A CASE OF LIGAMENTUM TERES HEPATIS ABSCESS DIAGNOSED BY A CT IMAGE

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  • ＣＴ画像が診断に有用であった肝円索膿瘍の１例

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A patient 71-year-old female came to the emergency room of our hospital with the complaint of vomiting and upper abdominal pain. Blood study revealed WBC of 11,100/μl, CRP of 0.5 mg/dl and serum amylase of 1472 IU/L and a diagnosis of acute mild pancreatitis was made and she was treated with pancreatic enzyme inhibitors, antibiotics and intravenous fluid administration. The value of serum amylase came down to normal on the 2nd day of treatment, but the abdominal pain worsened along with elevation of WBC and CRP value. Abdominal CT revealed a vague tumor shadow of 3×1.5 cm size on the midline of upper abdomen directly beneath the abdominal wall. On the 9th day of admission this tumor grew to the size of 7×4 cm with low consistency stripe pattern inside. Necrosis of ligamentum teres hepatis was suspected and laparotomy was performed which revealed abscess formation of the inflamed ligament. The culture of the specimen revealed Enterobacter cloacae and histological study revealed necrotic panniculitis. Abscess of ligamentum teres hepatis is classified as acute abdomen, but it is very rarely reported and therefore we report its surgical significance here.

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