复旦大学：《传染病学 Infectious Disease》课程教学资源（MBBS）教案案例（英文）Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract Chong LW, Sun C K, WuC C, et al Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: a case report and literature 杂志英文版电子版)

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract Chong L W, Sun C K, Wu C C, et al. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review[J]. 世界胃肠病学杂志:英⽂版(电⼦版), 2014, 20(13):3703-3711

A41-year-old man no previous history of medical illness Chief complaint: intermittent upper abdominal pain and acid regurgitation for two months Symptoms: fever occurred when the abdominal pain frst started vital signs T369 C, P95 /min, R16/min, BP140/71 mmHg Physical examination: mild epigastric tenderness

• A 41-year-old man • no previous history of medical illness • Chief complaint: intermittent upper abdominal pain and acid regurgitation for two months. • Symptoms: fever occurred when the abdominal pain frst started. • vital signs :T36.9 ℃, P95 /min, R16 /min, BP140/71 mmHg. • Physical examination: mild epigastric tenderness

Examination Esophago gastroduodenoscopy :a toothpick penetrating the posterior wall of the gastric antrum Blood culture: no bacterial growth Laboratory studies: WBC 14.6*10 6/L, neutrophils 66.4%

Examination • Esophago gastroduodenoscopy :a toothpick penetrating the posterior wall of the gastric antrum. • Blood culture: no bacterial growth. • Laboratory studies :WBC 14.6*10^6/L , neutrophils 66.4%

CT revealed a hyperdense, linear foreign body within the gastric antrum with transgastric penetration through the posterior wall of the antrum and close contact with the pancreatic body( Figure1)

CT revealed a hyperdense,linear foreign body within the gastric antrum with transgastric penetration through the posterior wall of the antrum and close contact with the pancreatic body (Figure1)

Diagnosis hepatic abscess complicating foreign body Figure 2 Liver abscess demonstrated in imaging study. Contrast-enhanced penetration of the gastric computed tomography scan showing a 7-cm hypodense mass in the lateral antrum segment of the left hepatic lobe(outlined by arrows)

Diagnosis: hepatic abscess complicating foreign body penetration of the gastric antrum

Treatment a 7-cm wooden toothpick, was successfully removed endoscopically Percutaneous drainage of the liver abscess was not performed “ faction(液化)

Treatment • a 7-cm wooden toothpick, was successfully removed endoscopically • Percutaneous drainage of the liver abscess was not performed due to the absence of liquefaction(液化）

Antibiotics ceftriaxone2 g/d and metronidazole(甲硝唑)500mgq8h drop for 10 days 2. levofloxacin 500mg/d po for 2 weeks Outcome: Complete resolution of the hepatic abscess was noted six months after discharge

• Antibiotics： 1.ceftriaxone 2 g/d and metronidazole (甲硝唑）500 mg q8h iv.drop for 10 days 2.levofloxacin 500mg/d p.o for 2 weeks • Outcome: Complete resolution of the hepatic abscess was noted six months after discharge

Review of literature 79 journal articles 88 patients 1. Demography and clinical manifestations Gender 64(73%)males, 24(27%)females The mean age: 50.4+ 186y(11-86 y signs and symptoms: abdominal pain(77.3%), fever (58%), omiting(19.3%) and nausea(13.6% only 5% of patients reported a positive history of foreign body Ingestion

Review of literature 79 journal articles 88 patients 1.Demography and clinical manifestations Gender:64 (73%) males , 24 (27%) females. The mean age :50.4 ± 18.6 y (11 -86 y). signs and symptoms : abdominal pain (77.3%) , fever (58%) ,vomiting (19.3%) and nausea(13.6%). only 5% of patients reported a positive history of foreign body ingestion

2. Foreign bodies fish bone (33%), toothpick (27. 3%), chicken bone(12.5%) and needle(9.1%) 3. Site of perforation stomach(40.9%), duodenum(20.5%) and colon(11.4%) location: of the hepatic abscess: the left lobe(65.9%), right lobe(29.5%) The size of the liver abscesses ranged from 2 to16 cm(mean, 6.82+ 3.09 cm)

2.Foreign bodies fish bone (33%), toothpick(27.3%),chicken bone (12.5%) and needle (9.1%) 3.Site of perforation :stomach (40.9%),duodenum (20.5%) and colon (11.4%). location: of the hepatic abscess: the left lobe (65.9%), right lobe (29.5%). The size of the liver abscesses: ranged from 2 to16 cm (mean, 6.82 ± 3.09 cm)

4. Pathogens Bacterial flora Prevalence No. of patients Streptococcus sp. 72.30% 34 Escherichia col 17.00% Klebsiella pneumoniae 10.60% 85

4.Pathogens