[Pyogenic liver abscess in chronic alcoholic pancreatitis].
METHODS
A 44-year-old patient was transferred for further treatment of pyogenic liver abscess and a severe attack of a chronic pancreatitis for strong upper right quadrant abdominal pain and recurring fever.


METHODS
Laboratory results revealed a significant inflammatory constellation. Abdominal ultrasound was performed which showed a big pyogenic abscess in the right lobe of the liver. Escherichia coli and Enterococcus faecalis could be isolated from abscess aspirates. Endoscopic retrograde cholangiography (ERC) without access of the pancreatic duct showed stenosis of the Ductus hepatocholedochus which was treated with a biliary endoprothesis.


METHODS
Antibiotic treatment and percutaneous drainage led to complete remission of the abscess. A few days after discharge the patient returned with identical clinical symptoms. Abdominal ultrasound showed recurrence of the abscess. Because of excessively high pancreatic amylase in aspirated abscess material the patient underwent endoscopic retrograde cholangiopancreaticography (ERCP). There, a pancreatico-hepatic fistula was seen, probably the result of necrosis caused by a severe acute attack of the chronic pancreatitis. After insertion of a naso-fistular drainage, continous rinse and appropriate antibiotic therapy both abscess and fistula completely disappeared without recurrence.


CONCLUSIONS
The rare case of a pancreatic fistula should be considered when a pyogenic liver abscess follows an episode of acute pancreatitis or attack of chronic pancreatitis. Determination of pancreatic amylase in aspired abscess material can be an important step towards correct diagnosis.
Medizinische Klinik und Poliklinik II, Universität Leipzig. Felix.Gundling@GMX.de
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Gundling
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Secknus
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Tröltzsch
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Borte
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Mössner
D000328:Adult; D000681:Amylases / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D016154:Digestive System Fistula / Q000150:complications / Q000175:diagnosis*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000209:etiology / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000382:microbiology; D006801:Humans; D008100:Liver Abscess / Q000201:enzymology / Q000209:etiology* / Q000382:microbiology; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis*; D008297:Male; D010185:Pancreatic Fistula / Q000150:complications / Q000175:diagnosis*; D019512:Pancreatitis, Alcoholic / Q000150:complications*; D012008:Recurrence
D000681:Amylases