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Peritoneal dialysis (PD)-related infection rates have improved, but serious complications such as liver abscesses remain an issue, posing unique management challenges including safety of continuing PD versus early PD catheter removal. Current literature describing this is unfortunately limited. This study aims to describe the characteristics, management and outcomes of liver abscesses in PD patients from a retrospective review of prevalent PD patients on follow-up at Tan Tock Seng Hospital between 1st January 2016 and 30th June 2021. A total of 11/383 PD patients (2.9%) were treated for liver abscesses. Most were diabetic ( n =10, 90.9%), with a median PD vintage of 541 days (interquartile range: 310-931 days). Fever ( n = 7, 63.6%), bacteraemia ( n = 7, 63.6%) and concomitant PD peritonitis ( n = 7, 63.6%) were the most common presenting symptoms. Majority of patients underwent radiological aspiration of abscess in addition to antibiotics ( n = 7, 63.6%). PD catheter was removed in eight patients (72.7%), with the most common indications being empirical removal due to intra-abdominal abscess ( n = 5, 62.5%) followed by septic shock ( n = 2, 25%) and refractory PD peritonitis ( n = 1, 12.5%). Only three patients (37.5%) remained on PD, as they did not develop PD peritonitis during their course of treatment. The overall mortality remains high with three patients (27.3%) passing away within 6 months of presentation. Liver abscesses in PD patients is associated with poor technique and overall survival. Absence of PD peritonitis appears to be a good prognostic factor, but larger studies are required to guide the optimal management of liver abscesses in PD patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment., Competing Interests: The authors declare no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Pyogenic liver abscesses (PLAs) are a suppurative infection of the hepatic parenchyma responsible for significant morbidity and mortality. PLAs are categorized into a variety of mechanisms: (1) via the portal vein, (2) through the biliary tract, (3) via the hepatic artery, (4) from trauma, (5) contiguously via direct extension, and (6) cryptogenically. The pathogenesis of PLA, which informs treatment, can often be discerned based on host factors, clinical presentation, and causative microorganisms. The Streptococcus anginosus group, hypervirulent Klebsiella pneumoniae , and multidrug-resistant gram-negative pathogens have emerged as microbiologically challenging organisms to treat. The identification of hypervirulent K. pneumoniae should prompt for assessment for metastatic spread and consideration of prolonged antimicrobial treatment. Abdominal imaging is indispensable in characterizing PLAs and facilitating source control interventions. Source control remains the most critical aspect of PLA management, followed by antimicrobial therapy. Empiric antibiotics for PLAs are informed by the suspected etiology of PLA formation. Duration of antimicrobial therapy is individualized and dependent on multiple components, including the success of achieving source control, host factors, mechanism of PLA development, and the illness course of the individual-factoring in clinical, biochemical, and radiographic parameters., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Surgical excision of hemorrhoids remains the gold standard for patients who have grade III or IV hemorrhoids. The complication rate is low and success rate is high. In this case, we describe a 44-year-old male with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy., Methods: In this case report, we describe the case of a patient with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. A search in the PubMed database showed only three publications describing patients with liver abscesses after hemorrhoidectomy and some more cases after rubber band ligation., Results: The patient was admitted at the intensive care unit and received intravenous antibiotics. He could leave the hospital in good condition after 17 days. He received antibiotics for six weeks in total., Conclusion: Pyogenic liver abscess after open hemorrhoidectomy is a rare complication after Milligan-Morgan hemorrhoidectomy and rubber band ligation. Pyogenic liver abscesses can be treated with antibiotics, sometimes associated with percutaneous drainage or surgeryIn patients with predisposing factors prophylactic use of antibiotics could be considered on a case-by-case basis.

Pyogenic liver abscess (PLA) is a life-threatening infection in both liver transplant (LT) and non-LT patients. Several risk factors, such as benign and malignant hepatopancreatobiliary diseases and colorectal tumors have been associated with PLA in the non-LT population, and hepatic artery stricture/thrombosis, biliary stricture, and hepaticojejunostomy in the LT patients. The objective of this study is to compare the outcomes of patients with PLA in LT and non-LT patients and to determine the risk factors associated with patient survival. From January 2000 to November 2020, a total of 296 adult patients were diagnosed of PLA in our institution, of whom 26 patients had previously undergone liver transplantation (LTA group), whereas 263 patients corresponded to the non-LTA population. Seven patients with PLA who had undergone previous kidney transplantation were excluded from this retrospective study. Twenty-six patients out of 1503 LT developed PLA (incidence of 1.7%). Median age was significantly higher in non-LTA patients (p = .001). No significant differences were observed in therapy. PLA recurrence was significantly higher in LTA than in non-LTA (34.6% vs. 14.8%; p = .008). In-hospital mortality was greater in the LT group than in the non-LT group (19.2% vs. 9.1% p = .10) and was identified in multivariable analysis as a risk factor for mortality (p = .027). Mortality rate during follow-up did not show significant differences between the groups: 34.6% in LTA patients versus 26.2% in non-LTA patients (p = .10). The most common causes of mortality during follow-up were malignancies, Covid-19 infection, and neurologic disease. 1-, 3-, and 5-year actuarial patient survival rates were 87.0%, 64.1%, and 50.4%, respectively, in patients of LTA group, and 84.5%, 66.5%, and 51.0%, respectively, in patients with liver abscesses in non-LTA population (p = .53). In conclusion, LT was a risk factor for in hospital mortality, but not during long-term follow-up., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.

Background: Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST., Methods: We reviewed the medical charts of all of our institution's adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST (n = 41 patients) and non-ST (n = 255). A comparison between groups was performed., Results: The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group (p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST (p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST., Conclusions: There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Pyogenic liver abscess (PLA) is a severe disease, which unfavourable evolution remains frequent. Our objective was to assess predictive factors of unfavourable outcome in patients with PLA., Methods: We conducted a retrospective study in a French tertiary care centre. All patients admitted for PLA between 2010 and 2018 were included. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence of PLA after an initial cure, or death within 3 months after diagnosis. Hazard ratios (95% CI) were calculated with multivariable Cox proportional hazard models., Results: 302 patients were included among which 91 (30.1%) patients had an unfavourable outcome because of PTF, recurrence or death in 55 (18.2%), 28 (9.2%) and 32 (10.6%) patients, respectively. Hepatic metastases (HR 2.08; 95% CI 1.04-4.15), a nosocomial infection (2.25; 1.14-4.42), portal thrombosis (2.12; 1.14-3.93), and the isolation of Enterococcus spp. (2.18; 1.22- 3.90) were independently associated with PTF. Ischemic cholangitis (6.30; 2.70-14.70) and the isolation of Streptococcus spp. (3.72; 1.36-10.16) were associated with the risk of recurrence. Charlson comorbidity index (HR 1.30 per one point; 95% CI 1.15-1.46; p < 0.001), portal thrombosis (3.53; 1.65-7.56) and the presence of multi-drug-resistant organisms (3.81; 1.73-8.40) were associated with mortality within 3 months following PLA diagnosis. PLA drainage was the only factor associated with a lower mortality (0.14; 0.06-0.34)., Conclusion: Identification of specific risk factors may help to improve the management of PLA and to elaborate targeted recommendations according to patient's and disease's characteristics., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Purpose: Pyogenic liver abscess (PLA) is a collection of pus in the liver, often without a known direct cause. There is discord on the best diagnostic and therapeutic strategy. We aimed to examine these questions in our patient cohort., Methods: A total of 66 out of 309 patients with PLA at our tertiary referral center between 2012 and 2020 had a primarily unknown cause. We analyzed PLA configuration, comorbidities, and whether an underlying cause could be found later. Therapy was sorted by antibiotics alone, percutaneous drainage, and primary surgery. Success was assessed by a change of initial therapy, in-hospital mortality, and mean hospital stay., Results: Overall mortality was 18%; in 55%, a causative condition could be found. CRP, GGT, size, and multiple localization go along with higher mortality. Antibiotics alone had a failure rate of 82%. Percutaneous drainage was successful in 70% of cases. Surgery was mainly reserved for failed previous non-surgical treatment and had in-hospital mortality of 12%., Conclusions: PLA goes along with high mortality. In the majority of all patients, a causative condition can be identified by detailed diagnostics. Percutaneous drainage together with antibiotics is the therapy of choice and is successful in 70% of cases. If drainage is insufficient or impossible, surgery is an effective alternative., (© 2022. The Author(s).)

A pyogenic hepatic abscess is an uncommon complication after laparoscopic sleeve gastrectomy (LSG) that can develop secondary to an infected hematoma or a staple line leak due to bacterial seeding. Appropriate screening for and management of a pyogenic hepatic abscess are essential in patients with clinical suspicion for complications after LSG. Early diagnosis is essential as pyogenic hepatic abscess can be fatal if not treated early. Only five cases have been reported in the literature so far. We present a case of pyogenic hepatic abscess that occurred two weeks after LSG in a 46-year-old female without immunosuppressive conditions or early postoperative leak. The abscess was diagnosed by computed tomography (CT) and was successfully treated with antibiotics and CT-guided drainage., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: : Limited research has been conducted on afebrile pyogenic liver abscess (PLA). This poses a challenge in rapid diagnosis and early tailored care to physicians. In his study, we aimed to compare the clinical characteristics of afebrile and febrile patients with PLA., Methods: : We retrospectively analyzed the data of patients with PLA who were admitted to the emergency departments of two university hospitals between January 2014 and March 2020. Patients were classified into afebrile and febrile groups by using body temperature higher than 38°C as the reference standard. The demographic, clinical, and laboratory characteristics of both groups were compared. The primary outcome was all-cause in-hospital mortality and length of hospital stay. Multivariate analysis was performed to define factors associated with afebrile PLA., Results: : Of the 239 patients included in this study, 51 patients (21.3%) were afebrile and 188 patients (78.7%) were febrile. There were no differences between the abscess characteristics, laboratory manifestations, and disease severity of both groups; however, age and Charlson score differed between the groups (P = 0.009 and P = 0.011). The all-cause in-hospital mortality rate was much higher in the afebrile PLA group than in the febrile PLA group (9.8% vs. 2.1%, P = 0.011). Regarding the length of stay, no significant differences were noted in the febrile PLA group compared with the afebrile PLA group (18.5% vs 17.3%, P = 0.514). In multivariate analyses, only age greater than 65 years was significantly associated with afebrile PLA., Conclusions: : Afebrile patients with PLA tend to be older, have higher Charlson scores, and in-hospital mortality rate than those with febrile patients. PLA patients older than 65 years are more likely to present without fever (<38°C) at the time of the emergency visit., Competing Interests: None

Aim: Laparoscopic appendectomy is currently the treatment of choice for acute appendicitis in emergency setting. When appendicitis is clinically suspected, an appendicolith can be found in 30% of the patients. Retained or dropped appendicoliths are an uncommon complication that may occur as a consequence of stone expulsion from the appendix, before or during laparoscopic appendectomies. This is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. The objective of this case report is to illustrate an intrahepatic localization of a dropped appendicolith causing liver abscess., Case Presentation: A 23-year-old female was admitted to the emergency department of our hospital for an acute appendicitis with coprolite obstructing the lumen and periappendicular effusion. Laparoscopic appendectomy was performed. Persistent liver abscess due to appendicolith was a rare complication treated by percutaneous drainage. The appendicolith was successfully removed from the liver parenchyma by Dormia basket recovery system., Discussion: Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient., Conclusion: Only a handful of cases of hepatic abscess formation as a result of dropped appendicoliths have been reported in literature. Our proposal of treatment was the percutaneous approach. There was no need for a surgical procedure to remove the intrahepatic appendicolith., Key Words: Dormia basket, Intrahepatic abscess, Laparoscopic appendectomy, Percutaneous drainage.

Background/aims: This study aimed to investigate the factors associated with prolonged hospital stay and in-hospital mortality in patients with pyogenic liver abscess., Methods: We retrospectively reviewed data from patients with pyogenic liver abscess who were admitted between 2005 and 2018 at three tertiary hospitals in Jeonbuk province, South Korea. Prolonged hospital stay was defined as a duration of hospital admission of more than 21 days., Results: A total of 648 patients (406 men and 242 women) diagnosed with pyogenic liver abscess were enrolled in the study. The mean maximal diameter of the liver abscess was 5.4 ± 2.6 cm, and 74.9% of the lesions were single. The three groups were divided according to the maximal diameter of the abscess. Laboratory parameters indicated a more severe inflammatory state and higher incidence of complications and extrahepatic manifestations with increasing abscess size. Rates of percutaneous catheter drainage (PCD) insertion, multiple PCD drainage, and salvage procedures as well as duration of drainage were also higher in the large liver abscess group. Of note, the duration of hospitalization and in-hospital mortality were significantly higher in the large hepatic abscess group. A multivariate analysis revealed that underlying diabetes mellitus, hypoalbuminemia, high baseline high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and large maximal abscess diameter were independent factors associated with prolonged hospital stay. Regarding in-hospital mortality, acute kidney injury at admission and maximal diameter of the abscess were independent factors associated with in-hospital mortality., Conclusions: A large maximal diameter of the liver abscess at admission indicated prolonged hospitalization and poor prognosis. More aggressive treatment strategies with careful monitoring are warranted in patients with large liver abscesses.

Approximately 90% of patients with autoimmune neutropenia (AIN) suffer from mild infections although neutrophil count often decreases to <500/μL. Here, we report 2 cases of infant pyogenic liver abscess complicated with AIN. We should consider the possibility of AIN as an underlying disease when diagnosing pyogenic liver abscess during childhood., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Pyogenic liver abscesses are classified by the bacteria that have caused the abscess because this guides treatment and can point to the underlying cause. The most common cause is biliary disease. The diagnosis is made by imaging. Treatment is a combination of antibiotics and percutaneous drainage. Amebic liver abscess is caused by extraintestinal spread of Entamoeba histolytica. E histolytica is spread by fecal-oral transmission and typically colonizes the gastrointestinal tract. It is diagnosed based on imaging and the mainstay of treatment is metronidazole. Only about 15% of cases require percutaneous drainage. The prognosis is good, with almost universal recovery., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The causes and management of pyogenic liver abscess (PLA) have undergone multiple changes over the past decades. It is a relatively rare disease in the USA, and its incidence rate in the USA is increasing. The last US community hospital experience of PLA was published in 2005. We performed a retrospective study of patients admitted with PLA to an urban safety net hospital., Aims: To ascertain risk factors, management approaches, and outcomes of PLA., Methods: Electronic medical record was queried for diagnosis codes related to PLA during the years 2009-2018. Clinical information was compiled in an electronic database which was later analyzed. Main study outcomes were in-hospital mortality, 30-day readmission rate, and intensive care utilization rate., Results: A total of 77 patients with PLA were admitted in the study period. Most common risk factors were diabetes mellitus (23.4%), previous liver surgery (20.7%), and hepatic malignancy (16.9%). 89% of patients were treated with percutaneous drainage or aspiration, and surgical drainage was reserved for other with other indications for laparotomy. In-hospital mortality, 30-day readmission, and intensive care utilization rates were 2.6%, 7% and 22%, respectively. Median length of stay was 11 days (inter-quartile range 7). Rate of antimicrobial resistance in abscess fluid cultures was 40%; 13 cases of Klebsiella pneumoniae liver abscess were noted in our cohort, most of whom were Hispanic or Asian., Conclusions: PLA was principally managed by percutaneous drainage or aspiration with good outcomes. Further studies investigating the racial predilection of K. pneumoniae liver abscesses could reveal clues to its pathogenesis.

Background: In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA)., Aims: To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality., Methods: One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis., Results: Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041)., Conclusions: E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.

Pyogenic liver abscess (PLA) formation is a rare complication of Crohn's disease (CD). As symptoms often mimic a CD exacerbation, diagnosis can be delayed leading to severe disease. The current case report describes a case of a patient with a history of CD that was admitted with multiple PLAs, which persisted despite percutaneous drainage combined with antibiotics. After a sigmoid resection, the liver abscesses diminished rapidly., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cryptogenic pyogenic liver abscess (PLA) could result due to compromised colonic mucosal barrier in patients with colorectal cancer (CRC). Association of PLA and CRC is unclear. Evidence is weak and limited to small sized studies. As a result, the need for colonoscopy in PLA patients is debatable., Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through January 2019) to identify studies that reported on the prevalence of CRC in PLA patients. Our goals were to evaluate the pooled rate of CRC in patients with cryptogenic PLA., Results: 12 studies were included in the analysis. 18,607 patients were diagnosed with PLA in study group and 60,130 patients were in control group. 63% were males in the age range of 56-94 years. 90.5% of the colonic lesions were left sided and 93.1% were positive for Klebsiella pneumoniae. The pooled rate of prevalence of CRC was 7.9% (95% CI (confidence interval) 5-12.1, I 2  = 92.4, relative risk = 6.6) in patients with PLA, as compared to 1.2% (95% CI 0.3-5.7, I 2  = 93.4) in control, with statistical significance (p = 0.001 respectively)., Conclusion: Our study, albeit limited by heterogeneity, demonstrates that patients with cryptogenic PLA are at a 7-fold risk of having CRC. A screening colonoscopy may be considered in population with cryptogenic PLA, especially if positive for K. pneumoniae. Well-conducted studies are needed to answer this question., (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

BACKGROUND Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. CASE REPORT A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40th day and the subdiaphragmatic drains were removed on the 114th day. Sixteen months after surgery, the patient's condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. CONCLUSIONS A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.

Background: Pancreaticoduodenectomy (PD) is a complex procedure with a morbidity rate of 40%-50%. We evaluated the incidence, associated factors, etiologic characteristics, and outcome of pyogenic liver abscess (PLA), a rare infectious complication of PD., Methods: We retrospectively assessed the data of patients who underwent PD (n = 326) between January 2012 and February 2017 at a single institution. Patients who developed PLA after PD were matched (1:3) for age, sex, and pathologic diagnosis with patients without PLA after PD. Patients who developed PLA without abdominal operation history (n = 77) were also reviewed in the same period., Results: Eleven patients (3.4%) developed PLA after PD; diabetes (5/11, 45.5% versus 4/33, 12.1%; P = 0.031) increased the risk of PLA after PD. The preoperative and postoperative fasting blood glucose (FBG) was significantly higher in PLA+ group than PLA- group: preoperative FBG (median: 7.39 versus 4.49; P < 0.01), postoperative FBG (median: 8.98 versus 5.68; P < 0.01). The occurrence of multiple liver abscess was significantly higher in patients with PLA after PD than patients who developed PLA without abdominal operation history (7/11 versus 22/77; P = 0.036). Microbial pus culture was positive in eight patients with PLA after PD (n = 8/11) and in forty-one patients who developed PLA without abdominal operation history (n = 41/77). Klebsiella pneumoniae was the most commonly isolated microorganism in PLA patients with or without a history of PD (5/8, 62.5% versus 34/41, 82.9%; P = 0.333)., Conclusions: Patients with diabetes (including impaired fasting plasma glucose) have a higher risk of developing PLA after PD. Multiple liver abscess was the most common type of PLA after PD; K pneumoniae should be covered when empirically treated patients with PLA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Objectives: The purpose of this study was to investigate the relationship between periodontitis, dental scaling (DS) and pyogenic liver abscesses (PLAs)., Material and Methods: A nationwide population-based case-control study was applied using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 691 PLA patients, who were individually matched by age and sex to 2764 controls., Results: Conditional logistic regression was applied to estimate adjusted odds ratios (aORs) in patients with exposure to periodontitis and DS before PLA. After adjusting for other confounding factors, periodontitis remained a risk factor for PLA among patients aged 20-40 years, with an aOR of 2.31 (95% confidence interval [CI] = 1.37-3.90, P = .0018). In addition, the average aOR for PLA was significantly lower among patients with one DS (aOR = 0.76, 95% CI = 0.59-0.96) and more than one DS (aOR = 0.61, 95% CI = 0.39-0.95) within 1 year before the index date., Conclusion: According to these results, we concluded that adult patients with periodontitis aged <50 years old are more at risk for PLA than controls, particularly when they have no DS. Moreover, from 20 years of age, non-periodontal patients subjected to at least 2 DS per year are less at risk for PLA than controls., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Many pyogenic liver abscess (PLA) patients underwent abdominal surgery before. However, little is known about the impact of previous abdominal surgery on the clinical characteristics and prognosis of PLA.The clinical data of 392 adult PLA patients who received treatment at our hospital from January 1, 2007 to December 31, 2016 were collected. The demographic data, cause, comorbidities, surgery history, clinical features, laboratory results, imaging findings, microbiological characteristics, choices of treatment, and clinical outcomes were analyzed.In all, 177 PLA patients (45.2%) underwent abdominal surgery before. The median time for the occurrence of PLA after the most recent abdominal surgery was 2.0 (interquartile range 0.25, 6.0) years. PLA patients with a previous abdominal surgery history were more likely to have underlying diseases and presented with more abnormal laboratory values. Klebsiella pneumonia and Escherichia coli were the most common pathogens. Previous abdominal surgery appeared to increase the incidence of E coli. More PLA patients without a previous abdominal surgery history required surgical drainage. However, there were no differences in PLA-related complications, days required for temperature normalization, and length of hospital stay between the 2 groups.Because a large number of PLA patients had a history of abdominal surgery, and proper screening should be performed for patients with any suspicion of a liver abscess after abdominal surgery. Despite the differences in the coexisting conditions, clinical and microbiological characteristics between PLA patients with and without a previous abdominal surgery history, the overall short-term outcomes were comparable.

Gastrointestinal foreign bodies are commonly encountered in clinical practice. However, although perforation of the gastrointestinal tract by a foreign body is not unusual, the formation of a hepatic abscess as a result of the migration of a foreign body is extremely rare. Patients usually present with atypical symptoms, and the treatment of such pyogenic liver abscesses presents a challenge. Here we report a case of hepatic abscess secondary to stomach perforation by a fish bone.

Background and Aim: Cholangitis, bacteremia, and pyogenic liver abscess (PLA) can be often caused by intrahepatic bile ducts stone (IBDS), which is endemic to South-East Asia. The association between IBDS and cholangiocarcinoma has been well recognized. Concomitant cholangiocarcinoma in the PLA related to IBDS is often missed., Methods: A case-control study consisting of 64 patients with PLA related to IBDS and 256 control patients with PLA not related to IBDS was used to investigate clinical features of PLA and incidence of concomitant cholangiocarcinoma in patients with PLA related to IBDS., Results: The main imaging manifestations of PLA related to IBDS was cystic-solid lesions and solid lesions. Of seven patients (10.9%) with pathology-proven cholangiocarcinoma in the same area of PLA related to IBDS among 64 patients, only two patients were initially diagnosed as having concomitant cholangiocarcinoma by biopsy, and other five patients diagnosed as acute inflammatory lesion. Within 60 days after onset, the infection-related death rate and recurrence rate in patients with PLA related to IBDS were 12.9% and 20.3%, respectively, whereas in patients with PLA not related to IBDS were 3.9% and 3.1%, respectively. Only 25% of patients with PLA related to IBDS underwent surgery after admission. The main pathogens in PLA patients related to IBDS were Escherichia coli and extended-spectrum beta-lactamase-producing Enterobacteriaceae., Conclusions: The imaging manifestations of PLA related to IBDS often present cystic-solid or solid lesions. PLA related to IBDS is characterized by high rate of recurrence and infection-related death, difficulty in diagnosis of concomitant cholangicarcinoma., (© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Objectives: To evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES)., Setting: A population-based cohort study using data from Taiwans' National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates., Participants: Patients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES., Results: The overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4-5 years of follow-up., Conclusions: Patients receiving ES are associated with having a higher risk of PLA., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Liver abscess due to perforation of the gastrointestinal tract by a foreign body is a rare and possibly fatal event. Diagnosing this pathology is complicated by the lack of specific symptoms and unfamiliarity of ingestion by the patient and low clinical suspicion of this disease. In the case of liver abscess unresponsive to aspiration and administration of antibiotics, this hypothesis must be made, despite its low incidence. This case report describes and illustrates a case of liver abscess secondary to fish bone ingestion with consequent piercing of the lesser gastric curvature, diagnosed by computed tomography and specific anamnesis. Laparoscopy was performed to extract the foreign body, without complications; the patient is currently asymptomatic and does not present any abnormal physical examination findings. We believe this represents the first case report of a successful laparoscopic treatment in South America for the removal of an ingested foreign body associated with pyogenic liver abscess.

Background: Pyogenic liver abscesses (PLA) remain a significant clinical problem. Unfortunately, little is known about current bacterial susceptibility profiles and the incidence of multidrug resistant organisms (MDROs) causing PLA in Western countries. Yet, this crucial information is pivotal to guide empirical antibiotic therapy. Aim of this study was to provide detailed characteristics of PLA with a special focus on underlying bacterial pathogens and their susceptibility to antibiotics., Methods: A retrospective study of patients diagnosed with PLA from 2009 to 2015 in a large tertiary reference center in Germany was performed in order to characterize PLA and antimicrobial susceptibility profiles of causative bacterial species., Results: Overall, 86 patients were included. The most common causes of PLA were bile duct stenosis/obstruction (31.4%) and leakage of biliary anastomosis (15.1%). Frequent predisposing diseases were malignancies (34.9%), diabetes (24.4%) and the presence of liver cirrhosis (16.3%). Of note, Enterococcus spp. were the most frequently cultured bacterial isolates (28.9%), and in 1/3 of cases vancomycin resistance was observed. In addition, a relevant frequency of gram-negative MDROs was identified. In particular, an alarming 10% and 20% of gram-negative bacteria were resistant to carbapenems and tigecycline, respectively. Of note, MDRO status did not predict ICU stay or survival in multivariate regression analysis. The mortality rate in our series was 16.3%., Conclusion: Our study demonstrates an as yet underreported role of Enterococcus spp., often associated with vancomycin resistance, as well as of gram-negative MDROs causing PLA.

Background: Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature., Case Presentation: A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords "Fusobacterium" and "Liver abscess". Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre's Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks., Conclusion: Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.

Background & Aims: Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae., Methods: An analysis between pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates and those caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae was performed., Results: Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended-spectrum beta-lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae. Independent risk factors for occurrence of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae were biliary disorders including extra- and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus., Conclusions: Pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To investigate the association between a recent gastrointestinal (GI) endoscopy and the subsequent risk of pyogenic liver abscess (PLA)., Methods: We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date (when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies., Results: Patients with a history of diabetes [adjusted odds ratio (aOR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease (aOR = 3.98, 95%CI: 1.45-10.91), biliary tract infection (aOR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis (aOR = 2.19, 95%CI: 1.39-3.46), GI malignancies (aOR = 5.68, 95%CI: 4.23-7.64), appendicitis (aOR = 3.16, 95%CI: 2.27-4.41), diverticulitis (aOR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography (aOR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy (aOR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy (aOR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA., Conclusion: An upper GI panendoscopy performed before 90 d may increase the risk of PLA., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest.

Background: Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease., Objective: To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition., Methods: This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed., Results: The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%)., Conclusions: Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care., Case Presentation: The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged., Conclusion: Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.

Background: The relationship between chronic pancreatitis (CP) and subsequent pyogenic liver abscess (PLA) is not well understood., Methods: We investigated the risk of PLA in patients with CP using inpatient claims data from the Taiwan National Health Insurance Program for the period 2000-2010. We identified 17,810 patients with chronic pancreatitis (CP group) and 71,240 patients without CP (non-CP group). Both cohorts were followed until a diagnosis of PLA, until they were censored from the study because of loss to follow-up, death, or termination of insurance, or until the study cut-off date of 31 December 2011. Incidence and risk factors for development of PLA, and the effects of comorbidities, were assessed., Results: The incidence of PLA in the CP group was 12.9 times that in the non-CP group (38.3 vs. 2.89 events per 1000 person-years; 95% confidence interval [CI], 10.5-15.8). After adjusting for age, sex, and the comorbidities of hypertension, diabetes, hyperlipidemia, cerebral vascular accident, cirrhosis, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cancer, alcoholism, other diseases of the pancreas, cholecystitis, and cholelithiasis and other disorders of the biliary tract and endoscopic insertion of stent (tube) into the bile duct, the risk of PLA remained higher among CP patients than among the comparison cohort (adjusted hazard ratio, 6.40; 95% CI, 4.83-8.49). CP patients with five or more comorbidities had a significantly higher risk of PLA (adjusted hazard ratio, 24.9; 95% CI, 18.3-33.8)., Conclusion: CP was associated with increased risk of subsequent PLA. The risk of PLA was higher in patients with five or more comorbidities.