Hepatic abscess after biliary tract procedures.

Seven patients with hepatic abscess that developed after prior operation upon the biliary tract were treated during a two year period. In contrast with the fulminant clinical presentation of hepatic abscess usually associated with acute obstructive suppurative cholangitis, the presentation of hepatic abscess after prior biliary tract procedures was surprisingly indolent; several patients had been treated with oral antibiotics for several weeks or months with the presumptive diagnosis of nonsuppurative cholangitis. Thorough investigation of the entire biliary tree was necessary to identify associated biliary disease, which included biliary-enteric anastomotic stricture, intrahepatic stricture, excluded sectoral bile duct from iatrogenic injury and reflux of abnormally contaminated intestinal contents. Extensive reconstructions of the biliary tract were performed upon three patients. Recurrence of the abscess occurred once after percutaneous and once after surgical drainage and was managed by drainage of the associated excluded sectoral bile duct or fistulojejunostomy. Operative drainage of hepatic abscess after prior biliary operation may be preferable to percutaneous techniques to provide definitive surgical management of associated pathologic findings of the biliary tract.