Patient Discharged With Untreated Hepatic Abscess

This case involves a forty-five-year-old female who presented to the emergency room with a history of severe right upper quadrant abdominal pain. A CT scan of her abdomen revealed a non-specific vascular liver lesion. At the time of diagnosis, the lesion was biopsied and found to be nonmalignant. On this visit, the patient underwent a hepatic angiogram with embolization, which characterized the lesion as a hemangioma with necrosis and hemorrhagic infiltrates. After the procedure, the woman experienced an acute loss of appetite which was never resolved during the admission. The patient was discharged two weeks after the admission despite a lack of improvement in her overall clinical status. Two days after discharge, she established subsequent care at another hospital where she was diagnosed with a hepatic abscess. The patient required a right hepatic lobectomy which resulted in intraoperative hemorrhage that resulted in an extended hospital stay in an ICU setting.

Question(s) For Expert Witness

1. What are the risks of discharging a patient with an untreated hepatic abscess?

Expert Witness Response

An untreated hepatic abscess can lead to fatal complications in the patient. Examples include sepsis, empyema, or peritonitis from rupture of the hepatic abscess into the pleural, peritoneal and retroperitoneal extension. Depending on the type of abscess, treatment involves percutaneous drainage or surgically removing the lobe of the liver. In certain abscesses, performing surgery is not recommended as there is a great risk of rupture; thus antibiotic therapy would be the treatment modality. Although most surgeons do not advocate antibiotic therapy, it has been successful in a few reported cases. The non-invasive approach may be the alternative in patients who are too ill to undergo invasive procedures. In these circumstances, patients are likely to require extensive antimicrobial therapy.