Liver abscess formation after local treatment of liver tumors

Abstract

Our goal was to determine a subset of patients at high risk of developing liver abscesses after local treatment of liver tumors (LTLT) and establish guidelines for the conduct of LTLT in the safest conditions in such patients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC, 10 hepatic embolizations, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma necrosis and abscess formation. Four patients developed abscesses, three after TAC and one after PIT. Despite broad-spectrum antibiotherapy, percutaneous drainage, and surgery, two patients died. A left hepatectomy was required in the other two patients for cure. All four patients had a carcinoid or a neuroendocrine pancreatic tumor. Three out of four patients had bilioenteric anastomoses, and the fourth had recently undergone cholecystectomy and papillotomy. A Lipiodol/doxorubicin mixture without any particulate embolization was injected in the three patients who developed abscesses after TAC. LTLT in patients with bilio enteric anastomosis or papillotomy and/or neuroendocrine or carcinoid tumor should be performed with strict precautions during the procedure and for peri-procedural care.

Bacterial Infections Associated with Hepatic Arteriography and Transarterial Embolization for Hepatocellular Carcinoma: A Prospective Study

“…In contrast to the predominance of gram-negative bacteria in cases of pyogenic liver abscess, gram-positive bacteria, mainly Staphylococcus, Streptococcus, Enterococcus, and Clostridium, have been reported before as causative microorganisms in approximately one-half of the cases of TAErelated liver abscesses [3,5]. Our prospective study confirms this finding.…”

“…Whether this difference holds true in bacteremia or other infectious complications after angiographic procedures deserves further investigation, as it may affect strategy for antibiotic prophylaxis. In addition, risk factors for developing bacterial infections after TAE have not been determined prospectively, although diabetes mellitus, cholelithiasis, previous biliary manipulation, enterobiliary anastomosis, and large tumor size have been proposed [4,5]. Since TAE for unresectable HCC is common practice in our hospital, we conducted a prospective study to address these questions and to determine the exact incidence of and identify the possible risk factors for infectious complications after HA and TAE for HCC.…”

Multimicrobial Sepsis Including <i>Clostridium perfringens</i> after Chemoembolization of a Single Liver Metastasis from Common Bile Duct Cancer

“…However, whether the rate or severity of infection after chemoembolization can be decreased by prophylactic antibiosis remains unclear. Risk factors of developing liver abscesses after chemoembolization are intestinal biliary reflux caused by bilioenteric anastomosis or biliary stenting and neuroendocrine cancer [14, 20]. Our patient had a bilioenteric anastomosis and a common bile duct cancer.…”

“…Deaths after clostridial bacteremia following chemoembolization had been reported before [13, 14]. The proposed mechanism of entry in the blood circulation is a defective colonic mucosa, allowing clostridial organisms to invade tissues which are able to support their growth [2].…”

“…In a randomized controlled trial no bacterial infection was observed after chemoembolization with or without prophylactic antibiosis, but the number of patients was very low (61 patients, 75 procedures) [18]. The rate of hepatic abscess after chemoembolization with prophylactic antibiosis is 0.6–1.3% (3/489 [14]and 6/480 procedures [19]). However, whether the rate or severity of infection after chemoembolization can be decreased by prophylactic antibiosis remains unclear.…”