PMC9537032_01
Contrast-enhanced computed tomography on arrival which shows multilocular abscess cavities with a mild enhancement.
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Cell (WBC) was 8,500/mul and C reactive protein (CRP) was 26.7 ng/dl. CT on arrival (Figure 1) revealed a multifocal lesion (46 mm x 52 mm) in the lateral area of the liver with a contrast effect on the margins.
Clinical course after admission. BCx: blood culture, ABPC/SBT: sulbactam/ampicillin, CTX: cefotaxime, NAD: noradrenalin, RBC: red blood cell, FFP: flesh frozen plasma, PC: platelet concentrate, Hb: hemoglobin, and HR: heart rate.
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Blood examination showed a platelet count of 50,000/mul, CRP was 26.7 ng/dl, creatinine was 1.39 mg/dl, T-Bil was 2.9 mg/dl, PT% was 54%, PT-INR was 1.42, and an acute DIC score was 8 (Figure 2). The patient was diagnosed to be in shock due to rupture of a liver abscess and intra-abdominal bleeding, and emergency laparotomy was performed (Figure 2).
Plain-computed tomography (a) and contrast-enhanced computed tomography (b) after percutaneous transhepatic abscess drainage (PTAD). Extravasation of contrast media and hematoma was observed around the liver and spleen (b, arrowhead).
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When compared with plain CT (Figure 3(a)), a new fluid accumulation and contrast material were seen dorsal to the abscess (Figure 3(b)), suggesting that the abscess had perforated into the abdominal cavity. In addition, extravasation of contrast medium was observed in the perihepatic fluid accumulation (Figure 3(b), arrowhead).
Operative findings. The sutured part (arrow) of lateral hepatic segment was completely free of active bleeding by gauze packing.
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The suture closure of the laceration in the lateral area was completely hemostatic with packing (Figure 4, arrow).
Pathologic findings. Subcapsular hematoma formation of 9.5 x 2.2 x 13 cm (arrowhead) was observed in the lateral area of the liver. Arrows indicate abscess formation of 4.0 x 3.0 x 6.0 cm in the liver lobe.
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Following histopathological examination, a 9.5 x 2.2 x 13 cm subcapsular hematoma formation (Figure 5(a), arrowhead) was found on the posterior aspect of the lateral area of the liver. A 4.0 x 3.0 x 6.0 cm geographic abscess formation (Figure 5(a), arrow) was found near the hepatic parenchymal margins. There was an abscess formation near the bile duct (Figure 5(b)), and HKp was also detected in this culture.