A Case of Ruptured Liver Abscess caused by Clostridium Perfringens after Pancreatoduodenectomy

Masaharu Tada, Ryuichiro Doi, Kohei Ogawa, Yoshiya Kawaguchi, Hiroto Egawa, Fumihiko Hirai* and Shinji Uemoto

Department of Surgery, Kyoto University Hospital
Department of Surgery, Kyoto Postal Services Agency Hospital*

A 62-year-old woman suffering a high sudden-onset fever on postoperative day (POD) 35 after pancreatoduodenectomy was found elsewhere in computed tomography to have a hepatic abscess and systemic antibiotics were initiated. Her condition worsened rapidly over the next 12 hours, so she was transferred to our hospital. Due to the rapid progression of the liver abscess, the large amount of portal gas, and free air in the abdominal cavity, we conducted laparotomy, which showed no gastrointestinal perforation or failure of the previous sutures, but the liver abscess had ruptured and this was considered to be the source of free abdominal air. The presence of Clostridium perfringens was histopathologically confirmed in liver tissues and ascites. After surgery, severe hemolysis progressed rapidly, causing circulatory disorder and killing the patient 22 hours after admission. Clostridium infection is very rare, but opportunistic infection may occur in a host compromised by major surgery similar to this current case. When rapid progression of jaundice and gas generation on imaging is encountered, the possibility of Clostridium infection should be considered. Because the systemic condition worsens rapidly, early diagnosis and early initiation of active treatment are vital in preserving life in such cases.

Key words
liver abscess, hemolysis, Clostridium perfringens

Reprint requests
Masaharu Tada Department of Surgery, Graduate School of Medicine, Kyoto University
54 Kawara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
May 30, 2007

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