Backgrounds/AimsGas-forming pyogenic liver abscess (GFPLA) has an incidence of up to 30% of all pyogenic liver abscesses (PLA). GFPLA has higher mortality compared to non-GFPLA. Mere presence of gas within abscess may not determine clinical outcome. Hence it is important to study biologic characteristics that make GFPLA a distinct clinical entity. The aim of this study was to conduct a world review on GFPLA.MethodsWe conducted literature searches in PubMed using the following MeSH terms: “gas forming” AND “Liver abscess, pyogenic”, “gas” AND “Liver abscess, pyogenic”, “gas” AND “Liver abscess”, “gas forming” AND “Liver abscess”. Thirteen case series including 313 GFPLA patients were included. Age, gender, diabetes mellitus (DM), bacteriology, underlying etiology, symptoms, investigations, operative indications, and mortality rates were tabulated.ResultsGFPLA is often cryptogenic. There was no difference in age, gender, or symptomatology between GFPLA and non-GFPLA patients. DM was more common in patients with GFPLA compared to that in non-GFPLA patients (mean: 83.5% vs. 38.3%). Klebsiella pneumoniae is the most common causative pathogen. GFPLA has higher mortality compared to non-GFPLA (mean: 30.3% vs. 9%).ConclusionsGFPLA is associated with DM and monomicrobial Klebsiella pneumoniae infection. GFPLA has high mortality. It needs to be recognized as a distinct clinical entity.

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The boundary between the anterior and posterior segments is not always a plain along RHV. It was presumed that intraoperative color change and RHV could not accurately indicate the boundaries of left hepatic trisectionectomy. Methods: After the treatment of hilar portal vein, 0.25 mg ICG was intravenously administered prior to the parenchymal resection. It was possible to confirm the liver parenchyma where blood flow remained by the ICG camera. Even when the condition of the liver surface was poor such as after PTCD or PVE, the planned incision line was described accurately. Conclusion: By using the ICG fluorescence method, it was easy to recognize the posterior section that remaining blood flow, and the left hepatic trisectionectomy was completed more safely.

Extravasation injury is a well-known complication of central venous catheter placement, with potential for extensive soft tissue necrosis. Here, we describe the case of a patient who developed a large right chest well soft tissue defect, due to a chest wall abscess from calcium gluconate infusion via a right internal jugular central venous catheter. After multiple debridements, the chest wall defect was reconstructed with a single stage ipsilateral pectoralis major turnover flap, rhomboid skin flap, and inferior nipple transposition to match the contralateral nipple. There was no further infection, no nipple necrosis, and patient regained full range of motion of the ipsilateral shoulder.