Pyogenic Liver Abscess Leading to IVC Syndrome

Abstract

Introduction: Inferior Vena Cava (IVC) syndrome is caused by compression of IVC in the abdominal cavity. It is characterized by abrupt onset of ascites, hepatomegaly, splenomegaly and fluid retention below the diaphragm with edema of the lower extremity. In clinical practice, it is encountered much less frequently than Superior Vena Cava Syndrome. Amoebic liver abscess has been reported as a cause of IVC syndrome but that is very rare. We hereby present a case of pyogenic liver abscess presenting as IVC syndrome, which is the first reported case to the best of our knowledge. Case Report:  A 3 year old male child with fever and pain abdomen for 15 days was referred to our institute with outside ultrasound (USG) abdomen suggestive of liver abscess. USG abdomen done in our institute confirmed the findings. Child was admitted and started on empirical IV antibiotics. On day 3 of admission, child developed swelling of bilateral lower limbs, scrotum and abdominal distension, findings consistent with inferior vena cava syndrome. CECT abdomen was done to rule out malignancy. It showed significant IVC compression. The pus culture sent from ultrasound guided tap showed Methicillin resistant Staphylococcus aureus and Klebsiella pneumoniae grew in the subsequent attempt to relieve compression. IV antibiotics were adjusted according to sensitivity but there was no relief of symptoms. Surgical drainage of abscess through posterior thoracotomy was done which led to resolution of symptoms in the next 48 hours. Discussion: Although a rare occurrence, IVC syndrome can be a distressing and difficult to treat condition when accompanied with mass effect. In such circumstances, surgical drainage might be the only option and must be sought once USG guided drainage fails.