Case Summary of Patient with Life-Threatening and Complex Hepatic Abscess

  • Male patient, 46 years-old
  • Presented with abdominal pain, acute and progressive abdominal sepsis
  • Poor response to treatment for sepsis; patient exhibited rapid decline, became gravely ill
  • CT scan revealed massive hepatic abscesses (Figure):
    • Bilateral
    • Multi-loculated
    • Solid necrotic debris
  • Placement of two 24F multipurpose drains and one 28F drain.
  • Repeat catheter exchanges and lavage protocols, limited progress in removal of necrosis
  • For left hepatic abscess, replaced 28F drain with 9mm flexible endoscope:
    • EUS-guided use of floppy endoscopic snare to removal of solid necrotic debris
    • High-volume saline lavage
    • Drain replacement
    • Repeated procedure for right hepatic abscess
  • Marked patient improvement; discharge
  • Four procedures performed over ten days with full recovery by week ten
  • Ongoing oral antibiotic treatment

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