Risk factors for and clinical findings of liver abscess after biliary-intestinal anastomosis.

BACKGROUND/AIMS: Aggressive treatment for malignancy of the biliary tract has resulted in an increased incidence of pyogenic liver abscess. We retrospectively studied risk factors for and clinical findings of the liver abscess.

METHODOLOGY: The subjects were 45 patients who underwent pancreatoduodenectomy (group A), 38 patients who underwent liver resection with biliary-intestinal anastomosis (group B), and 55 patients who underwent biliary-intestinal anastomosis alone (group C) during the past 13 years. We retrospectively studied risk factors by univariate and multivariate analyses.

RESULTS: Liver abscess occurred in 6 patients in group A and 4 in group B. No patient developed liver abscess in group C. The incidence of liver abscess was significantly higher in groups A and B than in group C (p = 0.0068 and p = 0.0253, respectively). The incidence was significantly higher in patients who underwent anastomosis with subsegmental bile ducts (p = 0.0264). The incidence was significantly higher in patients with vascular reconstruction (p = 0.0254). Abscess or biliary drainage and administration of antibiotics were performed. Five patients died secondary to multiple organ failure.

CONCLUSIONS: Pancreatoduodenectomy or liver resection with biliary-intestinal anastomosis, anastomosis with subsegmental bile ducts, and vascular reconstruction are risk factors for refractory liver abscesses after biliary-intestinal anastomosis.