1/10. The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
2/10. Hepatic abscess as a complication of the sump syndrome.We report a case of hepatic abscess associated with the sump syndrome. The patient was a 66-year-old woman who had undergone cholecystectomy and side-to-side choledochoduodenostomy for a common bile duct (CBD) stone in 1983, and who presented with fever and right lower chest pain. A hepatic abscess was diagnosed; after it was drained, percutaneous transhepatic biliary drainage was performed. Bacteriological studies revealed the presence of bacteroides fragilis and streptococcus intermedius in the pus in the hepatic abscess cavity, and klebsiella pneumoniae and pseudomonas aeruginosa in the bile. The hepatic abscess and cholangitis rapidly resolved in response to two drainage procedures. At surgery, simple closure of the anastomosis was performed, because free drainage was observed from the distal CBD into the duodenum, despite the existence of a periampullary diverticulum.- - - - - - - - - - ranking = 78.360107387947keywords = sump syndrome, sump (Clic here for more details about this article) |
3/10. Yoghurt consumption and damaged colonic mucosa: a case of lactococcus lactis liver abscess in an immunocompetent patient.lactococcus lactis is an uncommon cause of invasive disease in humans. We present a case of L. lactis liver abscess in an immunocompetent adult, apparently related to consumption of live culture yoghurt.- - - - - - - - - - ranking = 5keywords = sump (Clic here for more details about this article) |
4/10. A fatal pseudo-tumour: disseminated basidiobolomycosis.BACKGROUND: Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum, member of the class Zygomycetes, order entomophthorales, found worldwide. Usually basidiobolomycosis is a subcutaneous infection but rarely gastrointestinal manifestations have been described; 13 adults and 10 children and a few retroperitoneal or pulmonary cases. In gastrointestinal basidiobolomycosis the colon is most frequently involved, usually presenting with subacute mild abdominal pain. In contrast to children only very few described adult patients had hepatic masses. Definitive diagnosis requires culture, serological testing can be helpful. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features. There are no prominent risk factors. Usually surgery and prolonged antifungal therapy are required. CASE PRESENTATION: A 61 year old man presented with progressive left abdominal pain and constipation since a few months. colonoscopy showed an obstructing tumour in the descending colon, and a hemicolectomy was performed. histology showed inflammation, possibly caused by a fungal or parasitic infection, without definite identification of an organism. A few weeks postoperatively a CT scan made because of abdominal discomfort, revealed a livermass (6 cm). Treatment with metronidazole, directed against an amoebic liver abscess, was unsuccessful. He developed a marked eosinophilia (27.7%). A liver biopsy was performed and the patient was referred to a university hospital.A repeated CT scan showed a livermass of 9 cm diameter. review of colon and liver biopsy samples showed extensive necrosis and histiocytes, multinucleated giant cells and numerous eosinophils. Grocott stained sections contained unusually large hyphae surrounded by strongly eosinophilic material in haematoxylin and eosin stained sections (Splendore-Hoeppli phenomenon). A presumptive diagnosis of Basidiobolus spp. infection was made and treated with amphotericin b (Itraconazol contra-indicated because of renal insufficiency). A few days later the patient died of a septic shock. After autopsy Basidiobolus ranarum was cultured from liver, gallbladder and colon. CONCLUSION: Our patient died of gastrointestinal basidiobolomycosis with an obstructing colon tumour and a large hepatic mass. This was a rare presentation of basidiobolomycosis and the second fatal case described worldwide.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
5/10. "Spontaneous sump syndrome": Successful treatment by duodenoscopic sphincterotomy."Sump syndrome" is a rare complication of side-to-side choledochoenterostomy operations which develops in the distal, nonfunctioning limb of the common bile duct where lithogenic bile, gastrointestinal contents, and debris accumulate. We report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula, and who presented with multiple pyogenic liver abscesses. The patient's symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics. This case demonstrates that sump syndrome may occur spontaneously, that it can be a cause for pyogenic liver abscess formation, and that it may be treated effectively by endoscopic sphincterotomy.- - - - - - - - - - ranking = 94.032128865537keywords = sump syndrome, sump (Clic here for more details about this article) |
6/10. Post-choledochoenterostomy 'sump syndrome'.The 'sump syndrome' is an uncommon, late complication of a side-to-side choledochoenterostomy. Five patients with this syndrome were encountered over a 5-year period. Pain or cholangitis was the clinical presentation in four patients, whereas one patient presented with secondary septic arthritis and a hepatic abscess. liver function tests were mildly abnormal in each patient. All patients had a stomal size of less than 1 cm as assessed by forward- or side-viewing endoscopy. Endoscopic retrograde cholangiography revealed either stones or debris in the distal common bile ducts of all patients. Four patients had a surgical clearance of their duct with concurrent closure of the choledochoduodenostomy in three patients and the creation of a Rouxen-Y end-to-side choledochojejunostomy in the fourth patient. The other patient had an endoscopic sphincterotomy performed. After 1-4 years of follow-up, four patients have had a total resolution of symptoms. The other patient with follow-up for 4 years has had one episode of cholangitis which resolved rapidly with antibiotic treatment. The pathogenesis and clinical spectrum of the sump syndrome are reviewed and current management strategies are discussed.- - - - - - - - - - ranking = 94.032128865537keywords = sump syndrome, sump (Clic here for more details about this article) |
7/10. Hepatic abscesses as a complication of the sump syndrome: combined surgical and endoscopic therapy. Case report and review of the literature.The "sump syndrome" is an unusual complication of side-to-side choledochoduodenostomy in which the portion of the common bile duct distal to the anastamosis acts as a sump and may collect bile, stones, food, and other debris. Partial or complete obstruction of the stoma and resultant bacterial proliferation may result and lead to recurrent cholangitis or pancreatitis. A single hepatic abscess as a complication of the sump syndrome has been reported only once. We have recently seen a patient presenting with multiple hepatic abscesses as a complication of the sump syndrome. This is the first report of endoscopic treatment of this syndrome associated with a hepatic abscess. The literature on the endoscopic approach to this problem will be reviewed.- - - - - - - - - - ranking = 110.70415034313keywords = sump syndrome, sump (Clic here for more details about this article) |
8/10. Benign liver nodules presenting as apparent hepatic metastases: a report of 5 cases.Five cases are described in which hepatic nodules discovered as an incidental finding at laparotomy performed for other reasons were thought to be metastatic tumour. In each case histology and clinical course proved this assumption to be incorrect. It is emphasized that biopsy is mandatory in such circumstances to establish the diagnosis. Where the nature of the hepatic lesion might affect the choice of operative procedure frozen section examination should be performed at the time of surgery. Bacteriological culture may also be helpful.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
9/10. Multiple hepatic abscesses due to yersinia enterocolitica.We report a case of multiple hepatic abscesses due to yersinia enterocolitica in a 58 yr old male. This case is typical of the other 39 cases reported in the literature in that the patient had alcoholism, malnutrition, iron overload and a subsequently diagnosed malignancy. Ultrasound showed multiple hypoechoic areas in the liver which were confirmed by CT scan. The patient also had a rectal lesion initially thought to be malignant, leading to a presumptive diagnosis of metastatic disease. A CT-guided fine needle aspiration biopsy of a liver lesion unexpectedly revealed pus which subsequently grew yersinia enterocolitica. The organism was also isolated from the patient's blood and feces. This case illustrates the need for histological microbiological investigation of radiologically diagnosed presumptive malignancy.- - - - - - - - - - ranking = 2keywords = sump (Clic here for more details about this article) |
10/10. What appears to be cancer.We describe a case of multiple hepatic pyogenic abscesses with an unusual presentation. The typical signs and symptoms of fever and pain in the right upper quadrant were absent. Instead, the chief complaint was muscle weakness and myalgias accompanied by weight loss. Findings from an ultrasonogram of the abdomen revealed multiple hepatic lesions consistent with metastases. Hence, the initial presumptive diagnosis was metastatic malignancy with unknown primary tumor. It was only when purulent material was unexpectedly encountered when a needle biopsy was performed that the true diagnosis of pyogenic liver abscess was recognized. While liver abscess is rare, it should not be forgotten in the differential diagnosis for multiple hepatic lesions seen on imaging studies.- - - - - - - - - - ranking = 1keywords = sump (Clic here for more details about this article) |
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