Piyojenik Karaciğer Apsesi: Olgu Sunumu.

Abstract

Piyojenik karaciğer apsesi PKA nadir görülen, drenaj ve uygun antibiyotik tedavisi ile mortalitesi azalan bir hastalıktır. Altmış yaşında erkek hasta yaklaşık iki ay önce sağ üst kadran da ağrı, ateş, halsizlik ve iştahsızlık nedeniyle genel cerrahi servisine yatırıldı. Ultrasonografide 10 cm’lik karaciğer apsesi ile uyumlu bir kitle saptandı. Perkütan kateter ile abse drene edildi. Hasta iki hafta genel cerrahi servisinde yattıktan sonra genel durumunun düzelmesi üzerine taburcu edildi. Fakat sağ üst kadran da ağrı, ateş, halsizlik ve iştahsızlık nedeniyle enfeksiyon hastalıkları servisine yatırıldı. Hastanın fizik muayenesinde batın sağ üst kadranda hassasiyet mevcuttu. Sağ hipokondriumda da perkütan drenaj kateteri bulunmaktaydı. Antibiyotik tedavisine başlandı. Görüntüleme tetkiklerinde karaciğerde multiloküler apse olması nedeniyle hastaya 2. Peruktan kateter dreni takıldı. Klinik ve laboratuvar bulguları düzelen hasta oral antibiyotik tedavisi ile taburcu edildi. Bu olguda piyojenik karaciğer apselerine genel yaklaşım ve tedavi seçenekleri incelendi

Keywords

• Piyojenik karaciğer apsesi, antibiyotik tedavisi, perkütan drenaj

Pyogenic Liver Abscess: Case Report.

Abstract

Pyogenic liver abscess PKA is a rare disease, which mortality could decrease with drainage and appropriate antibiotic therapy. A sixty year-old male patient was admitted to general surgery inpatient unit with findings of fever, anorexia, fatigue and right upper quadrant abdominal pain about two months ago. Ultrasonography revealed a 10 cm mass which is suitable with liver abscess. Abscess was drained by a percutaneous catheter. The patient was discharged from general surgery inpatient unit when his clinical findings improved after two weeks of inpatient follow-up. The patient was admitted to infectious diseases in patient unit with findings of fever, malaise, anorexia and right upper quadrant pain. Physical examination of the patient revealed sensitivity in the right upper quadrant of the abdomen. And there was a percutaneous drainage catheter in the right hypochondrium. Antibiotic therapy was started. Second percutaneous drainage catheter was inserted because of the multilocular abscess in the liver imaging. The patient was discharged with oral antibiotic therapy when his clinical and laboratory findings improved. In this case, it was evaluated general approach to pyogenic liver abscess and treatment options

Keywords

• Pyogenic liver abscess, antibiotic therapy, percutaneous drainage

References

1. Wong WM, Wong BC, Hui CK, et al. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10 year period. J Gastroenterol Hepatol, 2002; 17(9): 1001-7.
2. Chan KS, Chen CM, Cheng KC, Hou CC, Lin HY, Yu WL: Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period. Jpn Infect Dis, 2005; 58(6): 366-8.
3. Cigarran S, Neches C, Lamas JM, Garcia-Trio G, Alonso M, Saavedra J. A case report of a pyogenic liver abscess caused by Fusobacterium nucleatum in a patient with autosomal dominant polycystic kidney disease undergoing hemodialysis. Ther Apher Dial, 2008; 12(1): 91-5.
4. Ural O. Batın içi infeksiyonlar. Ulusoy S, Leblebicioğlu H, ed. Anaerop Bakteri İnfeksiyonları’nda. Ankara: Bilimsel Tıp Yayınevi, 2005; 57-66.
5. Mohsen AH, Green ST, Read RC, McKendrick MW. Liver abscess in adults: ten years experience in a UK centre. QJM, 2002; 95(12): 797-802.
6. Rockey DC. Hepatobiliary infections. Curr Opin Gastroenterol, 2001; 17: 257-61.
7. Koo HC, Kim YS, Kim SG, Tae JW, Ko BM, Lee TI, et al. Should colonoscopy be performed in patients with cryptogenic liver abscess? Clin Res Hepatol Gastroenterol, 2013; 37(1): 86-92.
8. Lai HC, Lin CC, Cheng KS, Ko JT, Chou JW, Peng CY, et al. Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study. Gastroenterology, 2014; 146(1): 129-37.

9. Chen SC, Wu WY, Yen CH, Lai KC, Cheng KS, Jeng LB, et al. Comparison of Eschericia coli and Klebsiella pneumoniae liver abscesses. Am J Med Sci, 2007; 334(2): 97-105
10. Huang WK, Chang JW, See LC, Tu HT, Chen JS, Liaw CC, et al. Higher rate of colorectal cancer among patients with pyogenic liver abscess with Klebsiella pneumoniae than those without; an 11-year follow- up study. Colorectal Dis, 2012; 14(12): e794-80.
11. Chung YF, Tan YM, Lui HF, Tay KH, Lo RH, Kurup A, et al. Management of pyogenic liver abscesses- percutaneous or open drainage? Singapore Med J, 2007; 48(12): 1158-65.
12. Giorgio A, De Stephano G, Di Sarno A, Liorre G, Ferraioli G. Percutaneous needle aspiration of multiple pyogenic abscess of the liver: 13-year single center experience. Am J Roentgenol, 2006; 187(6): 1585-90.
13. Fontanilla T, Noblejas A, Cortes C, Minaya J, Mendez S, Van den Brule E, et al. Contrast -enhanced ultrasound of liver lesions related to arterial thrombosis in adult liver transplantation. J Clin Ultrasound, 2013; 41(8): 493-500.