LIVER-ABSCESS - COMPLICATION RELATED TO E NDOPROSTHESIS OR STENT PLACEMENT

Purpose: Patients with malignant, unresectable biliary strictures and endoprosthesis or stents for drainage often develop liver abscess. The aim of the investigation was to assess the relationship and the facto rs causing the development of these abscesses. Method: 9 patients with a median age of 65.6 years, liver abscess and endoprosthesis or stent s were studied retrospectively. The occlusions were made visible sonog raphically and by ERC or PTC. With sonography the abscess was diagnose d and punctured. Results: 5 patients (56%) had a bile duct carcinoma, two patients had a distal tumor stenosis, one a tumor of the gallbladd er and one an obstructive jaundice due to liver metastases. 8 patients required a percutaneous drainage (PTCD). 6 cases of occlusions were f ound. 1 patient had a biliary obstruction because of a broken endopros thesis. On an average it took 11.6 months from the first endoprosthesi s or stent placement to the formation of an abscess. Plastic endoprost heses tend to occlude more rapidly (5 months versus 17.6 with stents). After the sonographically guided puncture of the liver abscess, i.v. antibiotics were given for 5 to 14 days. The antibiotics were continue d orally. Two cases required a sonographically placed percutaneous dra inage. 78% of the abscesses could be cured. One patient died because o f sepsis. Conclusions: Liver abscesses were connected with intrahepati c carcinomas (56%). In such cases drainage is difficult and requires m any interventions. Furthermore, we find this especially after percutan eous transhepatic drainage and with plastic endoprostheses.