Department of General Surgery, Inonu University, Turgut Ozal Medical Centre, Malatya 44315, Turkey.
Singapore Med J. 2011 Jul;52(7):e153-5.
We report pyogenic liver abscess complicated by fistulisation into the portal vein and bile ducts in a 58-year-old diabetic woman, who was admitted to the hospital with fever, chills and rigors. Abdominal ultrasonography and computed tomography demonstrated a 7-cm multiloculated abscess in segment III, close to the left branch of the portal vein. The abscess was drained under fluoroscopic guidance in a single pass. Pus was aspirated, and diluted water-soluble contrast was injected into the cavity. Early films revealed filling of the cavity. Later, the contrast appeared in the bile ducts and left branch of the portal vein. Radiological intervention was discontinued. Immediate surgery, including left lateral segmentectomy, was performed. The preoperative course was uneventful, except for superficial surgical site infection. We opine that a hepato-venous fistula is an indication for surgical intervention, and that early resection of the fistula can prevent severe septic complications.
我们报告了一例 58 岁糖尿病女性患者的化脓性肝脓肿并发门静脉和胆管瘘，她因发热、寒战和肌强直而住院。腹部超声和 CT 显示在 III 段有一个 7 厘米的多房脓肿，靠近门静脉左支。脓肿在透视引导下一次性引流。抽吸脓液，并向腔内注入稀释的水溶性造影剂。早期的片子显示了腔的充盈。后来，造影剂出现在胆管和门静脉左支。放射介入停止。立即进行手术，包括左外侧段切除术。术前过程平稳，除了浅表手术部位感染。我们认为肝静脉瘘是手术干预的指征，早期切除瘘管可以防止严重的感染性并发症。
