title: Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome.
abstract: BACKGROUND
  Pancreaticoduodenectomy (PD) remains a challenging operation with a 40% postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD.
  
  
  METHODS
  We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994-January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6%) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD.
  
  
  RESULTS
  PLA occurred in 2.6% (22/839) of patients following PD, with 13 patients (59.1%) having a solitary abscess and 9 (40.9%) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2%) or antibiotics alone (N = 7, 31.8%) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14%) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0%, p = 0.014) or who required reoperation (18.2 vs. 1.5%, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74%), 2-year (50 vs. 57%), and 3-year (38 vs. 33%) survival rates and hepatic function between patients with PLA and matched controls.
  
  
  CONCLUSIONS
  Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86% of patients with no adverse effects on long-term hepatic function or survival.
authors: Department of Surgery and Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Victor C
authors: VC
authors: Njoku
authors: Thomas J
authors: TJ
authors: Howard
authors: Changyu
authors: C
authors: Shen
authors: Nicholas J
authors: NJ
authors: Zyromski
authors: C Max
authors: CM
authors: Schmidt
authors: Henry A
authors: HA
authors: Pitt
authors: Attila
authors: A
authors: Nakeeb
authors: Keith D
authors: KD
authors: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001658:Biliary Fistula / Q000209:etiology*; D016022:Case-Control Studies; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D046290:Liver Abscess, Pyogenic / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents