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[经皮血栓切除术治疗化脓性肝脓肿并发右心房血栓形成]

[Thrombectomy for right atrial thrombosis complicating a pyogenic liver abscess].

作者信息

Nishiwaki Yuki, Baba Takeshi, Mizutani Saori, Yokoyama Satoko, Hojo Aya, Nakagawa Hiroki, Okubo Yusuke, Nakano Shigeru, Miki Takahisa, Mori Mitsuharu

机构信息

Department of Gastroenterology, Saiseikai Yokohamashi Tobu Hospital.

Depatrtment of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital.

出版信息

Nihon Shokakibyo Gakkai Zasshi. 2020;117(9):811-818. doi: 10.11405/nisshoshi.117.811.

Abstract

Vascular complications from a liver abscess are rare but life-threatening. Herein, we report the case of a man in his 40s with a pyogenic hepatic abscess complicated by an inferior vena caval thrombus extending to the right atrium. His presenting complaint was a high fever. Blood tests revealed elevated inflammatory markers and liver enzymes. An abdominal CT demonstrated a 10cm abscess in the right hepatic lobe. A blood culture grew Streptococcus intermedius, which was sensitive to ampicillin sulbactam. He was diagnosed with a pyogenic liver abscess and treated with metronidazole and ampicillin sulbactam. Three days following admission, an abdominal CT scan revealed the thrombus extending from the liver abscess into the right atrium. He underwent thrombectomy and received antibiotic therapy. Postoperatively, abdominal ultrasound revealed a significant decrease in the size of the hepatic abscess. The patient was discharged in good condition on the 46th day of hospitalization. When encountering a hepatic abscess, it is important to consider that it may be associated with a thrombus extending from the inferior vena cava into right atrium.

摘要

肝脓肿引起的血管并发症罕见但危及生命。在此,我们报告一例40多岁男性患者,患有化脓性肝脓肿,并伴有下腔静脉血栓延伸至右心房。他的主要症状是高热。血液检查显示炎症指标和肝酶升高。腹部CT显示右肝叶有一个10厘米的脓肿。血培养生长出中间型链球菌,对氨苄西林舒巴坦敏感。他被诊断为化脓性肝脓肿,并接受甲硝唑和氨苄西林舒巴坦治疗。入院三天后,腹部CT扫描显示血栓从肝脓肿延伸至右心房。他接受了血栓切除术并接受了抗生素治疗。术后,腹部超声显示肝脓肿大小显著减小。患者在住院第46天状况良好出院。当遇到肝脓肿时,重要的是要考虑到它可能与下腔静脉血栓延伸至右心房有关。

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