Research progress on pyogenic liver abscess after pancreaticoduodenectomy

Pancreaticoduodenectomy (PD) is the standard surgical procedure for diseases of the pancreatic head and periampullary region. Pyogenic liver abscess (PLA) is a rare but potentially devastating complication after PD, with reported mortality of 14–28.6%. Its occurrence is often not isolated but is associated with pancreatic fistula, biliary leakage, anastomotic stenosis, and other perioperative factors. This review aims to systematically summarize the epidemiology, risk factors, pathogenesis, diagnosis, treatment, and follow-up management of PLA after PD, and to construct a clinically applicable cognitive framework from basic mechanisms to practical management. A narrative review with a systematic literature search was conducted using PubMed, Web of Science, and the Cochrane Library for publications from January 2000 to December 2025. Two authors independently screened and extracted data. PLA after PD shows a bimodal onset pattern, a predilection for the right hepatic lobe, and a predominance of gram-negative bacteria, especially Klebsiella pneumoniae. Early PLA is mainly related to surgery-associated factors such as biliary leakage, hepatic artery injury, and pancreatic fistula, whereas late PLA is associated with diabetes, bilioenteric anastomotic stenosis, and postoperative radiofrequency ablation. Diagnosis relies on symptoms, inflammatory markers, imaging, and bacteriological culture. Treatment requires individualized drainage—percutaneous, surgical, or endoscopic—combined with antibiotics. Endoscopic intervention, especially double-balloon enteroscopy-assisted ERCP, is valuable for late PLA caused by anastomotic stenosis. Given the limited number of high-quality studies, current evidence should be interpreted with caution. Future multicenter prospective studies are needed to define incidence, risk factors, outcomes, and standardized follow-up strategies.