Pyogenic liver abscess: a very late and rare complication after pancreaticoduodenectomy

Despite significant amelioration of success rates registered in the last decades, currently, pancreaticoduodenectomy (PD) conducted for pancreatic cancer remains a formidable operation with a mortality of 4% and morbidity of 40%. According to the timing of presentation, postoperative adverse events are divided into early and late complications. The former occur within 1 month after PD and include (in decreasing order of frequency): delayed gastric emptying, pancreatoenterostomy leakage with pancreatic fistula, hepaticojejunostomy leakage, cholangitis, intra-abdominal infections, intra-abdominal and upper gastrointestinal bleeding. The latter develop more than 1 month following PD and are mainly represented by glucose intolerance or diabetes, long-term delayed gastric emptying, stomal ulcer and late cholangitis. Pyogenic liver abscess (PLA) is a very rare and little-known complication of PD: after having examined the world literature and excluded cases ensuing from ablation of liver metastases or hepatic artery embolization for bleeding or pseudo-aneurysmatic vascular stumps, as of 2016, we have found only 35 instances fulfilling the definition of merely post-surgical PLA.