Successful Hepatectomy for a Liver Abscess With Portal Vein Thrombus and Hepatic Artery Dissection: A Case Report

Liver abscesses can be associated with biliary disease and are occasionally accompanied by portal vein thrombosis. Hepatic artery obstruction has been reported to result from aneurysms, thrombosis, iatrogenic factors, and arterial dissection; however, to the best of our knowledge, no cases of liver abscess with obstruction of the portal vein and hepatic artery have been reported. A 51-year-old man presented with a chief complaint of heartburn. A detailed investigation revealed common bile duct stones and an 8-cm multilocular abscess in the left lobe of the liver. Choledocholithiasis was achieved by endoscopic retrograde cholangiopancreatography. Despite antibiotic treatment with meropenem, his symptoms and inflammatory reaction did not improve, and computed tomography (CT) revealed obstruction of the left branch of the portal vein and left hepatic artery. Because it proved difficult to control his infection, we performed a left hepatic lobectomy. Histopathological examination of the operative specimen revealed a hepatic abscess with portal vein thrombosis and left hepatic artery dissection. The postoperative course was favorable, and the patient was discharged on postoperative day eight. Thirty months later, he continues to do well. We here report a patient with a liver abscess with portal vein thrombus and hepatic artery dissection whose infection was successfully controlled by hepatectomy.