Department of Surgery, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Department of Internal Medicine, AHEPA General University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Medicina (Kaunas). 2022 Jun 9;58(6):782. doi: 10.3390/medicina58060782.
Acute cholecystitis, which is usually associated with gallstones is one of the most common surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation and abscess formation. Perforation of the gallbladder is a relatively uncommon complication of acute cholecystitis (0.8-3.2% in recent reviews). The intrahepatic perforation causing a liver abscess is an extremely rare condition, anecdotally reported in the scientific literature, even in the rare types of subacute or acute perforation. Liver abscess caused by gallbladder perforation can be a life-threatening complication with a reported mortality of 5.6%. The treatment of synchronous pyogenic liver abscess and acute cholecystitis may be challenging. We reported three cases of liver abscess due to acute cholecystitis in which different therapeutical approaches were employed. The first case was treated with antibiotics and interval laparoscopic cholecystectomy; the second case was treated with emergency cholecystectomy; and the third case with percutaneous aspiration of the abscess only. The appropriate therapeutical method in these cases depends on the patient's clinical condition, the on-site expertise that is available in the hospital, and the experience of the surgeon.
急性胆囊炎通常与胆结石有关，是急诊住院的最常见外科原因之一，可能进一步并发壁坏死、穿孔和脓肿形成。胆囊穿孔是急性胆囊炎的一种相对罕见的并发症（最近的综述中为 0.8-3.2%）。导致肝脓肿的肝内穿孔是一种极其罕见的情况，在科学文献中有零星报道，即使在亚急性或急性穿孔的罕见类型中也是如此。胆囊穿孔引起的肝脓肿可能是一种危及生命的并发症，据报道死亡率为 5.6%。同时发生化脓性肝脓肿和急性胆囊炎的治疗可能具有挑战性。我们报告了三例由急性胆囊炎引起的肝脓肿病例，其中采用了不同的治疗方法。第一例采用抗生素和间隔腹腔镜胆囊切除术治疗；第二例采用急诊胆囊切除术治疗；第三例仅采用脓肿经皮抽吸治疗。在这些情况下，适当的治疗方法取决于患者的临床状况、医院现有的现场专业知识以及外科医生的经验。
