DICを併発した治療抵抗性クレブシエラ肝膿瘍に対してダメージコントロール戦略を用いて救命した1例(A case of treatment–resistant Klebsiella liver abscess with DIC saved by a damage control strategy)

• Published in: Nihon Kyūkyū Igakkai zasshi 2022-02, Vol.33 (2), p.68-73
• Main Authors: (Keita Sato), 佐藤 啓太, (Koji Takahashi), 高橋 幸二, (Yoshihisa Tamura), 田村 佳久, (Yosuke Yamauchi), 山内 洋介, (Tsukasa Kusuta), 楠田 司
• Format: Article
• Language: English
• Subjects: damage control operation; hepatectomy; sepsis; パッキング; 敗血症; 肝切除
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12683

要旨 Hypermucoviscosity phenotype of Klebsiella pneumonia（以下，HKp）による肝膿瘍は，組織侵襲性が強く，全身の多発感染が特徴である。このため，敗血症を生じて多臓器不全や凝固障害を併発する 1)。内科的治療で奏功しない症例では感染コントロールのための外科手術が選択される。本症例ではHKpによる肝膿瘍に対して経皮経肝ドレナージを行ったが，出血性ショックに陥った。内科的治療抵抗性のHKp肝膿瘍は，DIC合併や多臓器不全状態での手術になりうるため，初回手術で止血と感染制御のみを行い，肝離断を二期的に行うダメージコントロール戦略を考慮すべきである。 ABSTRACT Liver abscess caused by the hypermucoviscosity phenotype of Klebsiella pneumonia is characterized by tissue invasiveness and multiple systemic infections. For this reason, multiple organ failure occasionally occurs as a result of sepsis and disseminated intravascular coagulation (DIC). Hepatectomy is selected for infection control in cases for which the patient does not respond to drainage. In this case, percutaneous transhepatic drainage was performed for liver abscess, but it caused intra–abdominal hemorrhage. Because the septic shock was already accompanied by DIC and because the patient was bleeding, a damage control strategy was implemented and radical resection was performed in two stages. We report this case as one that is suggestive of liver abscess caused by the hypermucoviscosity phenotype of Klebsiella pneumonia and it should be used as guidance for the treatment policy for this condition.