Salvage hepatectomy in refractory pyogenic liver abscess: a case report

Pyogenic liver abscess (PLA) is a rare but life-threatening condition. First-line management includes antimicrobial therapy and image-guided percutaneous drainage. Surgical resection is rarely required but remains an important method for definitive source control in selected cases. We report the case of a 65-year-old man with a large hepatic abscess that remained refractory to percutaneous drainage. Culture of the drain aspirate grew <i>Klebsiella aerogenes</i> and <i>Candida albicans</i>. Despite appropriate antimicrobial therapy, the patient's sepsis persisted, and imaging demonstrated inadequate resolution of the abscess. The patient underwent a hepatectomy and cholecystectomy. The post-operative course was complicated by a prolonged ileus, and the patient was well in his outpatient follow-up a few months after discharge. While uncommon in the modern era, hepatectomy remains a definitive treatment option for hepatic abscess when percutaneous drainage fails. Early recognition of treatment failure and timely escalation to surgery can be lifesaving.