Journal of Clinical Cases

Pyogenic Liver Abscess Following Gastrectomy Performed For Benign Disease

Rocha Cabrera Cecilia Estefania ¹ , Punin Neira Roberto ¹ ,Carrión Astudillo Christian Marcelo ¹ , González Hernández Dolores ¹ , Herrera Esquivel José de Jesús ¹

1. Division of Gastrointestinal Endoscopy, Gastrointestinal Endoscopy Department, General Hospital Dr. Manuel Gea Gonzalez, Health Secretary, Mexico

Corresponding Author: González Hernández Dolores

ABSTRACT

Pyogenic liver abscess (PLA) is a rare but potentially life-threatening condition that may occur following gastrointestinal infections or some surgical procedures. Although gastrectomy has been associated with an increased risk of PLA, most reported cases occur after bariatric surgery and are commonly related to anastomotic leak or infected collections. We report the case of a 62-year-old female who developed a ruptured hepatic abscess four weeks after laparoscopic subtotal gastrectomy with Roux-en-Y reconstruction performed for benign disease. The patient presented with septic shock and was found on contrast-enhanced CT to have a large left-lobe hepatic abscess without evidence of anastomotic leak. Urgent diagnostic laparoscopy was performed, which confirmed a ruptured hepatic abscess with generalized purulent peritonitis and no signs of anastomosis leak. Cultures reported Escherichia coli and Enterococcus faecalis; the patient was successfully managed with surgical source control and targeted antibiotic therapy. This case highlights that PLA after non-bariatric gastrectomy may occur in the absence of anastomotic leak and is likely multifactorial. Early recognition and prompt intervention are essential to prevent severe complications and to promote recovery.

Key Words:pyogenic liver abscess; laparoscopic gastrectomy; Roux-en-Y gastrojejunostomy; bacterial translocation; laparoscopic surgery; intra-abdominal infection