title: [Septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage].
abstract: We report a case of septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage (PTAD). A 70-year-old male patient was admitted to our outpatient department of internal medicine with general fatigue, dullness of bilateral shoulders and extremities, appetite loss, weight loss, headache, and vertigo. Laboratory tests showed severe inflammatory indications, anemia, and high values of hepatobiliary enzymes and blood sugar. Abdominal ultrasonography and enhanced CT showed a pyogenic liver abscess of 10 cm in diameter at S 6-7 in the right hepatic lobe. The patient's condition deteriorated suddenly that night. From the results of abdominal ultrasonography and enhanced CT, we made diagnosis of septic shock associated with pyogenic liver abscess. Emergency abdominal ultrasound-guided PTAD was performed under local anesthetic. Postoperatively, the antibiotic was infused daily through a PTAD tube into the liver abscess space. He recovered and his laboratory tests improved gradually. On abdominal ultrasonography and enhanced CT, the liver abscess disappeared by 19th postoperative day, and PTAD tube was removed. There was no complication during PTAD treatment. We conclude that patients in septic shock should undergo further examinations immediately and treatment of the infected tissue should be started as soon as possible. PTAD may be an additional effective procedure for pyogenic liver abscess in septic shock. Furthermore, local antibiotic lavage through a PTAD tube into the liver abscess space may be an important supplementary method in the management of the illness.
authors.affiliation: Department of Anesthesia, JT Tokyo Senbai Hospital, Tokyo 108-8329.
authors.forename: Ju
authors.initials: J
authors.lastname: Mizuno
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tsujikawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Wakuta
authors.forename: Michiko
authors.initials: M
authors.lastname: Matsuki
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Morita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Gouda
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D002404:Catheterization / Q000379:methods*; D004322:Drainage / Q000379:methods*; D006801:Humans; D008100:Liver Abscess / Q000150:complications* / Q000601:surgery*; D008297:Male; D012772:Shock, Septic / Q000209:etiology*; D013492:Suppuration; D016896:Treatment Outcome