A Case of Liver Abscess after Severe Acute Pancreatitis Treated Successfully with Endoscopic Nasobiliary Drainage

Abstract

A 76-year-old woman was admitted to our hospital for severe acute biliary pancreatitis. The patient was evaluated as“severe”according to the severity criteria of the Japanese Ministry of Health and Welfare Study Group. The patient was treated by continuous regional arterial infusion using nafamostat mesilate and imipenem for 7 days. Symptoms of pancreastitis improved but high fever appeared on 15th hospital day. Liver abscess was suspected on the findings of the abdominal computed tomography. Antibiotic was intravenously administered but fever persisted. We judged that the patient has a indication of percutaneous abscess drainage, but we could not performed this because of bleeding tendency of idiopathic thrombocytopenic purpura. We performed endoscopic naso-biliary drainage (ENBD) for treatment of liver abscess. Endoscopic retrograde cholangiography visualized the dilated bile duct and connection between this duct and the liver abscess. A 7.5Fr. ENBD tube was placed in the abscess through the dilated bile duct. The clinical symptoms improved dramatically. Our experience suggests that ENBD is one of the effective treatment for liver abscess after biliary tract infection.