Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9198-9204
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9198
Recurrent pyogenic liver abscess after pancreatoduodenectomy caused by common hepatic artery injury: A case report
Fei Xie, Jie Wang, Qin Yang
Fei Xie, Jie Wang, Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China
Qin Yang, Department of Gastroenterology, The First People's Hospital of Neijiang, Neijiang 641000, Sichuan Province, China
Author contributions: Xie F and Wang J were the patient’s surgeons, reviewed the literature and contributed to manuscript drafting and revising; Yang Q was responsible for the collection of patient’s clinical data and the revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Qin Yang, MD, Doctor, Department of Gastroenterology, The First People's Hospital of Neijiang, No. 31 Tuozhong lane, Jiaotong road, Neijiang 641000, Sichuan Province, China. 309187701@qq.com
Received: April 18, 2021
Peer-review started: April 18, 2021
First decision: May 24, 2021
Revised: May 28, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 26, 2021
Processing time: 185 Days and 21.3 Hours
Abstract
BACKGROUND

Pancreaticoduodenectomy (PD) has been increasingly performed as a safe treatment option for periampullary malignant and benign disorders. However, the operation may result in significant postoperative complications. Here, we present a case that recurrent pyogenic liver abscess after PD is caused by common hepatic artery injury in atypical celiac axis anatomy.

CASE SUMMARY

A 56-year-old man with a 1-d history of fever and shivering was diagnosed with hepatic abscess. One year and five months ago, he underwent PD at a local hospital to treat chronic pancreatitis. After the operation, the patient had recurrent intrahepatic abscesses for 4 times, and the symptoms were relieved after percutaneous transhepatic cholangial drainage combining with anti-inflammatory therapy in the local hospital. Further examination showed that the recurrent liver abscess after PD was caused by common hepatic artery injury due to abnormal abdominal vascular anatomy. The patient underwent percutaneous drainage but continued to have recurrent episodes. His condition was eventually cured by right hepatectomy. In this case, preoperative examination of the patient’s anatomical variations with computed tomography would have played a pivotal role in avoiding arterial injuries.

CONCLUSION

A careful computed tomography analysis should be considered mandatory not only to define the operability (with radical intent) of PD candidates but also to identify atypical arterial patterns and plan the optimal surgical strategy.

Keywords: Liver abscess; Celiac axis; Right hepatectomy; Pancreaticoduodenectomy; Ischemic complication

Core Tip: The classic trifurcation of the celiac trunk contains common hepatic artery (CHA), left gastric artery, and splenic artery. CHA injury or interruption may lead to chronic biliary ischemia in the related hepatic territory or abscess. We presented a rare case of a 56-year-old man with recurrent pyogenic liver abscess and his common hepatic artery was injured by pancreatoduodenectomy. This case highlights a careful computed tomography analysis should be considered mandatory not only to define the operability (with radical intent) of pancreaticoduodenectomy candidates but also to identify atypical arterial patterns and plan the optimal surgical strategy.