A Case of Rupture of Liver Abscess 11 years after Duodenum-preserving resection of the head of the pancreas and Pancreatojejunostomy for Chronic Pancreatitis

This paper describes a case of liver abscess with septic shock that required emergency operation 11 years after duodenum-preserving resection of the head of the pancreas and pancreatojejunostomy to relieve intractable pain in chronic pancreatitis. A 49-year-old man was seen at our hospital with a chief complaint of fevers and chills caused by septic shock. Panperitonitis secondary to rupture of a liver abscess was suspected, and emergency surgery was performed. At surgery a ruptured liver abscess was observed and peritoneal lavage and abdominal drainage were performed. Percutaneous transhepatic abscess drainage (PTAD) after the operation contributed to decreasing the size of residual liver abscess. Pancreatojejunostomy has been effective in relieving the intractable pain of chronic pancreatitis. On the other hand, a causal association between pancreatojejunostomy and intra-abdominal abscesses occurring several years later and whose patho-genic mechanism is unclear has been described recently. In conclusion, abstinence from drinking and early diagnosis of intra-abdominal abscesses by long-term postoperative follow-up are required to prevent serious complications of chronic pancreatitis.