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Pyogenic Liver Abscess Following Pancreaticoduodenectomy: Risk Factors, Treatment, and Long-Term Outcome

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD.

Methods

We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994–January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD.

Results

PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 %) or antibiotics alone (N = 7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p = 0.014) or who required reoperation (18.2 vs. 1.5 %, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls.

Conclusions

Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.

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Authors and Affiliations

  1. Department of Surgery and Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Victor C. Njoku, Thomas J. Howard & Changyu Shen

  2. Department of Surgery, Indiana University School of Medicine, Emerson Hall 519, 545 Barnhill Drive, Indianapolis, IN, 46202, USA

    Nicholas J. Zyromski & C. Max Schmidt

  3. Department of Surgery, Temple University, Philadelphia, PA, USA

    Henry A. Pitt

  4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Attila Nakeeb & Keith D. Lillemoe

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  1. Victor C. Njoku
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  2. Thomas J. Howard
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  3. Changyu Shen
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  4. Nicholas J. Zyromski
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Correspondence to Nicholas J. Zyromski.

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Njoku, V.C., Howard, T.J., Shen, C. et al. Pyogenic Liver Abscess Following Pancreaticoduodenectomy: Risk Factors, Treatment, and Long-Term Outcome. J Gastrointest Surg 18, 922–928 (2014). https://doi.org/10.1007/s11605-014-2466-8

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  • DOI: https://doi.org/10.1007/s11605-014-2466-8

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