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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ingestion of a foreign body that penetrates the gastric wall and migrates to the liver, where it causes an abscess is uncommon. A case of an ingested rosemary twig perforating the gastric antrum, then migrating to the liver, complicated by hepatic abscess and Staphylococcus aureus sepsis is reported. A 59-year-old man without a history of foreign body ingestion was admitted to our hospital because of sepsis and epigastralgia, which had progressively worsened. No foreign body was identified at preoperative imaging, but a rosemary twig was discovered during laparotomy. The liver abscess and sepsis were controlled successfully with surgery and antibiotics. This unusual condition should be kept in mind when dealing with cases of hepatic abscess, or even sepsis of unknown origin. Despite the improvement of non-surgical techniques such as percutaneous drainage and interventional endoscopy, surgery still remains important in the treatment of hepatic abscess caused by an ingested foreign body.
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PMID:Hepatic abscess secondary to a rosemary twig migrating from the stomach into the liver. 1790 3

A 77-year-old woman was admitted suffering from fever and headache. On laboratory examination, bacterial meningitis and sepsis due to Klebsiella pneumoniae were diagnosed. In addition, a hepatic cystic lesion measuring 13 cm in diameter in the left lobe was indicated on diagnostic imaging. After treatment with antibiotics, her signs of infection improved and the hepatic lesion decreased in size. After discharge, however, the cystic liver mass increased and a gastric fistula developed. Hepatic and gastric resections were performed because of the possibility of biliary cystadenocarcinoma and gastric invasion. Pathologically, a pyogenic liver abscess complicated by gastric fistula was diagnosed.
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PMID:[Pyogenic liver abscess complicated by gastric fistula and bacterial meningitis]. 1791

This pictorial essay aims to review the literature on the management of pyogenic liver abscess, focusing on the choice of drainage. Articles on the treatment of pyogenic liver abscess, accessed through a MEDLINE search using PubMed, were reviewed. A case series of the authors' experience with clinicopathological correlation is presented to highlight the indication and outcome of each modality of drainage. Intravenous antibiotic is the first line, and mainstay, of treatment. Drainage is necessary for large abscesses, equal to or larger than 5 cm in size, to facilitate resolution. While percutaneous drainage is appropriate as first-line surgical treatment in most cases, open surgical drainage is prudent in cases of rupture, multiloculation, associated biliary or intra-abdominal pathology. Percutaneous drainage may help to optimise clinical condition prior to surgery. Laparoscopic drainage is a feasible surgical option with promising results in the future. Liver resection is reserved for concomitant localised intrahepatic disease and tumour, after control of sepsis. The final verdict on the outcome of percutaneous versus open surgical drainage of pyogenic liver abscesses requires further studies in a controlled trial setting. Nevertheless, in current good clinical practices, the choice of therapy needs to be individualised according to patient's clinical status and abscess factors. They are complementary in the management of liver abscesses.
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PMID:Management of pyogenic liver abscesses - percutaneous or open drainage? 1804 48

Liver abscess is a rare condition in neonates and its diagnosis requires a high degree of suspicion. CT scan and ultrasound are the most sensitive diagnostic modalities for detecting hepatic abscess. Portal vein thrombosis and cavernoma formation are rare complications following neonatal liver abscess and sepsis. We describe the case of two neonates with hepatic abscess following umblical vein catheterisation, with rare complications of portal vein thrombosis and portal vein cavernoma formation. Therefore, unreserved caution should be exercised in performing umbilical cannulation in neonates due to the inherent risks involved with this procedure.
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PMID:Liver abscess, portal vein thrombosis and cavernoma formation following umbilical vein catherisation in two neonates. 1805 Aug 47

Acute cholangitis is associated with a high mortality and morbidity and often requires drainage of the obstructed biliary system. The purpose of this study was to evaluate the usefulness and safety of endoscopic nasobiliary drainage in the treatment and prevention of acute cholangitis due to diverse etiology. During a 32-month period, 143 patients (67 males, 76 females) with age range of 15 to 84 years underwent urgent fluoroscopy guided endoscopic nasobiliary drainage using a 7 Fr catheter either to treat acute cholangitis not responding to antibiotics (group A, n = 116) or to prevent its development following endoscopic retrograde cholangiography performed in an obstructed biliary system (group B, n = 27). Underlying etiology included bile duct stones (92), malignant biliary obstruction (34), choledochal cyst (4), chronic pancreatitis (4), ruptured hydatid cyst (3), portal hypertensive cholangiopathy (3) and liver abscess (3). Endoscopic nasobiliary drainage was performed successfully in 129 patients (90.2%). Cholangitis improved within 1 to 3 days (in group A) or did not develop (in Group B) in 125 patients (96.7%) with successful endoscopic nasobiliary drainage. Two patients however required additional drainage by percutaneous transhepatic route, while two died inspite of effective endoscopic drainage. Of the 14 patients (9.8%) with failed endoscopic drainage, 9 were managed by surgical decompression or percutaneous transhepatic drainage, 3 died of septicemia. Endoscopic nasobiliary drainage is a safe and effective method to treat patients with acute cholangitis as well as to prevent its development following cholangiography performed in an obstructed biliary system.
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PMID:Endoscopic nasobiliary drainage in the management of acute cholangitis: an experience in 143 patients. 1849 31

Pyogenic-liver abscesses are due to bacteria mostly from the portal and biliary tracts. There is usually only one located in the right liver, but they may be found in the left liver, be multiple or multilocular. Diagnosis, based on ultrasound and/or computed tomography scan, is confirmed by percutaneous-needle aspiration to identify the bacteria causing the disease. Global management includes the treatment of sepsis and the aetiology of the liver abscess: biliary lithiasis, diverticular disease, colon cancer, appendicitis or other intra-abdominal infections. However, no cause is found in 20% of cases. Treatment is based on antibiotics and, sometimes, percutaneous drainage while the cause may be treated immediately or later if the sepsis is controlled. Interventional radiology is often used. Surgery may be performed in case of failure of initial treatment and to cure the cause of the abscess. Prognosis may be poor, especially if there are associated-risk factors, such as diabetes and immunodepression, even though the outcome has improved with a multidisciplinary approach.
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PMID:[Pyogenic-liver abscess: diagnosis and management]. 1901 4

FimH is an adhesive subunit of type 1 fimbriae expressed by different enterobacterial species. The enteric bacterium Klebsiella pneumoniae is an environmental organism that is also a frequent cause of sepsis, urinary tract infection (UTI), and liver abscess. Type 1 fimbriae have been shown to be critical for the ability of K. pneumoniae to cause UTI in a murine model. We show here that the K. pneumoniae fimH gene is found in 90% of strains from various environmental and clinical sources. The fimH alleles exhibit relatively low nucleotide and structural diversity but are prone to frequent horizontal-transfer events between different bacterial clones. Addition of the fimH locus to multiple-locus sequence typing significantly improved the resolution of the clonal structure of pathogenic strains, including the K1 encapsulated liver isolates. In addition, the K. pneumoniae FimH protein is targeted by adaptive point mutations, though not to the same extent as FimH from uropathogenic Escherichia coli or TonB from the same K. pneumoniae strains. Such adaptive mutations include a single amino acid deletion from the signal peptide that might affect the length of the fimbrial rod by affecting FimH translocation into the periplasm. Another FimH mutation (S62A) occurred in the course of endemic circulation of a nosocomial uropathogenic clone of K. pneumoniae. This mutation is identical to one found in a highly virulent uropathogenic strain of E. coli, suggesting that the FimH mutations are pathoadaptive in nature. Considering the abundance of type 1 fimbriae in Enterobacteriaceae, our present finding that fimH genes are subject to adaptive microevolution substantiates the importance of type 1 fimbria-mediated adhesion in K. pneumoniae.
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PMID:Population variability of the FimH type 1 fimbrial adhesin in Klebsiella pneumoniae. 1915 Nov 41

Bacillus species are aerobic, gram-positive, spore forming rods that are usually found in the soil, dust, streams, and other environmental sources. Except for Bacillus. anthracis (B. anthracis), most species display low virulence, and only rarely cause infections in hosts with weak or damaged immune systems. There are two case reports of B. cereus as a potentially serious bacterial pathogen causing a liver abscess in an immunologically competent patient. We herein report a case of liver abscess and sepsis caused by B. pantothenticus in an immunocompetent patient. Until now, no case of liver abscess due to B. pantothenticus has been reported.
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PMID:Liver abscess and sepsis with Bacillus pantothenticus in an immunocompetent patient: a first case report. 1990 47

In 2002-2008 yrs 85 patients were treated for abdominal cavity abscess (ACA). Hepatic abscess was revealed in 41 (33.6%) patients, subhepatic one--in 14 (16.5%), right-sided subdiaphragmatic--in 12 (14.1%), left-sided--in 18 (21.2%). In 42 (49.4%) patients abdominal sepsis was diagnosed, of them in 25 (29.4%)--severe one, in 18 (21.2%)--polyorganic insufficiency syndrome. For ACA in 67 (78.8%) patients the puncture--drainage interventions under ultrasonographic guidance were performed and in 18 (21.2%)--laparotomy. Miniinvasive interventions application in 48 (56.5%) patients had permitted to remove the sepsis signs already on the third--fifth day. In 19 (22.4%) patients in severe sepsis veno--venous hemodyafiltration was used for extracorporeal detoxication performance. Twelve (14.1%) patients died.
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PMID:[Mini-invasive methods in the treatment of abdominal sepsis caused by abdominal cavity abscess]. 2045 55

We describe a case of severe Salmonella O9 HG sepsis with a mass in the liver, which was diagnosed as hepatocellular carcinoma (HCC) by autopsy of the liver. The patient was a 67-year-old man with chronic high blood pressure. In addition, he was an alcoholic and had been drinking every day for many years. He had had a dinner of 'sukiyaki' with a raw egg two days before admission. The next morning, he had developed vomiting, diarrhea, and abdominal pain. Salmonella O9 HG was found in the blood and stool cultures. In the computed tomography (CT) finding of the liver, there was a 2 cm early-enhanced mass with a multilocular structure, with ringed enhancement and daughter nodes. Since we thought that the mass was a liver abscess, we performed needle aspiration from the liver mass and were able to withdraw blood. Despite adequate antibiotic treatment, the patient died as a result of complications on the 55th day after admission. After the patient's death, we conducted an autopsy. There were two HCC masses, a moderately-differentiated and a well-differentiated mass, as a result of alcoholic cirrhosis of the liver. As the HCC had multilocular cyst-like structures, which were fiber- and necrosis-rich, CT images of the liver masses resembled abscesses.
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PMID:Hepatocellular Carcinoma Mimicking Liver Abscesses in a Cirrhotic Patient with Severe Septic Shock as a Result of Salmonella O9 HG Infection. 2065 66


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