title: Multimicrobial sepsis including Clostridium perfringens after chemoembolization of a single liver metastasis from common bile duct cancer.
abstract: A 65-year-old woman underwent resection of a distal common bile duct carcinoma (Whipple's procedure). Twelve months later a single hepatic metastasis was detected and a chemoembolization was performed. Immediately after chemoembolization the patient developed a multimicrobial sepsis including Clostridium perfringens. CT scans depicted pathognomonic signs of gas-containing abscess in the necrotic liver metastasis. She was subsequently treated with broad-spectrum antibiotics, abscess drainage and hyperbaric oxygen therapy. We conclude that antibiotic prophylaxis is recommendable for chemoembolization of liver metastasis in patients with risk factors like intestinal biliary reflux (bilioenteric anastomosis or papillotomy and biliary stenting) and bile duct cancer, otherwise severe sepsis including clostridium bacteremia may occur.
authors.affiliation: Department of Medicine II, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. florian.eckel@lrz.tum.de
authors.forename: F
authors.initials: F
authors.lastname: Eckel
authors.forename: C
authors.initials: C
authors.lastname: Lersch
authors.forename: W
authors.initials: W
authors.lastname: Huber
authors.forename: W
authors.initials: W
authors.lastname: Weiss
authors.forename: H
authors.initials: H
authors.lastname: Berger
authors.forename: E
authors.initials: E
authors.lastname: Schulte-Frohlinde
mesh_terms: D000368:Aged; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003015:Clostridium Infections / Q000209:etiology* / Q000382:microbiology; D003016:Clostridium perfringens / Q000302:isolation & purification*; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000209:etiology / Q000382:microbiology; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D009336:Necrosis; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology; D014057:Tomography, X-Ray Computed