Pyogenic liver abscess related to intrahepatic bile duct stones: Difficulties in infectious control and diagnosis of concomitant cholangiocarcinoma

• Published in: Journal of gastroenterology and hepatology 2018-05, Vol.33 (5), p.1092-1099
• Main Authors: Shi, Shao‐hua, Feng, Xiao‐ning, Wang, Zhuo‐yi, Sun, Ke, Xu, Jing‐feng, Kong, Hai‐shen, Zheng, Shu‐sen
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asia, Southeastern - epidemiology; Bacteremia; Bile; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - epidemiology; Bile Duct Neoplasms - etiology; Bile ducts; Bile Ducts, Intrahepatic; Biopsy; Case-Control Studies; cholangicarcinoma; Cholangiocarcinoma; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - epidemiology; Cholangiocarcinoma - etiology; Cholangitis; Cholelithiasis - complications; Comorbidity; Diagnosis; Diagnosis, Differential; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - etiology; Escherichia coli Infections - epidemiology; Escherichia coli Infections - etiology; Female; Humans; imaging manifestations; Incidence; Inflammation; intrahepatic bile ducts stone; Liver; Liver Abscess, Pyogenic - diagnosis; Liver Abscess, Pyogenic - diagnostic imaging; Liver Abscess, Pyogenic - epidemiology; Liver Abscess, Pyogenic - etiology; Male; Middle Aged; pyrogenic liver abscess; recurrence; Surgery
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.14010

Background and Aim Cholangitis, bacteremia, and pyogenic liver abscess (PLA) can be often caused by intrahepatic bile ducts stone (IBDS), which is endemic to South‐East Asia. The association between IBDS and cholangiocarcinoma has been well recognized. Concomitant cholangiocarcinoma in the PLA related to IBDS is often missed. Methods A case–control study consisting of 64 patients with PLA related to IBDS and 256 control patients with PLA not related to IBDS was used to investigate clinical features of PLA and incidence of concomitant cholangiocarcinoma in patients with PLA related to IBDS. Results The main imaging manifestations of PLA related to IBDS was cystic‐solid lesions and solid lesions. Of seven patients (10.9%) with pathology‐proven cholangiocarcinoma in the same area of PLA related to IBDS among 64 patients, only two patients were initially diagnosed as having concomitant cholangiocarcinoma by biopsy, and other five patients diagnosed as acute inflammatory lesion. Within 60 days after onset, the infection‐related death rate and recurrence rate in patients with PLA related to IBDS were 12.9% and 20.3%, respectively, whereas in patients with PLA not related to IBDS were 3.9% and 3.1%, respectively. Only 25% of patients with PLA related to IBDS underwent surgery after admission. The main pathogens in PLA patients related to IBDS were Escherichia coli and extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Conclusions The imaging manifestations of PLA related to IBDS often present cystic‐solid or solid lesions. PLA related to IBDS is characterized by high rate of recurrence and infection‐related death, difficulty in diagnosis of concomitant cholangicarcinoma.