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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Step-up approach in emphysematous hepatitis: A case report
Silke Francois, Maridi Aerts, Hendrik Reynaert, Ruth Van Lancker, Johan Van Laethem, Rastislav Kunda, Nouredin Messaoudi
Silke Francois, Department of Gastroenterology, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
Maridi Aerts, Hendrik Reynaert, Department of Gastroenterology and Hepatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
Ruth Van Lancker, Department of Intensive Care, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
Johan Van Laethem, Department of Infectious Diseaeses, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
Rastislav Kunda, Nouredin Messaoudi, Department of Surgery, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels 1090, Belgium
Nouredin Messaoudi, Department of Surgery, Europe Hospitals, Brussels 1180, Belgium
Author contributions: Francois S designed the report and collected the patient’s clinical data; Francois S and Messaoudi N wrote the manuscript; Aerts M, Reynaert H, Van Lancker R, Van Laethem J and Kunda R read and approved the final manuscript.
Informed consent statement: Consent was obtained from the patient (on 09/06/2021) for publication of this anonymized case details and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Silke Francois, MD, Attending Doctor, Department of Gastroenterology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium. silkefrancois@gmail.com
Received: July 5, 2021
Peer-review started: July 5, 2021
First decision: August 18, 2021
Revised: September 4, 2021
Accepted: January 13, 2022
Article in press: January 13, 2022
Published online: February 27, 2022
BACKGROUND
Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients.
CASE SUMMARY
We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement.
CONCLUSION
EH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.
Core Tip: Emphysematous hepatitis (EH) is a very rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. There is a paucity of literature with regard to pathogenesis, involved organisms, imaging appearance, and management of this condition. We report the successful treatment of a patient diagnosed with EH by adopting a multimodal step-up approach including rigorous fluid resuscitation, early hemodynamic support, broad-spectrum antimicrobial therapy, and percutaneous radiologically guided drainage followed by minimal invasive surgical treatment.
