The spread of cancer treatments and the high incidence of chronic diseases resulted in an increase in the occurrence of opportunistic infections in immunocompromised patients. Clinical symptoms are often nonspecific and can make definitive diagnosis difficult. The basis for the treatment of liver abscesses has been minimally invasive, with percutaneous drainage in most cases or laparoscopy, leaving conventional surgery reserved for selected cases. Laparoscopic drainage of liver abscesses may be an alternative in services without 24-hour ultrasound, or complementary to ultrasound, offering the advantage of direct visualization, differential diagnosis, and drainage-associated debridement. Case description: Diabetic patient, 62 years old, reporting occasional abdominal pain for 4 days, associated with confusion in the period. On physical examination, there was no abdominal pain, tachycardia and no other changes. Laboratory tests with marked leukocytosis and high CRP. Tomography showing a single cystic image, with heterogeneous water content and level, affecting segments V, VI, VII and VIII. We opted for videolaparoscopy drainage, with 600 ml of purulent-looking fluid, debridement of devitalized liver tissue and associated cholecystectomy. The patient evolved well and was discharged on the 4th postoperative day. Conclusion: In immunosuppressed patients, the best treatment is related to less surgical and metabolic trauma. Laparoscopy allows the visualization of possible associated causes (gallbladder, tumor, abdominal infections), in addition to draining and removing devitalized tissue, which prolongs the inflammatory phase and can maintain foci of infection. Clinical Importance: The evaluation of the benefit of each procedure must be analyzed, proposing the most appropriate treatment for each clinical condition, opening the possibility of associating the procedure (exclusive or assisted laparoscopy) as a definitive or complementary treatment of this pathology in immunocompromised patients.

LIVER ABSCESS: THE ROLE OF LAPAROSCOPIC TREATMENT IN IMMUNOSUPPRESSED PATIENTS

• DOI: 10.22533/at.ed.1592542216093

• Palavras-chave: liver abscess; immunosuppression; laparoscopy; infection

• Keywords: liver abscess; immunosuppression; laparoscopy; infection

• Abstract:

  The spread of cancer treatments and the high incidence of chronic diseases resulted in an increase in the occurrence of opportunistic infections in immunocompromised patients. Clinical symptoms are often nonspecific and can make definitive diagnosis difficult. The basis for the treatment of liver abscesses has been minimally invasive, with percutaneous drainage in most cases or laparoscopy, leaving conventional surgery reserved for selected cases. Laparoscopic drainage of liver abscesses may be an alternative in services without 24-hour ultrasound, or complementary to ultrasound, offering the advantage of direct visualization, differential diagnosis, and drainage-associated debridement. Case description: Diabetic patient, 62 years old, reporting occasional abdominal pain for 4 days, associated with confusion in the period. On physical examination, there was no abdominal pain, tachycardia and no other changes. Laboratory tests with marked leukocytosis and high CRP. Tomography showing a single cystic image, with heterogeneous water content and level, affecting segments V, VI, VII and VIII. We opted for videolaparoscopy drainage, with 600 ml of purulent-looking fluid, debridement of devitalized liver tissue and associated cholecystectomy. The patient evolved well and was discharged on the 4th postoperative day. Conclusion: In immunosuppressed patients, the best treatment is related to less surgical and metabolic trauma. Laparoscopy allows the visualization of possible associated causes (gallbladder, tumor, abdominal infections), in addition to draining and removing devitalized tissue, which prolongs the inflammatory phase and can maintain foci of infection. Clinical Importance: The evaluation of the benefit of each procedure must be analyzed, proposing the most appropriate treatment for each clinical condition, opening the possibility of associating the procedure (exclusive or assisted laparoscopy) as a definitive or complementary treatment of this pathology in immunocompromised patients.