Kehr tube complication: recurrent hepatic abscess associated with actinomyces secondary to a foreign body in the bile duct—a case report

Abstract

Complications from the installation of a Kehr tube are frequent, up to 15% in some series.Hepatic abscesses secondary to a foreign intraciliary body are very rare. Actinomycosis is a rare chronic infection, has a liver involvement of 5% secondary to another intra-abdominal infection. We present a case of female patient aged 79 years. History of choledochostomy in 2007 due to choledocholithiasis and endoscopic biliary drainage due to residual choledocholithiasis. She consulted for pain in the epigastrium and right hypochondrium, associated with an increase in inflammation markers. Initial ultrasound identified a lesion in the left hepatic lobe compatible with a hepatic abscess. Nuclear magnetic resonance (NMR) revealed dilation of the intrahepatic bile duct, greater to the left, with thickening of the bile duct at the confluence level that extends to the middle third, with hepatolithiasis and choledocholithiasis and multiple hepatic abscesses. A left lateral segmentectomy was performed along with exploration of the bile duct, identifying a foreign body compatible with an old fragment of T tube. The deferred biopsy reported intrahepatic lithiasis and chronic hepatitis compatible with secondary biliary cirrhosis, acute and chronic hepatitis with purulent leukocytic exudate and actinomycete elements. In our case the T tube fragment could have acted as a foreign body and facilitated the infection by actinomyces.