Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor

Abstract

Background/aims: To study and review the clinical manifestations, microbiology, comorbidity, and diagnosis of liver abscess after transarterial chemoembolization for malignant hepatic tumor.

Methodology: We retrospectively reviewed 1374 patients who underwent 2581 transarterial chemoembolization procedures due to malignant hepatic tumors over an 8-year period.

Results: 7 patients had liver abscess after transarterial chemoembolization. The incidence was 0.27% (7/2581). Hepatocellular carcinoma was diagnosed in all 7 patients, whose liver function was classified as stage A by the Child-Pugh criteria. The clinical manifestations were intermittent fever, abdominal pain, and leukocystosis. All the patients had hyperechoic spots with reverberative shadows on sonograms or low attenuation areas with different Hounsfield units on computed tomography scan, which expressed the 100% incidence (7 of 7) of gas-forming abscesses. Percutaneous drainage or aspiration was done in 6 patients. One received laparotomy with local debridement due to suspicious organ rupture. The pus culture showed Gram-negative bacteria in all patients. Blood cultures were positive in only 3 of 7 patients (43%). No patients died of liver abscess after aspiration, drainage, or debridement of abscess combined with parenteral antibiotic treatment. Biliary tract diseases, found in 4 patients, were the most common comorbidity.

Conclusions: Liver abscess after transarterial chemoembolization is a very rare complication, which usually develops in patients with biliary tract disease. Gram-negative bacteria are the main pathogens. The incidence of gas formation is higher after transarterial chemoembolization than in the general population. However, the prognosis is good after adequate clearance of pus and antibiotic treatment.