The patient experienced clinical resolution after percutaneous drainage and treatment with caspofungin., Conclusions: To our knowledge, this is the first case reported in Peru of a liver abscess due to Candida haemulonii var. vulnera, a clinical presentation that has not been described previously. This finding should prompt us to establish active surveillance of causal agents of systemic candidiasis., (Copyright © 2021 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: We report an unusual case of infective colitis by Yersinia enterocolitica complicated by microliver abscesses mimicking multiple liver metastases in a 79 yr old female without any risk factors for bacteriaemia by this pathogen., Case Presentation: The patient was admitted to the Internal Medicine with Stroke Care ward of University Policlinico "P. Giaccone" in Palermo because of the appearance of diarrhoea. After the antimicrobial treatment for infective colitis, the clinicians observed a persistently increased white blood cells (WBC) count and multiple hepatic lesions; after having excluded any neoplastic disease and inflammatory bowel disease (IBD), blood cultures positive for Y. enterocolitica allowed to establish the final diagnosis was infective micro liver abscesses consequent to infective colitis due to Y. enterocolitica, which were successfully treated with cefixime and doxycycline., Conclusions: This case report should make clinicians reflect on how complex the differential diagnosis between microliver abscesses and metastasis could be and the possibility of bacteriaemia by Y. enterocolitica even without iron overload conditions.

Gram-positive anaerobic cocci (GPAC) are responsible for 30% of anaerobic infections. Parvimonas micra is an emergent pathogen that is part of the oral and gastrointestinal commensal flora, and its role in several infection processes has recently emerged thanks to the improvement of diagnostic techniques. P. micra bacteraemia is reported in immunocompromised patients and is often complicated by abscesses. Here, we present a case study of multiple hepatic and brain abscesses caused by P. micra bacteraemia in a patient with complicated diverticulitis., Competing Interests: Declaration of competing interest I certify that there is no actual or potential conflict of interest in relation to this article., (Copyright © 2021 Elsevier Ltd. All rights reserved.)