Background and Aim A pyogenic liver abscess (PLA) is an infectious disease with high in‐hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Ultrasound is commonly used to detect PLA lesions of PLA, but its sensitivity can be affected by lesion size, location, and clinician experience. Therefore, early diagnosis and prompt treatment (especially abscess drainage) are crucial for better patient outcomes and should be prioritized by clinical physicians. Methods We conducted a retrospective study to compare the effect of early and late (i.e., receiving CT scanning within 48 h and >48 h after admission) adoption of nonenhanced computed tomography (CT) scanning regarding the hospitalization days and interval between admission and drainage of patients with PLA. Results This study included 76 hospitalized patients with PLA in the Department of Digestive Disease of Xiamen Chang Gung Hospital in China who underwent CT examinations from 2014 to 2021. We conducted CT scans on 56 patients within 48 h of admission and on 20 patients more than 48 h after admission. The early CT group had a significantly shorter hospitalization length compared with the late CT group (15.0 days vs. 20.5 days; P = 0.035). Besides, the median time to initiate drainage after admission was also significantly shorter in the early CT group than in the late CT group (1.0 days vs. 4.5 days; P < 0.001). Conclusion Early CT scanning within 48 h of admission may aid in early PLA diagnosis and benefit disease recovery, as revealed by our findings.

BACKGROUND: Haemorrhage of pancreas is a rare cause of upper gastrointestinal bleeding, and currently there is no clinical satisfactory treatment for this disorder. OBIECTIVE: The present study envisaged to treat the haemorrhage of pancreas caused by pseudoaneurysm rupture using interventional super-selective coil impregnation therapy, so as to achieve a better treatment efficacy. METHODS: Six cases presenting haemorrhage of pancreas were employed for the study, including 5 cases caused by splenic artery pseudoaneurysm and 1 case caused by superior pancreatic artery pseudoaneurysm. In all 6 patients the femoral artery was punctured using Seldinger femoral artery puncture and intubation technique. Subsequently, a catheter was inserted into the abdominal trunk and the contrast medium was injected, and the pseudoaneurysm was developed. A coil was then inserted into the distal end and proximal end of the pseudoaneurysm, respectively, leading to the elimination of the pseudoaneurysm. RESULTS: All 6 patients with pancreatic haemorrhage were implanted with coil at the distal and proximal end of the aneurysm, until the aneurysm disappeared during intraoperative angiography. Further, clinical symptoms such as abdominal pain, melena and hematemesis disappeared after the operation. No recurrence of the symptoms was observed in the studied population. CONCLUSION: A 100% treatment outcome can be achieved in patients with pseudoaneurysm-induced haemorrhage of pancreas using interventional super-selective coil embolization.

Patient: Male, 68-year-old Final Diagnosis: Bronchobiliary Fistula • hepatocellular carcinoma • liver abscess Symptoms: Biliptysis • cough • fever Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual or unexpected effect of treatment Background: Bronchobiliary fistulas (BBFs) are abnormal communications between the biliary tract and bronchial tree. Transcatheter arterial chemoembolization (TACE) is a widely employed treatment for advanced hepatocellular carcinoma (HCC). While TACE is generally considered safe, there have been reports of severe complications. This case report is about a 68-year-old man who developed a BBF 6 months after undergoing TACE for HCC. Case Report: A 68-year-old man was diagnosed with HCC and underwent TACE at a local medical department. Two months after TACE, he presented with a liver abscess, which was drained and catheterized. Subsequently, the patient was transferred to our hospital. Initial MRI revealed abscesses in the right hepatic lobe extending into the lung cavity. Intrahepatic catheter replacement was performed. Six months after TACE, the patient developed cough and yellow sputum. Subsequent MRI confirmed smaller lung and liver abscesses, along with a BBF. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter replacement were conducted, closing the BBF with a covered stent. Despite drainage, antibiotics, and nutritional support, the patient’s condition deteriorated. Transition to hospice care was initiated, and the patient died due to sepsis and multiple organ failure. Conclusions: This case highlights the importance of obtaining a comprehensive patient history when a patient has bile in the sputum, and discusses the rare but previously reported BBF as a complication of TACE for HCC. The presence of bile collections in the lungs and liver can result in tissue necrosis, potentially leading to chronic infection, emphasizing the need for early diagnosis and management.

Pyogenic liver abscess (PLA) is an infectious disease and causes high in-hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Therefore, early diagnosis is an urgent need for clinicians. Ultrasound has been widely used to detect lesions of PLA. However, the sensitivity of ultrasound is affected by the size and location of lesions and clinician’s experience. We conducted a retrospective study to assess the effects of early adoption of non-enhanced computed tomography (CT) scanning (i.e., receiving CT scanning within 48 hours after admission) on treatment and disease status of patients with PLA. This study enrolled 76 hospitalized patients with PLA in department of digestive disease, who received CT examination during 2014 to 2021. Of the enrolled patients, 56 received an early CT scan and 20 received a late CT scan. Results showed that the length of hospitalization in the early CT group was significantly shorter than the late CT group (15.0 days vs. 20.5 days; p = 0.035). Besides, the median time to initiating drainage after admission was also significantly shorter in the early CT group than the late CT group (1.0 days vs. 4.5 days; p < 0.001). The early CT group was also associated with significantly lower prescription rates of antibiotics. Our findings revealed that to conduct early CT scanning within 48 hours of admission may assist in early diagnosis of PLA and be beneficial to disease recovery.