Liver actinomycotic abscess a rare complication of gastro- oesophageal reflux disease-related mucosal injury

Presented in 13th World Gastroenterology, IBD & Hepatology Conference in Holiday Inn Dubai, Al Barsha, UAE & Virtual from December 15-17, 2023. 

Poster Name: Dr. Nancy Brulinska (Ireland)
Category: (Poster presentation )

Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Visit Poster Presenter page: https://gastroenterology.universeconferences.com/speaker/nancy-brulinska/

BACKGROUND:

The Actinomycosisis a bacterial infection caused by Gram positive,non-acid fast,anaerobic ormicroacrophilic rods.Actinomycetescan be found inthe normal flora of the oral cavity,as well as less commonly inthe lower GIT and female genital tract but are not virulent. Actinomycosisof the abdomen and pelvis accounts for10-20% of reported cases. Untreated, pyogenicliver abscess remains uniformly fatal. With timely administrationof antibiotics anddrainage procedures, mortality currently occurs in5-30%.The most common causes of deathinclude sepsis, multiorgan failure, and hepatic failure.

CASEHISTORY

This is a casereport of57year old male presentingwith flulikesymptoms, high fever,myalgiaand very mil rightupperquadrantpain.Therewasnomedicalhistoryofnote.Initiallytreatedasinfectionofunknown source. Blood culturesultimatelygrewactinomycosisoris.

CT Abdomen/Pelvisshowed an 8.5cm liver abscess, predominantlylocated within segment5.Some mural thickening of the distal oesophaguswith periesophageal and coeliacaxis lymph nodeswas also noted.He wasfollowedupwithOGDwhichshowedahiatusherniaandgastritis.

Treatmentwas with IV antibiotics (piperacillin/tazobactam) for 6 weeks and CT guided drainage of the abscess. Thedrain wasremoved after 3 weeks.

DISCUSSION/CONCLUSION

As found in literature to date,risk factors include previous abdominal/pelvic surgery, abdominal wall trauma, gastrointestinal foreign body,gastrointestinaltract lesions and immunosuppression. Although thecauseinthemajorityofcases isunknown (80.7%),the abscess can appear after any disruption inmucosal integrity (Christodolou et al.,2004).

Inabsence of other risk factors,thispatient hada hiatus hernia, gastritis,and oesophageal thickening which suggests untreated gastro-oesophagealreflux disease.Thiscouldhaveledtothelossof integrity of the gastrointestinal mucosa.Mucosal injury or infection maycauseinvolvement oftheliverthroughhematogenous spread via theportalveinresultinginaliverabscess.Thiscouldsuggest a potential link between GORD,mucosal injuryandliveractinomycosis.

TREATMENTOPTIONS           

• Antibiotics
• Surgicalresection
  +/-Percutaneousdrainage
• Surgery
  Based on existing studies, antibiotics seem to beeffective in treating the infection. Surgery should beused aslast resort incases where percutaneousdrainage is not possible or where necrotictissueispresent.

Tags
Crohn’s and Colitis Journals | Gastroenterology & Hepatology Journals | Gastroenterology Journals | Research Gastroenterology and Hepatology Journals | Clinical and Experimental Gastroenterology Journals | Gastrointestinal Endoscopy Journals | Therapeutic Advances in Gastroenterology Journals | Colorectal Disease: clinical and molecular gastroenterology and surgery Journals | Inflammatory Bowel Diseases Journals | Expert Review of Gastroenterology & Hepatology Journals | Clinical Colorectal Journals | Cancer Gut Journals | Endoscopy Journals | Hepatitis B Annual Journals | Hepato-biliary-Pancreatic Sciences Journals | Medical Bulletin Journals 

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