title: Inferior vena caval thrombosis complicating pyogenic liver abscess after pancreatoduodenectomy: a case report.
abstract: Pyogenic liver abscess (PLA) complicated by inferior vena caval (IVC) thrombosis is rare but life-threatening. We experienced a case of PLA complicated by an IVC thrombus close to the right atrium after pancreatoduodenectomy. A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years prior, and no recurrence was noted on follow-up. He was admitted to our hospital owing to fever and general fatigue. PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated. His general condition gradually improved, but a thrombus in the middle hepatic vein and IVC was noted on follow-up computed tomography on hospital day 8. Although anticoagulant therapy using heparin was started, the thrombus size increase and extended to the right atrium. Considering the risk of pulmonary embolism, we planned a surgical intervention with a cardiovascular surgeon to remove the thrombus. During surgery, we made an incision in the right atrium and removed the thrombus using extracorporeal circulation. After removal, we dissected the middle hepatic vein using an automated suturing device to prevent the thrombus from extending into the IVC. The patient was discharged 10 weeks after surgery. Eighteen months post-intervention, there was no recurrence of either PLA or thrombi. Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.
authors.affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan ; Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Kubo
authors.affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Taniguchi
authors.affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Shimomura
authors.affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nanishi
authors.affiliation: Department of Respiratory Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ueshima
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Hommachi, Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shioaki
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto-shi, Kyoto, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
keywords: Inferior vena caval thrombosis; Pyogenic liver abscess; Thrombectomy