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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

Follow-up computed tomography on hospital day 25. a The abscess was reduced in size (arrow) b, c, d The thrombus enlarged further and extended close to the right atrium
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Fig3: Follow-up computed tomography on hospital day 25. a The abscess was reduced in size (arrow) b, c, d The thrombus enlarged further and extended close to the right atrium

Mentions: After being admitted to the hospital, the patient gradually recovered with antibiotic treatment. However, a contrast CT scan on hospital day 8 revealed a thrombus in the middle hepatic vein (Fig. 2). Therefore, we started anticoagulant therapy using heparin (15,000 U/d) and continued meropenem 1.5 g/d treatment. A follow-up CT scan on hospital day 17 revealed that the abscess had reduced in size but that the thrombus had slightly enlarged. We thought that the abscess was being controlled by the antibiotics; therefore, we continued the same treatment approach. A follow-up CT scan on hospital day 25 showed that the abscess had reduced further. However, the thrombus had enlarged again and reached the IVC close to the right atrium (Fig. 3). Considering the risk of pulmonary embolism, we planned a surgical intervention. A blood culture on admission was positive for Citrobacter freundii.Fig. 2


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)

Follow-up computed tomography on hospital day 25. a The abscess was reduced in size (arrow) b, c, d The thrombus enlarged further and extended close to the right atrium
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Follow-up computed tomography on hospital day 25. a The abscess was reduced in size (arrow) b, c, d The thrombus enlarged further and extended close to the right atrium
Mentions: After being admitted to the hospital, the patient gradually recovered with antibiotic treatment. However, a contrast CT scan on hospital day 8 revealed a thrombus in the middle hepatic vein (Fig. 2). Therefore, we started anticoagulant therapy using heparin (15,000 U/d) and continued meropenem 1.5 g/d treatment. A follow-up CT scan on hospital day 17 revealed that the abscess had reduced in size but that the thrombus had slightly enlarged. We thought that the abscess was being controlled by the antibiotics; therefore, we continued the same treatment approach. A follow-up CT scan on hospital day 25 showed that the abscess had reduced further. However, the thrombus had enlarged again and reached the IVC close to the right atrium (Fig. 3). Considering the risk of pulmonary embolism, we planned a surgical intervention. A blood culture on admission was positive for Citrobacter freundii.Fig. 2

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