Salvage hepatectomy in refractory pyogenic liver abscess: a case report

TL;DR

This case report describes a patient who required surgery for a severe liver abscess that did not respond to standard treatments.

Contribution

The report highlights the role of salvage hepatectomy in treating refractory pyogenic liver abscess.

Findings

The patient's abscess persisted despite antimicrobial therapy and drainage.

Hepatectomy and cholecystectomy led to resolution of the infection.

Surgical intervention was critical for source control and survival.

Abstract

Pyogenic liver abscess (PLA) is a rare but life-threatening condition. First-line management includes antimicrobial therapy and image-guided percutaneous drainage. Surgical resection is rarely required but remains an important method for definitive source control in selected cases. We report the case of a 65-year-old man with a large hepatic abscess that remained refractory to percutaneous drainage. Culture of the drain aspirate grew Klebsiella aerogenes and Candida albicans. Despite appropriate antimicrobial therapy, the patient’s sepsis persisted, and imaging demonstrated inadequate resolution of the abscess. The patient underwent a hepatectomy and cholecystectomy. The post-operative course was complicated by a prolonged ileus, and the patient was well in his outpatient follow-up a few months after discharge. While uncommon in the modern era, hepatectomy remains a definitive treatment option for hepatic abscess when percutaneous drainage fails. Early recognition of treatment failure and timely escalation to surgery can be lifesaving.

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