TY - JOUR
AR - AJSCR-2024-1-103
TI - Pyogenic Hepatic Abscess Formation after Roux-En-Y Gastric Bypass: A Case Report and Literature Review of an Infrequently Encountered Postoperative Complication
AU - Athary, Saleem
AU - Saqer, Alenezi
AU - Nimer, Al-Shadidi
AU - Khaleel, Mohammad
JO - American Journal of Surgical Case Reports
PY - 2024
DA - Wed 03, Apr 2024
SN - 2674-5046
DO - http://dx.doi.org/10.31487/j.AJSCR.2024.01.03
UR - https://www.sciencerepository.org/pyogenic-hepatic-abscess-formation_AJSCR-2024-1-103 
KW - Liver abscess, Roux-en-Y gastric bypass, percutaneous drainage, bariatric surgery, case report
AB - Introduction and Importance: Pyogenic liver abscess (PLA) is an uncommon postoperative complication of Roux-en-Y gastric bypass (RYGB). Radiological investigations such as abdominal ultrasonography (USG) and computed tomography (CT) are crucial to evaluate and diagnose intra-abdominal abscesses, especially hepatic collections.
Case Presentation: A 66-year-old female patient with multiple comorbidities, including urticaria requiring monoclonal antibody therapy (humera). She underwent an uneventful RYGB to treat her weight regain and reflux after a prior sleeve gastrectomy and presented with diffuse abdominal pain. This occurred on postoperative day 23 after the patient was discharged home. Patient evaluation was initiated by physical examination, laboratory investigations, and radiological diagnostic tools. Chest and abdominal X-rays together with abdominal ultrasonography were unremarkable. Then, abdominal computed tomography (CT) scans with IV contrast were done, and a liver abscess was detected. Image-guided percutaneous transhepatic liver abscess drainage through pigtail drain placement was performed. The patient’s response was evaluated by serial abdominal CT scans. The liver abscess was successfully treated by percutaneous drainage for 5 weeks and IV antibiotic therapy.
Clinical Discussion: PLA is a rare entity that might occur after gastro-intestinal surgery such as Roux-en-Y gastric bypass. Patients with a history of immunosuppressive therapy may be at increased risk of this complication. This life-threatening complication can be prevented by treating liver abscesses early on by utilizing imaging-guided drainage and intravenous antibiotics. 
Conclusion: Due to the unusual etiologic origin of hepatic abscess post-RYGB, we report the case of a 66-year-old female with diffuse abdominal pain, which was found to be caused by PLA.