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BMJ Case Rep. 2014 Jun 9;2014. pii: bcr2013202266. doi: 10.1136/bcr-2013-202266.

Pyogenic hepatic abscess presenting years after a choledochojejunostomy: a rare clinical occurrence.

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  • 1Department of Internal Medicine, Medical College of Georgia, Augusta, USA.
  • 2Department of Internal Medicine, Georgia Regents University-Medical College of Georgia, Augusta, Georgia, USA.


A 69-year-old Caucasian man presented with fever, chills/rigors and night sweats since 6 days. Blood cultures (4/4) initially reported Gram negative lactose-fermenting rods. Physical examination was fairly benign which included a normal abdominal examination. Laboratory tests were significant for an elevated white cell count, erythrocyte sedimentation rate and C reactive protein . Empirically, he was treated with piperacillin tazobactam. A chart review showed that he had undergone a choledochojejunostomy for a pancreatic head tumour 7 years before. We found a few reported cases of hepatic abscesses after choledochojejunostomy presenting years after the procedure. An abdominal CT scan confirmed our suspicion. Percutaneous drainage was performed and his antibiotics were switched to ciprofloxacin and metronidazole, based on the sensitivity report. The patient's clinical condition steadily improved.

2014 BMJ Publishing Group Ltd.

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