Idiopathic Abscess of the Hepatic Round Ligament Developed during Chemotherapy was Successfully Treated with Surgery—A Case Report—

Abstract

A 74-year-old man undergoing chemotherapy for left ureteral cancer presented to our hospital with epigastric pain. Blood tests showed elevated inflammatory response, biliary enzymes and bilirubin, and a plain computed tomography scan showed dilatation of the umbilical cord, enlargement and internal abscess formation along the entire length of the hepatic round ligament. Although conservative treatment was initially chosen, surgery was subsequently performed due to prolonged inflammatory reaction and exacerbation of the abscess on CT. We resected the inflammatory thickened round ligament of the liver, suture closed the umbilical cord disconnection, and placed drains in the abdominal cavity. Bacteriological examination of the abscess revealed Klebsiella pneumoniae. Histopathological examination showed thickening of the umbilical vein wall, lumen obstruction, and inflammatory cell infiltration into the surrounding fatty tissue. Though the patient suffered from postoperative paralytic ileus, he was discharged on the 31st postoperative day without recurrence of the abscess. A round ligament of liver abscess is a remarkably rare cause of acute abdomen. This case of the disease developed during chemotherapy is valuable as no case has been reported in the past.