Zhang K, Zhang HL, Guo JQ, Tu CY, Lv XL, Zhu JD. Repeated bacteremia and hepatic cyst infection lasting 3 years following pancreatoduodenectomy: A case report. World J Clin Cases 2022; 10(25): 9156-9161 [PMID: 36157635 DOI: 10.12998/wjcc.v10.i25.9156]
Corresponding Author of This Article
Jing-De Zhu, BSc, Chief Physician, Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. lszjd12@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kun Zhang, Heng-Li Zhang, Jing-Qiang Guo, Chao-Yong Tu, Xin-Liang Lv, Jing-De Zhu, Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui 323000, Zhejiang Province, China
Author contributions: Zhang K was responsible for collecting the medical history, reviewing the literature, and drafting the manuscript; Zhang HL and Guo JQ reviewed the literature and contributed to revising the manuscript; Tu CY and Lv XL analyzed the image findings and contributed to manuscript drafting; Zhu JD were the patient’s chief surgeons and reviewed the literature and contributed to manuscript drafting; all authors issued the final approval for the version to be submitted.
Supported bythe Health Commission of Zhejiang Province, No. 2020KY1088; and the Traditional Chinese Medicine Administration of Zhejiang Province, No. 2020ZB304.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-De Zhu, BSc, Chief Physician, Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. lszjd12@163.com
Received: April 28, 2022 Peer-review started: April 28, 2022 First decision: June 8, 2022 Revised: June 13, 2022 Accepted: August 1, 2022 Article in press: August 1, 2022 Published online: September 6, 2022
Abstract
BACKGROUND
Simple hepatic cysts are commonly occurring lesions that are usually asymptomatic and require no treatment. Hepatic cyst infection, however, is considered a severe complication. We report a case of hepatic cyst infection following pancreatoduodenectomy with repeated fever lasting for almost 3 years, and two cysts were infected successively.
CASE SUMMARY
A 72-year-old woman diagnosed with adenocarcinoma of duodenal papilla underwent pancreatoduodenectomy with Child reconstruction. She then suffered repeated occurrences of bacteremia and hepatic cyst infection for 3 years. Blood cultures were positive for Klebsiella pneumoniae and Escherichia coli a total of 7 times and 4 times, respectively. During the early stage, we suspected that postoperative reflux cholangitis was the cause of fever and bacteremia. Multiple cysts were observed, so it was difficult to determine which cyst was infected. Through repeat examination, we found the focus of infection, and we treated the patient with antimicrobials and performed percutaneous cyst drainage. The patient did not experience another cyst infection for more than 4 years.
CONCLUSION
Biliary reconstruction inducing hepatic cyst infection is easily misdiagnosed as biliary reflux infection, Repeated imaging examination is a method for identifying the infected focus.
Core Tip: Biliary reconstruction can induce repeated hepatic cyst infection for multiple cysts. Repeated imaging examination is a good method for identifying the infected focus. Antimicrobial treatment and percutaneous cyst drainage are simple and effective method to control infection.
