Percutaneous Drainage of Liver Abscess Complicated by Hepato-venous Fistula

YFA Chung, KH Tay, BS Tan, AMM Htoo, CH Thng, PKH Chow, LLPJ Ooi, TN Lau
Correspondence: Dr Y F A Chung, gsucyf@sgh.com.sg

ABSTRACT
Severe systemic sepsis after percutaneous drainage of liver abscess is rare. We report two cases of hepato-venous fistulas between hepatic abscesses and hepatic/portal veins documented on abscessography during percutaneous drainage of liver abscesses, which resulted in severe sepsis and a stormy post drainage clinical course. Liver abscesses can rupture into the portal and hepatic veins causing worsening of systemic sepsis especially when they are in close proximity to each other. During percutaneous drainage, care must also be taken to avoid overinjection of the abscess, which can worsen the fistula. The ensuing sepsis is severe and requires aggressive intensive medical care and ventilatory support to tide the patient over the septic episode.

Keywords: hepato-venous fistula, liver abscess, percutaneous drainage, sepsis
Singapore Med J 2003; 44(6): 299-301