Liver abscess after central bisegmentectomy with reconstruction of the right posterior segment artery: A case report
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A 68-year-old female was admitted with obstructive jaundice caused by gallbladder cancer invading the liver bed and hepatic hilum. The patient underwent a central bisegmentectomy, followed by bilateral hepaticojejunostomy with a transhepatic biliary stent and reconstruction of the right posterior segment artery. The color of the right posterior segment improved after arterial reconstruction, although good pulsation was not obtained in the right posterior segment artery. The patient had a febrile postoperative course. On the 22nd postoperative day,Bacteroides sp. was recovered from the arterial blood. On the 27th postoperative day, a CT examination revealed 2 liver abscesses in the right posterior segment, which was less enhanced than the left lateral segment. The right biliary stent penetrated the center of both abscesses, but the left lateral segment was intact. Percutaneous drainage of the liver abscesses was performed with intensive chemotherapy. The aspirated pus grewPseudomonas aeruginosa, Enterococcus faecalis, Enterobacter cloacae and unidentified gram-positive rods, but was free of fungus. The liver abscesses gradually resolved, and the pateint was discharged on the 78th postoperative day. Since the right posterior segment differed from the left lateral segment only by arterial reconstruction, it is suggested that arterial insufficiency may be of primary importance in the pathogenesis of the liver abscesses observed in this patient.
Key wordsliver abscess hepatic artery reconstruction hepaticojejunostomy biliary stent sphincter of Oddi catheter-associated infection
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