A 55-year-old woman with a past history of diabetes was admitted to the Kanazawa National Hospital complaining of high fever, general malaise, and disturbance of consciousness. The findings of ultrasonography and X-CT scan showed a gas-producing pyogenic abscess approximately 12cm in diameter in the right lobe of the liver. Immediately after diagnosis, percutaneous transhepatic abscess drainage was performed under ultrasonographic guidance. Klebsiella was detected by culture of drained pus. The findings of laboratory examinations showed dehydration, septic shock, and disseminated intravascular coagulation. Abscess drainage was effective, however, a granulomatous liver abscess was detected by X-CT and MRI in spite of the reduction of the abscess cavity. On hospital day 68, the patient underwent partial hepatectomy of segment 7 and 8, because it seemed unlikely that the abscess would heal completely by drainage alone. Thereafter, the patient recovered uneventfully and has been leading a healthy life without recurrence. Hepatic resection after adequate drainage is considered an effective procedure for cases of intractable pyogenic liver abscess.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)