Lee Kyu Won, Kim Hee Yeon, Kim Chang Wook, Kim Young Ki, Kwon Ohbeom, Kim Min Ah, Cho Youngyun, Yang Keungmo
Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Mol Hepatol. 2017 Mar;23(1):87-90. doi: 10.3350/cmh.2016.0029. Epub 2017 Mar 9.
Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.
化脓性肝脓肿后并发肝胃瘘极为罕见，仅有少数病例报道。一名88岁女性，出现全身乏力、发热和寒战症状。腹部计算机断层扫描显示肝左外叶有一个5厘米大小的低密度病变，内部有分隔。由于最初怀疑是早期肝脓肿，遂给予经验性静脉抗生素治疗。起初，因病变特征不成熟未进行肝脓肿穿刺或引流。住院17天后，因随访影像显示病变更为成熟，遂在超声引导下对肝脓肿进行了经皮引流。在管造影检查中，可见造影剂通过瘘管渗漏。随后进行了手术治疗，术后2周出院。
