BackgroundIn Lemierre’s syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre’s syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease.Case presentationA 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre’s syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient’s condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital.ConclusionWith the widespread use of antibiotics, Lemierre’s syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.

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: A 52-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension in July 2011. She had myasthenia gravis, but did not have any surgical history. Clinical examination showed a right lower abdominal mass, abdominal distension, decreased bowel sounds, and rebound tenderness in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A gastrografin enema image of the colon showed a 30-mm filling defect in the ascending colon. The patient underwent resection of the intussuscepted intestine by single-incision laparoscopic surgery SILS . The resected specimen contained a round tumor measuring 35 35 20 mm, which was diagnosed histopathologically as lipoma of the terminal ileum. The patient remains asymptomatic eight months after surgery.

A 44-year-old woman with a 10-year history of anemia presented to our hospital with anemia. At the Emergency Room, her initial hemoglobin and hematocrit levels were 10.9 g/dL and 33.4 %, respectively. A gastroscopy and contrast-enhanced computed tomographic scan of the abdomen did not identify any bleeding site. A colonoscopy showed a Meckelʼs diverticulum (MD) with an ulcer, at about 60 cm proximal to the ileocecal junction on the antimesenteric side, and few blood clots in the terminal ileum. Therefore, we performed a diagnostic and therapeutic single-incision laparoscopic surgery (SILS). The diverticulum was resected using a gastrointestinal anastomosis stapler, without requiring small bowel resection. Histopathological examination revealed MD with ectopic gastric tissue. The patient was discharged on postoperative day 7 without any complications. We report our initial experience from Japan with one patient who underwent SILS for MD.

A 25-year-old woman presented to the hospital with omphalitis. A physical examination revealed a poorly defined mass 3 cm in diameter without tenderness under her umbilicus. A contrast-enhanced computed tomography scan revealed an abscess cavity under the anterior abdominal wall and umbilicus. After conservative treatment with antibiotics and drainage, we performed laparoscopic resection of umbilical urachal remnant including some of the indurated surrounding tissues under pneumoperitoneum using a 3-port method. Histological examination revealed an urachal remnant with inflammation. The patient was discharged on postoperative day 7 without any complications.In this case, the patient was successfully treated with laparoscopic resection of the umbilical urachal remnant, and no evidence of local recurrence was observed during the follow-up period.