Document Detail


Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm.
MedLine Citation:
PMID:  20517180     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.
Authors:
Nicola Leggieri; Pedro Marques-Vidal; Herwig Cerwenka; Alban Denys; Gian Dorta; Vincent Moutardier; Didier Raoult
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Medicine     Volume:  89     ISSN:  1536-5964     ISO Abbreviation:  Medicine (Baltimore)     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-06-02     Completed Date:  2010-06-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985248R     Medline TA:  Medicine (Baltimore)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-95     Citation Subset:  AIM; IM    
Affiliation:
Service de Maladies Infectieuses et Laboratoire Central de Bact?riologie, H?pitaux Universitaires de Gen?ve, Geneva, Switzerland. nicola.leggieri)hcuge.ch
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms*
Diagnosis, Differential
Female
Foreign-Body Migration / complications*
Gastrointestinal Tract / microbiology,  radiography,  surgery
Humans
Klebsiella / isolation & purification
Klebsiella Infections / complications
Liver Abscess / diagnosis*,  etiology*
Liver Abscess, Pyogenic / diagnosis,  microbiology
Male
Middle Aged
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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