Staged percutaneous management of multiple postoperative pyogenic liver abscesses following cholecystectomy in a patient with type 2 diabetes: a case report

Background: Pyogenic liver abscesses remain a serious postoperative complication, particularly in patients with type 2 diabetes mellitus. The optimal staged, minimally invasive management of multiple postoperative abscesses remains challenging. Case presentation: A 46-year-old woman with type 2 diabetes mellitus developed high-grade fever, intoxication, and right upper quadrant pain 2 weeks after a laparoscopic cholecystectomy for acute calculous cholecystitis complicated by cholangitis. Laboratory evaluation demonstrated anemia, neutrophilic leukocytosis, elevated bilirubin, and inflammatory markers. Ultrasound and contrast-enhanced CT identified multiple liver abscesses, the largest measuring 10.4 × 9.1 cm. Management and outcome: Given the patient’s high operative risk, a staged minimally invasive strategy was chosen. Initial percutaneous transhepatic drainage of the largest abscess was performed under ultrasound guidance, yielding 250 mL of purulent material, followed by continuous irrigation. Microbiological culture identified Klebsiella pneumoniae, and targeted antimicrobial therapy was initiated. Persistent signs of intoxication prompted repeat imaging, which demonstrated a residual abscess in segments V–VI. A second percutaneous drainage procedure was performed. The patient showed rapid clinical and laboratory improvement after the second intervention and was discharged on day 9. Follow-up CT 1 month later demonstrated small, well-drained residual cavities without contrast accumulation. All drains were removed on day 39, and the patient fully recovered. No recurrence was observed during the 6-month follow-up. Conclusion: This case highlights the effectiveness of a staged percutaneous approach for managing multiple postoperative liver abscesses in a high-risk patient. Dynamic imaging, appropriate drainage techniques, and stepwise, minimally invasive management allowed complete resolution without the need for open surgery.