Treatment of pyogenic liver abscess by surgical incision and drainage combined with platelet-rich plasma:A case report

BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.

Surgical treatment for infra-cardiac total anomalous pulmonary venous drainage and early-mid follow-up results in 17 cases

Objective To evaluate effectiveness of urgent surgical correction for infra cardiac total anomalous pulmonary venous drainage (TAPVD) in infants and children. Methods From July 2000 to April 2009,seventeen patients with infra-cardiac type of total anomalous pulmonary venous connection received surgical correction

Pericardial Drainage by Xyphoidian Route at the Chu Point G

Tuberculosis is a public health problem in Mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in Mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.

Pyogenic liver abscess:An audit of 10 years’experience

AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were reviewed.Amoebic and hydatid abscesses were excluded.Demographic,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were recorded.RESULTS:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) d.Only 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was measured.Liver function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) cm.Causative organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial infarction.The initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their hospitalization.Serum hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION:PLA is a diagnostic challenge,because the presentation of this condition is non-specific.Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy

AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and out-come of surgery. RESULTS:The patients were predominantly women (10/13) with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multilocula-tion. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with perito-nitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism. CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.

Abscess of the caudate lobe of the liver, a rare disease with a challenging management: a case report

We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography （CT） guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in plan- ning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyo- genic liver abscess, but is it applicable also for caudate lobe abscess？

Drain-site hernia after laparoscopic rectal resection:A case report and review of literature

BACKGROUND Drain-site hernia(DSH)has an extremely low morbidity and has rarely been reported.Small bowel obstruction is a frequent concurrent condition in most cases of DSH,which commonly occurs at the≥10 mm drain-site.Here we report a rare case of DSH at the lateral 5 mm port site one month postoperatively without visceral incarceration.Simultaneously,a brief review of the literature was conducted focusing on the risk factors,diagnosis,and prevention strategies for DSH.CASE SUMMARY A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago.A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant,and that the content consisted of the large omentum.An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously.The postoperative period was uneventful.The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.CONCLUSION Emphasis should be placed on DSH despite the decreased use of intra-abdominal drainage.It is recommended that placement of a surgical drainage tube at the≥10 mm trocar site should be avoided.Moreover,it is advisable to have a comprehensive understanding of the risk factors for DSH and complete closure of the fascial defect at the drainage site for high-risk patients.