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• W2268809899 abstract "A 55-year-old male was admitted to a community hospital with right upper quadrant pain and fever for two weeks. Ultrasonography showed a large right lobe liver abscess (volume 350 mm3), for which he received intravenous injection metronidazole 800 mg thrice daily with injection ceftriaxone 1 g twice daily for seven days without any improvement. A percutaneous drain was placed successfully in the liver abscess and drained creamy pus. One week later, the percutaneous catheter was removed after improvement of symptoms. Four days after that, he developed three episodes of haematemesis that required transfusion of five units of packed red blood cells. He was shifted to this centre with ongoing melaena, pain in abdomen, jaundice and fever. On admission, physical examination revealed pallor and tender hepatomegaly. Laboratory investigation reports revealed haemoglobin 9.5 g/dL (normal 11–15), bilirubin 5.5 mg/dL (normal 0.6–1.2), alkaline phosphatase 324 IU/L (normal 50–150) with normal platelet count and normal bleeding, clotting and prothrombin times. Oesophagogastroduodenoscopy and duodenoscopy revealed no obvious source of bleeding. Ultrasonography showed bilobar intrahepatic biliary dilation with residual liver abscess. Computed tomography (CT) of abdomen with arterial phase was performed, which is shown in (Figure 1A) . He underwent selective celiac arteriogram and appropriate therapy was given as shown in Figure 2, Figure 3, respectively. Subsequently melaena stopped, jaundice improved, fever subsided and repeat CT angiogram showed minimal residual abscess and healing of the above-mentioned lesions.Figure 2Selective celiac angiography showing arteriovenous fistula between right hepatic artery and right branch of portal vein.View Large Image Figure ViewerDownload (PPT)Figure 3Successful embolization of right hepatic artery and fistula by coils.View Large Image Figure ViewerDownload (PPT) What is the diagnosis?Images in Hepatology – AnswerRight lobe Liver abscess, Post-PCD (percutaneous drainage), Right Hepatic artery-portal vein AVF (arteriovenous fistula) and successful coil embolization.Percutaneous liver abscess drainage is a common interventional radiology procedure with a relatively low complication rate; most are self-limiting. In this patient, we report a major haemorrhagic complication following percutaneous liver abscess drainage that resulted in a right hepatic artery pseudoaneurysm with early enhancement of portal vein suggestive of arteriovenous fistula (Figure 1B).Selective celiac arteriogram revealed right hepatic artery to portal vein arteriovenous fistula (Figure 2). This was treated successfully by transcatheter coil embolization (Figure 3).Causes of hepatic AVF include trauma, surgery, liver abscess drainage, radio-frequency ablation, percutaneous transhepatic biliary drainage (PTBD) and liver biopsy.1Druy E. Hepatic artery-biliary fistula following percutaneous transhepatic biliary drainage.Radiology. 1981; 141: 369-370Crossref PubMed Scopus (15) Google Scholar Bleeding as a result of an AVF following percutaneous liver abscess drainage is extremely rare and can be managed successfully with coil embolization, balloon tamponade or stent placement.2Hidalgo F. Narvaez J.A. Rene M. et al.Treatment of hemobilia with selective hepatic artery embolization.J Vasc Interv Radiol. 1995; 6: 793-798Abstract Full Text PDF PubMed Scopus (81) Google Scholar Right lobe Liver abscess, Post-PCD (percutaneous drainage), Right Hepatic artery-portal vein AVF (arteriovenous fistula) and successful coil embolization. Percutaneous liver abscess drainage is a common interventional radiology procedure with a relatively low complication rate; most are self-limiting. In this patient, we report a major haemorrhagic complication following percutaneous liver abscess drainage that resulted in a right hepatic artery pseudoaneurysm with early enhancement of portal vein suggestive of arteriovenous fistula (Figure 1B). Selective celiac arteriogram revealed right hepatic artery to portal vein arteriovenous fistula (Figure 2). This was treated successfully by transcatheter coil embolization (Figure 3). Causes of hepatic AVF include trauma, surgery, liver abscess drainage, radio-frequency ablation, percutaneous transhepatic biliary drainage (PTBD) and liver biopsy.1Druy E. Hepatic artery-biliary fistula following percutaneous transhepatic biliary drainage.Radiology. 1981; 141: 369-370Crossref PubMed Scopus (15) Google Scholar Bleeding as a result of an AVF following percutaneous liver abscess drainage is extremely rare and can be managed successfully with coil embolization, balloon tamponade or stent placement.2Hidalgo F. Narvaez J.A. Rene M. et al.Treatment of hemobilia with selective hepatic artery embolization.J Vasc Interv Radiol. 1995; 6: 793-798Abstract Full Text PDF PubMed Scopus (81) Google Scholar HKN, VAS, SM and AK were involved in the patient's management, manuscript writing and intellectual input. Dr. RP was involved in interventional radiological procedure. The authors have none to declare." @default.
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• W2268809899 date "2015-12-01" @default.
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• W2268809899 title "Upper Gastrointestinal Bleed Following Percutaneous Liver Abscess Drainage" @default.
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