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.