RIGHT HEPATECTOMY FOR PYOGENIC LIVER-ABSCESSES WITH TRUE MULTILOCULATION

We report the case of a 61-year-old woman with cryptogenic liver absce sses who had been profoundly ill with severe upper abdominal pain, imp aired consciousness, prostration, continuous high fever secondary to s epsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm(3)) since admis sion. Ultrasonograms and computed tomograms revealed two separate mult iloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess dr ainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of th e abscess cavity. Four days later, transcatheter hepatic arterial infu sion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underw ent right hepatectomy because the multiloculated lesions were refracto ry to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphren ic abscess formation, and prolonged thrombocytopenia with associated c oagulation disorders for two months. Examination of multiple cross sec tions of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication be tween the locules and there were true septations, rather than multiloc ulated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease .