Abscess of ligamentum teres hepatis post-endoscopic retrograde cholangiopancreatography: A case report and a literature review

Abstract

Abscess of the ligamentum teres hepatis has been described in the medical literature as an extremely rare clinical entity, which often presents a diagnostic dilemma. A 68-year-old man was hospitalized for upper abdominal pain and obstructive jaundice. The patient presented with low-grade intermittent fever. Laboratory investigations showed a white blood cell count of 32.38 × 109/L, a C-reactive protein level of 247.86 mg/L, abnormal liver enzyme and bilirubin levels, and elevated serum levels of amylase and lipase. He was first diagnosed with acute biliary pancreatitis. A computational tomography scan and magnetic resonance cholangiopancreatography revealed obstructive choledocholithiasis and cholecystolithiasis. The patient received preoperative antibiotics and symptomatic treatments for 5 days, followed by endoscopic retrograde cholangiopancreatography and a subsequent duodenal papilla incision to extract pigment and cholesterol gallstones. The patient recovered and was discharged on the fifth day after surgery. However, 10 days later, the patient was readmitted for the recurrence of acute calculous cholecystitis. Laboratory tests showed increases in total and direct bilirubin, γ-glutamyltransferase, and alkaline phosphatase, but not inflammatory parameters. After the patient’s nutritional status improved on the 11th day after admission, a laparoscopic cholecystectomy was performed. Intraoperative exploration revealed extensive abdominal adhesions; a thickened edematous gallbladder wall; and an unexpected abscess of the ligamentum teres hepatis. Pus aspiration was performed laparoscopically after laparoscopic cholecystectomy, and to ensure elimination of the abscess, ultrasound-guided pus aspiration was also performed 1 week later. Fortunately, the patient made an uneventful recovery and was discharged with a drain tube on the 16th day after surgery. Doppler ultrasound indicated that the abscess had completely disappeared 2 weeks after discharge. This case highlights an unusual presentation of a ligamentum teres hepatis abscess caused by obstructive cholangitis but that appeared after the choledocholithiasis was resolved. However, the mechanism of abscess formation remained uncertain.

Rare Sequelae of Endoscopic Retrograde Cholangiopancreatography: Polymicrobial Bloodstream Infection and Hepatic Abscess in an Elderly Individual

“…Informed consent for ERCP should address at least these six possible complications: (a) acute pancreatitis, (b) bleeding, (c) infections, (d) cardiorespiratory events, (e) hypersensitivity reaction, and (f) perforation [ 1 ]. Clinically significant bacteremia post-ERCP occurs in up to 5% of patients [ 7 - 8 ]. Our patient had multiorganism bacteremia: Klebsiella pneumoniae and Enterococcus faecalis.…”

“…Unfortunately, due to the patient's worsening critical condition, the patient was managed only per comfort-care measures and did not undergo any interventions. Similarly, Ji et al reported an interesting case when a patient developed a ligamentum teres hepatic abscess after an ERCP and underwent laparoscopic drainage of the abscess with complete recovery [ 7 ]. Sonography and/or CT scans are primarily used to diagnose hepatic abscesses, with needle aspiration for bacteriology studies to confirm the diagnosis if needed.…”

Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi

“…Therefore, the high recurrence rate of choledocholithiasis has become the focus of attention for surgeons worldwide[ 6 ]. Presently, domestic and foreign studies on the recurrence mechanism of choledocholithiasis mainly focus on crucial issues such as biliary microecology, duodenal papilla sphincter functional damage and abnormalities caused by surgery, and individual biliary anatomical differences[ 7 ].…”