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Synchronous pyogenic liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy)

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Abstract

Background

The treatment of synchronous pyogenic liver abscess (PLA) and acute cholecystitis (AC) may be challenging. Moreover, because of the similarity of symptoms and the suboptimal accuracy of ultrasound (US), PLA(s) may be undetected, unless a computer tomography (CT) scan is performed. The aims of this study were (1) to evaluate the results of emergency cholecystostomy (CS) and late laparoscopic cholecystectomy (LC) in such a population and (2) to identify the criteria for selecting patients with AC and a high risk of having synchronous PLA(s) for referral for a CT scan.

Methods

A retrospective analysis of the outcome of 12 patients with AC and PLA(s) treated by emergency CS followed by delayed LC from January 1996 through May 2010 at a tertiary-care university hospital was performed. Clinical, laboratory, and radiological data of patients with synchronous AC and PLA(s) are compared with those of 66 patients with “simple” AC.

Results

The association of age >55 years, temperature >38°C, WBC count >12,000/ml, and ASAT >50 UI/l and/or ALAT >75 UI/l allows for the selection of patients at high risk of PLA to undergo a CT scan (sensitivity: 100%; specificity: 86%). All treated patients had a sudden improvement within 24 h following CS. PLA was treated in 10/12 patients (83%). Hospital stay lasted 21.5 ± 3.5 days. Ten patients underwent elective LC 12 ± 4 weeks after CS with no conversion and 30% perioperative morbidity. Operating time was 91 min. Hospital stay was 1.7 days [7 patients (70%) underwent surgery as an outpatient].

Conclusions

A simple algorithm is presented for the selection of patients with AC to undergo a CT scan to identify synchronous PLA. Emergency CS followed by delayed LC is a viable, first-line treatment option for synchronous PLA and AC.

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Acknowledgments

No institutional affiliations or funding sources supported the specific paper submitted (from any grant, funding source, or commercial interest including pharmaceutical or device companies).

Disclosure

Drs. Renato Costi, Alban Le Bian, François Cauchy, Papa Saloum Diop, Alessio Carloni, Laurence Catherine and Prof. Claude Smadja have no conflicts of interest or financial ties to disclose. In particular, the authors do not have any institutional or corporate/commercial relationships (including consultantships, honoraria, stock ownership, gifts, free or reimbursed travel/ vacations, equity interests, arrangements regarding patents or other vested interests, etc.) going back 36 months, or to the time of the data collection if the data were collected longer than 3 years ago, that might pose a conflict of interest. The Journal will be informed if any conflicts of interest arise after submission and before publication of the paper.

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Authors and Affiliations

  1. Service de Chirurgie Digestive, Hôpital Antoine Béclère, Assistance Publique—Hôpitaux de Paris, Université Paris XI, 157, Rue de la Porte de Trivaux, 92141, Clamart, France

    Renato Costi, Alban Le Bian, François Cauchy, Papa Saloum Diop, Alessio Carloni & Claude Smadja

  2. Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy

    Renato Costi

  3. Service de Radiologie et Imagerie, Hôpital Antoine Béclère, Assistance Publique—Hôpitaux de Paris, Université Paris XI, Clamart, France

    Laurence Catherine

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  1. Renato Costi
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Correspondence to Renato Costi.

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Costi, R., Le Bian, A., Cauchy, F. et al. Synchronous pyogenic liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy). Surg Endosc 26, 205–213 (2012). https://doi.org/10.1007/s00464-011-1856-1

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