Clostridium perfringens liver abscess after pancreatic resection.
BACKGROUND
Liver abscess is a rare complication after pancreatectomy. Clostridium perfingens is a rare cause of intrahepatic infections.


METHODS
A 65-year-old woman with pancreatic cancer underwent explorative laparotomy, during which encasement of the hepatic artery by the tumor was found. Neoadjuvant radiochemotherapy with capecitabine was started, which caused tumor regression, and duodenopancreatectomy was performed. The portal vein was occluded and infiltrated by cancer and therefore was resected and not reconstructed. After a slow recovery, the patient developed hemorrhage at the gastrojejunal anastomosis, which was controlled by fibrin injection. Within a few days, she presented with signs of sepsis, and blood cultures yielded Clostridium perfringens, Streptococcus oralis, Staphylococcus aureus, and Candida albicans. The source of the sepsis proved to be a 9-cm liver abscess, which was drained; cultures grew C. perfringens, Hafnia alvei, and Enterobacter cloacae. Despite antibiotic treatment, the patient died from sepsis and multiorgan failure 27 days after pancreatic surgery.


CONCLUSIONS
Such rare infections can follow pancreatic resection with neoadjuvant radiochemotherapy. Clostridium perfringens-associated liver abscess maintains a high mortality rate.
Tabarelli
Walther
W
Bonatti
Hugo
H
Cejna
Manfred
M
Hartmann
Gabriele
G
Stelzmueller
Ingrid
I
Wenzl
Etienne
E
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008100:Liver Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000078142:Tazobactam
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin