A rare complication of pyogenic hepatic abscess after laparoscopic sleeve gastrectomy—case report and literature review emphasizing the role of imaging


      • Pyogenic hepatic abscess is a rare complication after laparoscopic sleeve gastrectomy (LSG).
      • Causes of pyogenic hepatic abscess after (LSG) include hematoma or staple line leak, portal pylephlebitis or cryptogenic.
      • Contrast-enhanced CT has 95% sensitivity in the diagnosis of pyogenic hepatic abscess.
      • Imaging is essential to rule out staple line leak, assess the extent of disease and offer percutaneous drainage.


      A pyogenic hepatic abscess is an uncommon complication after laparoscopic sleeve gastrectomy (LSG) that can develop secondary to an infected hematoma or a staple line leak due to bacterial seeding. Appropriate screening for and management of a pyogenic hepatic abscess are essential in patients with clinical suspicion for complications after LSG. Early diagnosis is essential as pyogenic hepatic abscess can be fatal if not treated early. Only five cases have been reported in the literature so far. We present a case of pyogenic hepatic abscess that occurred two weeks after LSG in a 46-year-old female without immunosuppressive conditions or early postoperative leak. The abscess was diagnosed by computed tomography (CT) and was successfully treated with antibiotics and CT-guided drainage.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abdelhady M.H.
        • Salama A.F.
        • Karam M.
        • Bashah M.
        Solid organ infections: rare complications after laparoscopic sleeve gastrectomy: a report of four cases.
        Obes Surg. 2017; 27: 1374-1380
        • Avallone M.
        • Iossa A.
        • Termine P.
        • Silecchia G.
        Splenic and concomitant liver abscess after laparoscopic sleeve gastrectomy.
        CRSLS. 2018; 71e2017
        • Cervera-Hernandez M.E.
        • Pohl D.
        Splenic abscess caused by Streptococcus anginosus following laparoscopic sleeve gastrectomy: a case report of a rare complication of bariatric surgery.
        J Surg Case Rep. 2017; 2017rjx072
        • Demir H.
        • Ozdemir K.
        • Karaman K.
        Pyogenic liver abscess after laparoscopic sleeve gastrectomy.
        Pak J Med Sci. 2018; 34: 767-769
        • Alfalah H.
        • D’Souza J.
        • Abbass G.
        Liver abscess, a rare complicationpost sleeve gastrectomy.
        in: XVI annual meeting of European Society of Surgery. 2012: 1-70
        • Tsai M.S.
        • Lin C.L.
        • Jeng L.B.
        Gastrectomy is associated with an increased risk of pyogenic liver abscess: a 13-year nationwide cohort study.
        Sci Rep. 2016; 6: 33788
        • Doyle D.J.
        • Hanbidge A.E.
        • O'Malley M.E.
        Imaging of hepatic infections.
        Clin Radiol. 2006; 61: 737-748
        • Garrido D.
        • Bush L.M.
        Liver abscess as a complication of laparoscopic gastric banding bariatric surgery.
        Surg Infect (Larchmt). 2013; 14: 464-469
        • Kaba A.
        • Odufalu F.D.
        • Ahmed Z.
        • Prather C.
        • Nazzal M.
        Recurrent perihepatic abscesses arising from a gastric remnant leak: delayed complication of a revision roux-en-Y gastric bypass.
        Case Rep Surg. 2021; 2021: 5510526
        • Chivot C.
        • Robert B.
        • Lafaye N.
        • Fuks D.
        • Dhahri A.
        • Verhaeghe P.
        • Regimbeau J.M.
        • Yzet T.
        Laparoscopic sleeve gastrectomy: imaging of normal anatomic features and postoperative gastrointestinal complications.
        Diagn Interv Imaging. 2013; 94: 823-834
        • Liu Y.
        • Yang N.N.
        • Guan Y.S.
        • He Q.
        Anastomotic leakage with abscess after laparoscopic sleeve gastrectomy for obesity: report of a series and review of literature.
        Ther Adv Gastrointest Endosc. 2020; 132631774520925963
        • Brockmeyer J.R.
        • Simon T.E.
        • Jacob R.K.
        • Husain F.
        • Choi Y.
        Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature.
        Obes Surg. 2012; 22: 1039-1043
        • Kim K.W.
        • Choi B.I.
        • Han J.K.
        • Kim T.K.
        • Kim A.Y.
        • Lee H.J.
        • Kim Y.H.
        • Choi J.I.
        • Do K.H.
        • Kim H.C.
        • Lee M.W.
        Postoperative anatomic and pathologic findings at CT following gastrectomy.
        Radiographics. 2002; 22: 323-336