Pyogenic liver abscess following Roux-en-Y choledochojejunostomy in advanced pancreatic cancer: a retrospective case series

Background Roux-en-Y choledochojejunostomy increases the incidence of pyogenic liver abscess, but no cohort study has been reported to date on pyogenic liver abscess occurring in pancreatic cancer patients after Roux-en-Y choledochojejunostomy. Methods This article (Oct 2020–Sep 2024) analyzed 81 advanced pancreatic cancer patients undergoing Roux-en-Y choledochojejunostomy, of whom 11 (13.6%) developed postoperative PLA. Data included preoperative labs, imaging, microbiology, and outcomes. Results The study (6 males, 5 females; mean age 65.3 ± 12.2 years) exhibited elevated preoperative biomarkers: CA19-9 (395.3 ± 513.8 U/mL), ALT (131.7 ± 149.7 U/L), total bilirubin (109.8 ± 121.9 µmol/L). Median PLA onset was 6.0 months postoperatively (range:1.0–30.0). Abscesses were solitary (45.5%, 5/11) and multiple (54.5%, 6/11), averaging 12.4 ± 8.3 cm. CT revealed gas-containing cavities in 36.4% (4/11). Pus cultures were positive in 81.8% (9/11), dominated by Klebsiella pneumoniae (55.6%) and Escherichia coli (44.4%), with 33.3% polymicrobial infections. All patients received antibiotics plus percutaneous drainage (median hospitalization:19 days; 1 recurrence). No major surgical complications occurred. Mortality reached 54.5% (6/11) by Dec 2024, with median survival of 9.0 months. Literature review identified 10.5% PLA incidence post-choledochojejunostomy (vs. 0.0023–0.0155% in general population), driven by bacterial translocation, immunosuppression, and hepatic ischemia. Conclusions PLA incidence after Roux-en-Y choledochojejunostomy in pancreatic cancer patients is 13.6%, predominantly caused by Gram-negative bacilli. Early antibiotic-minimally invasive drainage remains critical. Clinicians should monitor high-risk patients for delayed PLA onset (median 6 months).