CHOLANGIOGENIC LIVER ABSCESSES: DIAGNOSIS, TREATMENT, COMPLICATIONS

In recent decades, the number of cases of patients with liver abscesses has been increasing in the world. This is due to the development of innovative methods of diagnosis, a decrease in the sensitivity of microorganisms to antibacterial therapy, antiseptic and disinfectant substances, a large number of cases of gallstone disease and its complications, and in some cases, a late request for help. The purpose of the study: to improve the results of treatment of cholangiogenic liver abscesses by improving surgical tactics and implementing minimally invasive techniques. Materials and methods. The object of the study were 56 patients with cholangiogenic liver abscesses (HLA) who were treated at the Clinical Highly Specialized Surgical Center of the Vinnytsia Regional Clinical Hospital named after M. I. Pirogov from 2013 to May 2023. Women predominated among the patients. The age of the patients is from 27 to 83 years, the average age is 55±1.4 years. Until the age of 60, HLA was 1.5 times more common among women than among men (58 % vs. 42 %). The duration of the disease is from 7 days to 4 months. The clinical diagnosis was based on clinical laboratory and instrumental research methods: ultrasound, fibrogastroscopy and MSCT with intravenous contrast. Operative interventions – percutaneous drainage, laparoscopic method, opening and drainage of abscess with laparotomy access. When prescribing antibacterial therapy for HLA, antibiotics of a broad spectrum of action (fluotoguinolones, aminoglycosides, cephalosporins) were used to the results of a bacteriological examination. After the results on the antibiotic sensitivity of the microbial fl on the 5-7th day, the correction of antimicrobial therapy was carried out in accordance with the result of the study. Among the microorganisms that were found during the bacteriological examination of the contents of the abscess, gram- negative fl prevailed, among which strains of Proteus, Streptococcus, Kl pneumoniae and Pseudomonas and their combination were most often detected. Complications in the postoperative period – suppuration of the surgical wound – in 8 cases, hospital-acquired pneumonia – in 2 cases, bilious and hemorrhagic hemorrhage – in 2 cases, early adhesion intestinal obstruction – in 3 cases. Lethality – 2 cases (3.57 %). Conclusions. 1. Cholangiogenic abscesses are formed when the patency of the bile ducts is disturbed: cicatricial strictures, choledocholithiasis, biliary fistulas, reflux cholangitis, atresia of the bile ducts, hepatolithiasis, Karoli’s disease, primary sclerosing cholangitis and complicated destructive cholecystitis. 2. Treatment should be started conservatively with massive antibacterial therapy, biliary drainage and drainage of HLA. 3. It is necessary to use mini-invasive methods of treatment for single HLA due to their low trauma, safety and short postoperative period in relation to laparotomy accesses. 4. HLA are most often localized in the 3rd, 6th and 7th segments of the liver. 5. With any method of surgical treatment of cholangiogenic liver abscesses, all patients are given antibacterial and remedial therapy.