Objective: To investigate the safety and efficacy of embedding the stump of gastroduodenal artery between the left lateral lobe of the liver and the left caudate lobe to prevent bleeding after laparoscopic pancreaticoduodenectomy. Methods: The clinical data of 41 patients who underwent laparoscopic pancreaticoduodenectomy at the second Hospital of Hebei Medical University from October 2021 to April 2022 were analyzed retrospectively.There were 27 males and 14 females, aged (63.0±9.2)years (range: 48 to 78 years), and the body mass index was (24.1±3.2)kg/m² (range: 15.4 to 31.6 kg/m²). After routine laparoscopic pancreaticoduodenectomy, the stump of gastroduodenal artery was embedded between the left lateral lobe and the left caudate lobe of the liver, and the hepatic parenchyma of the left lateral lobe and the left caudate lobe were sutured with absorbable sutures.The occurrence and recovery of postoperative complications (pancreatic fistula, biliary fistula, postoperative abdominal bleeding, abdominal infection, liver abscess) were observed. Results: All the operations of 41 patients were completed successfully.The operation time was (277.5±52.0) minutes (range: 192 to 360 minutes). The entrapment time of gastroduodenal artery stump was (3.1±0.6) minutes (range: 2.3 to 4.2 minutes), and the intraoperative blood loss (M(IQR)) was 300 (200) ml (range: 50 to 800 ml).The results of ultrasound examination of hepatic artery on the first day after operation showed that the blood flows of hepatic artery were unobstructed.Postoperative pancreatic fistula occurred in 3 cases, including grade B pancreatic fistula in 2 cases (1 case with abdominal infection) and biochemical leakage in 1 case. Three patients with pancreatic fistula were discharged successfully after continuous abdominal drainage. There was no biliary fistula, abdominal bleeding, abdominal infection, liver abscess or postoperative liver dysfunction. Conclusion: The encasement of the gastroduodenal artery stump by the left outer and left caudate lobes of the liver may be an effective way to prevent bleeding from the rupture of the gastroduodenal artery stump after laparoscopic pancreatoduodenectomy, which is easy and safe to perform.
Female ; Male ; Humans ; Hepatic Artery ; Pancreaticoduodenectomy ; Pancreatic Fistula ; Retrospective Studies ; Laparoscopy ; Liver Abscess ; Intraabdominal Infections ; Postoperative Hemorrhage/prevention & control*

Objective. Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.

Method. We conducted a review of medical records of admitted patients aged ?18 years diagnosed with hepatic abscess in a tertiary referral center from 2007-2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.

Result. We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.

Conclusion. Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.

No abstract available.
Gallbladder Neoplasms ; Gallbladder ; Liver Abscess ; Liver

BACKGROUND: Hepatic or liver tuberculosis is an uncommon form of extra-pulmonary tuberculosis which accounts for less than 1% of all tuberculous infections. Furthermore, tuberculous liver abscess (TLA), a subset of hepatic tuberculosis is extremely rare with a prevalence of 0.34% and is usually associated with foci of infection either in the lung, gastrointestinal tract, or an immunocompromised state. CASE PRESENTATION: A case of a 63-year-old immunocompetent male, with no history of prior pulmonary tuberculosis, was initially diagnosed with pyogenic liver abscess and treated with empiric two-week therapy of Metronidazole 500mg/tab 1 tablet TID and Ciprofloxacin 500mg/tab 1 tablet BID. However, there was the persistence of right upper quadrant pain and jaundice despite compliance to therapy, hence admission. Initial antibiotics were re-initiated and subsequently underwent ultrasound-guided liver aspiration draining a thick, light brown abscess. Microbiologic cultures of the abscess turned out negative but AFB smear revealed 1+ on the AFB national TB program scale signifying 10-99 AFB seen/ 100 visual fields in at least 50 fields. Currently, there are no local treatment recommendations specific for isolated tuberculous liver abscess, thus was empirically started on 2HRZE/4HR for six months. On follow-up, the patient had no recurrence of liver abscess via a repeat ultrasound of the whole abdomen. CONCLUSION This is an uncommon presentation of extra-pulmonary tuberculosis, an isolated tuberculous liver abscess in an immunocompetent male presenting with persistent right upper abdominal quadrant pain and jaundice. Despite the endemicity of tuberculosis in the Philippines, an isolated tuberculous liver abscess is uncommon or often overlooked. The excellent clinical prognosis of these patients with appropriate therapy necessitates timely diagnosis of this infrequent clinical entity and will prevent further unnecessary surgical interventions.
Tuberculosis ; Tuberculosis, Extrapulmonary ; Liver Abscess

No abstract available.
Gastrointestinal Microbiome ; Klebsiella pneumoniae ; Klebsiella ; Liver Abscess ; Liver

liver abscesses in East Asia including the Republic of Korea (ROK). Although gastrointestinal colonization of K. pneumoniae may cross the intestinal barrier to invade the liver, characteristics of gastrointestinal carriage K. pneumoniae of hvKP liver abscess patients in the ROK are not well known.METHODS: Characteristics of K. pneumoniae isolated from stool samples and liver aspirate samples of patients with hvKP liver abscess at a tertiary care hospital in the ROK between 2017 and 2018 were evaluated.RESULTS: Out of 37 patients with hvKP liver abscess, 11 patients were noted to have K. pneumoniae isolated from stool samples and were enrolled for analysis. The median age was 71 years. For hvKP isolates from the liver aspirate samples, the most common serotype was K1 (72.7%) followed by K2 (27.3%). For K. pneumoniae isolates from the stool sample, the majority was non-K1/K2 serotype (72.7%). Among non-K1/K2 serotype isolates, high variability of sequence type (ST; ST15, ST307, ST37, ST273, ST2622, and ST42) with high rate of presence of extended-spectrum beta-lactamase (100.0%) was noted. The concordance rate of the K. pneumoniae isolates between the liver aspirate samples and the stool samples from the primary hvKP liver abscess was low (27.3%).CONCLUSION: This study suggests that significant heterogeneity of K. pneumoniae colonizing intestinal tract of the hvKP liver abscess patients. Further studies involving a larger number of hvKP liver abscess patients with continuing surveillance are needed to define the changing epidemiology and the role of gastrointestinal K. pneumoniae in the hvKP liver abscess patients in the ROK.]]>
beta-Lactamases ; Colon ; Epidemiology ; Far East ; Humans ; Klebsiella pneumoniae ; Klebsiella ; Liver Abscess ; Liver ; Pneumonia ; Population Characteristics ; Republic of Korea ; Serogroup ; Tertiary Healthcare

BACKGROUND: This is a rare case of two large urinary bladder stones causing severe infection of the urinary tract affecting the bone marrow due to chronic immune stimulation in a patient with recurrent anemia. Urinary bladder calculi are hard masses of minerals. They develop when the minerals in concentrated urine crystallize. This often happens when the bladder cannot be emptied. Signs and symptoms can vary from severe abdominal pain to blood in the urine. Sometimes, bladder stones don't cause any symptoms. If left untreated, bladder stones may lead to infections and other complications such as hepatic abscess via a hematogenous route. CASE: This is a case of a seventy-eight-year-old man with a history of multiple blood transfusions secondary to anemia of unknown cause. He came into our institution for a second opinion. We worked up the patient, which showed hepatic abscess and two large urinary bladder calculi. Further investigation of the anemia later led to a diagnosis of primary myelofibrosis. DIAGNOSTICS: Ultrasound showed a complex mass on the left hepatic lobe measuring 7.5 cm x 6.0 cm x 2.1 cm consistent with a hepatic abscess. The culture of the abscess was positive for E. coli. Computed Tomography (CT) scan of the lower abdomen showed heterogeneous mass measuring 8.6 cm x 8.7 cm x 9.2 cm within the urinary bladder (see Figure 2). Urinalysis was consistent with a urinary tract infection. Urine culture showed E. coli. Video-assisted cystoscopy showed two urinary bladder calculi, measuring 1.5 cm x 3.2 cm x 4.2 cm weighing 30 grams each (see Figure 3). The calculi were composed of 100% Calcium Oxalate. He underwent a series of diagnostic examinations for anemia including gastroscopy to rule out a bleeding ulcer. Complete blood count showed hemoglobin of 77 g/L and a hematocrit of 0.23. Finally, bone marrow core biopsy was done which is consistent with primary myelofibrosis. CONCLUSION: Urinary bladder stones can be asymptomatic and may present only with vague abdominal pain. It should be one of the considerations in asymptomatic patients with long-standing prostatitis or benign prostatic hyperplasia. Detailed history, thorough physical examinations, and cautious diagnostic tests are mandatory to confirm the diagnosis. A hepatic abscess may arise from infections in the urinary tract such as prostatitis through hematogenous extension. Therefore, it is important to address the origin of the infection to prevent such complications. This is a rare case of an elderly man who presented with chronic anemia and later found out to have large urinary bladder stones that caused severe infection leading to immune stimulation of the bone marrow, hence the diagnosis of primary myelofibrosis by bone marrow biopsy. Such a rare case must be thought of holistically and analytically.
Male ; Prostatitis ; Prostatic Hyperplasia ; Urinary Bladder Calculi ; Liver Abscess ; Anemia

INTRODUCTION: In recent years, () has emerged as the predominant cause of pyogenic liver abscess in Asia. - as the causative microorganism in other visceral organ abscesses-is less described. In this study, we seeked to describe the clinical characteristics of visceral organ abscesses in our institution and evaluated the prescription practices of physicians with regard to antibiotic therapy. MATERIALS AND METHODS: A retrospective analysis of patients with culture positive (blood or abscess aspirate) visceral organ abscesses from May 2014 to April 2016 requiring hospitalisation in Changi General Hospital was conducted. RESULTS: A total of 140 adult patients with visceral organ abscesses were identified. The commonest site of involvement was the liver (77.9%), followed by genitourinary tract (20.7%). Diabetic patients were more likely to have liver abscesses, genitourinary abscesses, abscesses in 2 or more organs, genitourinary disease with abscess formation outside of the genitourinary tract, and endovascular infection. Patients with extended spectrum beta-lactamase producing , were more likely to have an obstructive lesion related to the site of the abscess. Overall mortality rate was 7.1%. Amongst survivors, the mean total duration of parenteral antimicrobial therapy was 2.5 weeks before switching to oral antimicrobial agents. CONCLUSION Genitourinary tract is the commonest extra-hepatic site for visceral organ abscess in infections. Parenteral to oral switch of antimicrobial agents appears to be a safe and effective treatment option.
Abscess ; classification ; microbiology ; mortality ; therapy ; Anti-Bacterial Agents ; therapeutic use ; Diabetes Mellitus ; epidemiology ; Female ; Humans ; Klebsiella pneumoniae ; isolation & purification ; Liver ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survival Analysis ; Urogenital System ; pathology ; Viscera ; pathology

Anaerobic infections have been reported to be responsible for 3–10% of pyogenic liver abscesses in Korea, and reported anaerobes include Fusobacterium, Bacillus fragilis, and Bacteroides melaninogenicus. Parvimonas micra is an anaerobic, Gram-positive, non-spore-forming bacterial species and a constituent of normal flora on skin, vagina, gastrointestinal tract, and oral cavity that can cause opportunistic infections. However, it has only rarely been reported to be a cause of liver abscess; only one such case has been reported in Korea. We experienced a case of concomitant liver and brain abscesses caused by Parvimonas micra in a non-immunodeficient 65-year-old female patient without diabetes or periodontal disease. Parvimonas micra infection was confirmed by blood culture using VITEK® 2 cards and by bacterial 16s ribosomal RNA gene sequencing. We conclude that we should not overlook anaerobes as a cause of liver abscess.
Aged ; Bacillus ; Bacteria, Anaerobic ; Brain Abscess ; Brain ; Female ; Fusobacterium ; Gastrointestinal Tract ; Humans ; Korea ; Liver Abscess ; Liver Abscess, Pyogenic ; Liver ; Mouth ; Opportunistic Infections ; Periodontal Diseases ; Prevotella melaninogenica ; RNA, Ribosomal, 16S ; Skin ; Vagina

BACKGROUND/AIMS: Percutaneous transhepatic cholangioscopy (PTCS) is an effective treatment used for intrahepatic stone in patients who have undergone hepatectomy. There are few reports on natural course in these patients. Thus, we report the long-term results. METHODS: We conducted a retrospective study of 19 patients who underwent PTCS after hepatectomy at Samsung Medical Center between January 1998 and December 2014. We investigated patient characteristics and recurrence of biliary complications during follow up period. Then, we analyzed the factors related to recurrence. RESULTS: Indications for PTCS were cholangitis, symptomatic stone, liver abscess and biliary dilatation. Complete stone removal was achieved in 12 patients (63.2%). After receiving PTCS, the recurrence of intrahepatic stone related complication occurred in 52.6% (10/19) of patients during a median follow-up of 4.9 years (range, 1.8–7.8). Complications were cholangitis (5/10, 50%), cholangitis with liver abscess (3/10, 30%), liver abscess (1/10, 10%) and symptomatic stone (1/10, 10%). On univariate analysis, factors including multiple stone involvement, complete stone removal and bile duct stricture were not significantly associated with recurrent biliary complications. CONCLUSIONS: PTCS is an effective treatment for complications of recurrent intrahepatic stones in patients who have undergone hepatectomy. However, long term follow-up is necessary because of the recurrence of biliary complications.
Bile Ducts ; Cholangitis ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver Abscess ; Liver ; Recurrence ; Retrospective Studies