Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm.

Details

Serval ID
serval:BIB_D061A6D28FCC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm.
Journal
Medicine
Author(s)
Leggieri N., Marques-Vidal P., Cerwenka H., Denys A., Dorta G., Moutardier V., Raoult D.
ISSN
1536-5964[electronic], 0025-7974[linking]
Publication state
Published
Issued date
2010
Volume
89
Number
2
Pages
85-95
Language
english
Notes
Publication types: Case Reports ; Journal Article ; Review
Abstract
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.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Diagnosis, Differential, Female, Foreign-Body Migration/complications, Gastrointestinal Tract/microbiology, Gastrointestinal Tract/radiography, Humans, Klebsiella/isolation & purification, Klebsiella Infections/complications, Liver Abscess/diagnosis, Liver Abscess/etiology, Liver Abscess, Pyogenic/diagnosis, Liver Abscess, Pyogenic/microbiology, Male, Middle Aged, Young Adult
Pubmed
Web of science
Create date
13/04/2010 11:04
Last modification date
20/08/2019 16:50
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