Abstract | HISTORY AND ADMISSION FINDINGS: INVESTIGATIONS: Laboratory results revealed a significant inflammatory constellation. Abdominal ultrasound was performed which showed a big pyogenic abscess in the right lobe of the liver. Escherichia coli and Enterococcus faecalis could be isolated from abscess aspirates. Endoscopic retrograde cholangiography (ERC) without access of the pancreatic duct showed stenosis of the Ductus hepatocholedochus which was treated with a biliary endoprothesis. DIAGNOSIS, TREATMENT AND COURSE:
Antibiotic treatment and percutaneous drainage led to complete remission of the abscess. A few days after discharge the patient returned with identical clinical symptoms. Abdominal ultrasound showed recurrence of the abscess. Because of excessively high pancreatic amylase in aspirated abscess material the patient underwent endoscopic retrograde cholangiopancreaticography (ERCP). There, a pancreatico-hepatic fistula was seen, probably the result of necrosis caused by a severe acute attack of the chronic pancreatitis. After insertion of a naso-fistular drainage, continous rinse and appropriate antibiotic therapy both abscess and fistula completely disappeared without recurrence. CONCLUSION:
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Authors | F Gundling, R Secknus, M Tröltzsch, G Borte, J Mössner |
Journal | Deutsche medizinische Wochenschrift (1946)
(Dtsch Med Wochenschr)
Vol. 129
Issue 31-32
Pg. 1679-82
(Jul 30 2004)
ISSN: 0012-0472 [Print] Germany |
Vernacular Title | Pyogener Leberabszess bei chronischer äthyltoxischer Pankreatitis. |
PMID | 15273919
(Publication Type: Case Reports, Journal Article)
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Chemical References |
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Topics |
- Adult
- Amylases
(analysis)
- Cholangiopancreatography, Endoscopic Retrograde
- Diagnosis, Differential
- Digestive System Fistula
(complications, diagnosis)
- Enterococcus faecalis
(isolation & purification)
- Escherichia coli
(isolation & purification)
- Escherichia coli Infections
(etiology, microbiology)
- Gram-Positive Bacterial Infections
(etiology, microbiology)
- Humans
- Liver Abscess
(enzymology, etiology, microbiology)
- Liver Diseases
(complications, diagnosis)
- Male
- Pancreatic Fistula
(complications, diagnosis)
- Pancreatitis, Alcoholic
(complications)
- Recurrence
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