Jetreni apsces kao terapijski i dijagnostički problem

Liver abscess still represents a significant clinical entity with mortality rates of up to 10%. Traditional treatment of liver abscesses is open surgical treatment. Recently, percutaneous and laparoscopic drainage has been increasingly used. Still, in spite of these relatively novel techniques and improved imaging, liver abscess can sometimes be difficult to diagnose or treat. Here we present two cases of chronic liver abscess treated at our department. First patient was twice hospitalized in other hospitals without reaching definitive diagnosis. He was admitted at our department because of clinical presentation of sepsis, and definitive diagnosis of liver abscess was established only during open surgery. Second patient was admitted after laparoscopic drainage and repeated percutaneous drainage had failed to resolve his symptoms. In both cases, liver segment resection led to complete healing. These cases indicate that chronic liver abscess can still present a diagnostic and therapeutic challenge.Jetreni apscesi i dalje predstavljaju ozbiljan klinički entitet sa stopom smrtnosti i do 10%. Tradicionalno liječenje apscesa jetre je putem otvorenog kirurškog zahvata, iako se u posljednje vrijeme sve češće rabi perkutana ili laparoskopska drenaža. Usprkos tim načinima liječenja i sve boljim dijagnostičkim metodama apsces jetre ponekad nije jednostavno niti dokazati ni liječiti. Ovdje prikazujemo dva slučaja kroničnog apscesa jetre liječena na našem odjelu. U prvom slučaju bolesnik je bio u dva navrata hospitaliziran u drugim ustanovama pod dijagnozom jetrene ehinokokoze. Kod nas je bio primljen zbog kliničke slike sepse. Cistična tvorba u jetri je dijagnosticirana kao apsces tek tijekom operacije. Učinjena je resekcija VII . segmenta jetre gdje se apsces nalazio. Drugi bolesnik je primljen nakon pokušaja laparoskopske drenaže i više pokušaja perkutane drenaže apscesa. U oba slučaja je učinjena segmentektomija jetre, što je dovelo do izliječenja bolesnika. Ova dva slučaja pokazuju kako kronični jetreni apscesi još uvijek ponekad predstavljaju dijagnostički i terapijski izazov