Absceso hepático gigante. Tratamiento quirúrgico primario

A 77-year-old patient with hepatorenal polycystic disease and chronic renal failure on hemodialysis came to our emergency department due to abdominal pain in the right upper quadrant. The symptoms had been developing over the previous week, including a fever of 39 8C with localized pain and tenderness in the right upper quadrant. Palpation revealed a large mass that occupied the entire right hemi-abdomen. Blood work-up and biochemistry showed leukocytosis 21 10/L with neutrophilia 9.7 10/L, anemia Hb 8.7 g/dL, no alteration in liver function tests (GPT 10 U/L; GGT 25 U/L; GOT 21 U/L; Bb 0.6 mg/dl), and procalcitonin 7.37 ng/mL. Abdominal CT showed evidence of multiple cystic formations, the largest measuring 20 cm in the right hepatic lobe, very heterogeneous, with multiple septa and dense areas that showed no uptake of contrast (Fig. 1). The patient underwent emergency surgery to drain the multiple liver abscesses (culture positive for Escherichia coli) and cholecystectomy was performed. The patient had a postoperative biliary fistula that was resolved endoscopically with the placement of an endoprosthesis. c i r e s p . 2 0 1 3 ; 9 1 ( 8 ) : e 4 7