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conferenceseries
.com
Volume 7, Issue 5 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN:2161-069X
Gastroenterology 2017
November 13-14, 2017
November 13-14, 2017 | Las Vegas, USA
13
th
International Conference on
Clinical Gastroenterology, Hepatology and Endoscopy
Hemobilia and hepatobiliary fistula formation: An unusual complication of a pyogenic liver abscess
P Faybusovich, Z Sira, S Aye, K Ahuja, S Eskaros
and
V Rizzo
Icahn School of Medicine at Mount Sinai, USA
Introduction:
A liver abscess leading to the formation of a fistula between the hepatobiliary tree and duodenum is a unique
complication. Further complication leading to hepatic artery rupture is extraordinary. Case study begins with a 68-year-old female
with history of schizophrenia presented with altered mental status, weight loss and hyperglycemia. Patient was found to be septic
and blood cultures grew ESBL
E. coli
and
Candida
requiring IV fluids, vasopressors, and IV antibiotics. CT abdomen with contrast
revealed an intrabiliary abscess requiring IR drainage and pigtail catheter placement. MRI performed showing connection between
intrahepatic bile duct and proximal duodenum confirmed by fistulogram. Subsequently the patient developed hematemesis and
hemodynamic instability requiring fluid resuscitation and blood transfusions. Upper GI endoscopy revealed blood in the stomach but
no active source of bleeding. CTA of abdomen was performed which showed extravasation from a branch of the right hepatic artery
with leakage into the liver. No aneurysm or pseudoaneurysm was identified. IR guided embolization of the hepatic artery performed
but due to fistula complexity surgery was not performed and nasogastric tube feeds started.
Discussion:
Pyogenic liver abscesses are the most common cause of visceral abscesses accounting for approximately 48% of cases.
Hemobilia is a rare complication of liver abscess but few cases where a complication of fistula formation was observed. Diagnostic
modalities include angiography, endoscopy and surgical exploration. Hepatic artery embolization is the standard treatment for liver
hemorrhage. In patients with liver abscesses and GI bleeding, hemobilia should be one of the differential diagnosis.
Biography
P Faybusovich has completed his DO degree in 2016 from NYIT College of Osteopathic Medicine. He is a Former Associate Researcher at the Icahn School of Medicine,
Department of Allergy and Immunology. He is currently a second-year Internal Medicine Resident at Queens Hospital Center of Icahn School of Medicine at Mount Sinai.
pfaybuso@nyit.eduP Faybusovich et al., J Gastrointest Dig Syst 2017, 7:5 (Suppl)
DOI: 10.4172/2161-069X-C1-056