Limits...
Inferior vena caval thrombosis complicating pyogenic liver abscess after pancreatoduodenectomy: a case report.

Kubo H, Taniguchi F, Shimomura K, Nanishi K, Ueshima Y, Takahashi A, Shioaki Y, Otsuji E - Surg Case Rep (2015)

Bottom Line: PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated.The patient was discharged 10 weeks after surgery.Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan ; Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto-shi, Kyoto, Japan.

ABSTRACT

Pyogenic liver abscess (PLA) complicated by inferior vena caval (IVC) thrombosis is rare but life-threatening. We experienced a case of PLA complicated by an IVC thrombus close to the right atrium after pancreatoduodenectomy. A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years prior, and no recurrence was noted on follow-up. He was admitted to our hospital owing to fever and general fatigue. PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated. His general condition gradually improved, but a thrombus in the middle hepatic vein and IVC was noted on follow-up computed tomography on hospital day 8. Although anticoagulant therapy using heparin was started, the thrombus size increase and extended to the right atrium. Considering the risk of pulmonary embolism, we planned a surgical intervention with a cardiovascular surgeon to remove the thrombus. During surgery, we made an incision in the right atrium and removed the thrombus using extracorporeal circulation. After removal, we dissected the middle hepatic vein using an automated suturing device to prevent the thrombus from extending into the IVC. The patient was discharged 10 weeks after surgery. Eighteen months post-intervention, there was no recurrence of either PLA or thrombi. Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.

No MeSH data available.


Related in: MedlinePlus

Computed tomography performed on admission. a, b Low-density area with air density detected in segment 8 of the liver (arrow). c The arrow shows air density in the middle hepatic vein. We determined that the abscess had ruptured into the middle hepatic vein
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4562987&req=5

Fig1: Computed tomography performed on admission. a, b Low-density area with air density detected in segment 8 of the liver (arrow). c The arrow shows air density in the middle hepatic vein. We determined that the abscess had ruptured into the middle hepatic vein

Mentions: A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years earlier and did not experience recurrence on follow-up. He was admitted to our hospital owing to fever and general fatigue. His vital signs on admission were as follows: consciousness, alert; heart rate, 69 beats/min; blood pressure, 77/48 mmHg; respiratory rate, 15 breaths/min; peripheral capillary oxygen saturation, 95 % on room air; and body temperature, 36.5 °C. On physical examination, his abdomen was soft and flat, and his skin turgor was poor. We detected elevated inflammatory levels and decreased renal function. Non-contrast computed tomography (CT) revealed an approximately 30-mm low-density area and an air density in segment 8 of the liver (Fig. 1). Furthermore, there was an air density in the middle hepatic vein. We diagnosed PLA due to cholangitis in the middle hepatic vein and septic shock. We subsequently initiated conservative treatment using antibiotics (meropenem 1.5 g/d).Fig. 1


Inferior vena caval thrombosis complicating pyogenic liver abscess after pancreatoduodenectomy: a case report.

Kubo H, Taniguchi F, Shimomura K, Nanishi K, Ueshima Y, Takahashi A, Shioaki Y, Otsuji E - Surg Case Rep (2015)

Computed tomography performed on admission. a, b Low-density area with air density detected in segment 8 of the liver (arrow). c The arrow shows air density in the middle hepatic vein. We determined that the abscess had ruptured into the middle hepatic vein
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562987&req=5

Fig1: Computed tomography performed on admission. a, b Low-density area with air density detected in segment 8 of the liver (arrow). c The arrow shows air density in the middle hepatic vein. We determined that the abscess had ruptured into the middle hepatic vein
Mentions: A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years earlier and did not experience recurrence on follow-up. He was admitted to our hospital owing to fever and general fatigue. His vital signs on admission were as follows: consciousness, alert; heart rate, 69 beats/min; blood pressure, 77/48 mmHg; respiratory rate, 15 breaths/min; peripheral capillary oxygen saturation, 95 % on room air; and body temperature, 36.5 °C. On physical examination, his abdomen was soft and flat, and his skin turgor was poor. We detected elevated inflammatory levels and decreased renal function. Non-contrast computed tomography (CT) revealed an approximately 30-mm low-density area and an air density in segment 8 of the liver (Fig. 1). Furthermore, there was an air density in the middle hepatic vein. We diagnosed PLA due to cholangitis in the middle hepatic vein and septic shock. We subsequently initiated conservative treatment using antibiotics (meropenem 1.5 g/d).Fig. 1

Bottom Line: PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated.The patient was discharged 10 weeks after surgery.Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan ; Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto-shi, Kyoto, Japan.

ABSTRACT

Pyogenic liver abscess (PLA) complicated by inferior vena caval (IVC) thrombosis is rare but life-threatening. We experienced a case of PLA complicated by an IVC thrombus close to the right atrium after pancreatoduodenectomy. A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years prior, and no recurrence was noted on follow-up. He was admitted to our hospital owing to fever and general fatigue. PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated. His general condition gradually improved, but a thrombus in the middle hepatic vein and IVC was noted on follow-up computed tomography on hospital day 8. Although anticoagulant therapy using heparin was started, the thrombus size increase and extended to the right atrium. Considering the risk of pulmonary embolism, we planned a surgical intervention with a cardiovascular surgeon to remove the thrombus. During surgery, we made an incision in the right atrium and removed the thrombus using extracorporeal circulation. After removal, we dissected the middle hepatic vein using an automated suturing device to prevent the thrombus from extending into the IVC. The patient was discharged 10 weeks after surgery. Eighteen months post-intervention, there was no recurrence of either PLA or thrombi. Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.

No MeSH data available.


Related in: MedlinePlus