Pyogenic liver abscess, polycystic pocket and chronic renal failure

Abstract

Pyogenic liver abscess usually has a serious clinical course. Occasionally the diagnosis is late and the mortality is high. This study presents the case of a 45-year-old male patient with chronic renal failure, with hemodialysis rejection, operated on nine 9 months before for a subhepatic abscess. The patient presented to the department of surgery of the "Guillermo Domínguez López" Hospital of Puerto Padre, Las Tunas, complaining of intense abdominal pain in the right hypochondrium and flank, fever of 38,5 degrees Celsius, polypnea, marked asthenia and nausea. Physical examination and investigations were performed. Very high creatinine levels, serious HTN and severe anemia were confirmed, as well as evident elements of a systemic inflammatory response and a tumor that occupied almost the entire right lobe of the liver, apparently coexisting with a retroperitoneal pocket. The patient was transferred to the intensive care unit, improving his general condition, including hemodialysis and percutaneous drainage of the liver abscess with 3200 mL of purulent content. Four hours later an exploratory laparotomy was performed with right nephrectomy and lavage of the abdominal cavity and retroperitoneum. The postoperative progress was satisfactory and the patient was discharged ten days later. Follow-up has been maintained through outpatient surgery and nephrology consultation, with scheduled hemodialysis and there has not been clinical evidence of abscess recurrence.