LAUSR

An 86-year-old woman with dementia and osteoporosis presented to the hospital with a 3-day history of right hypochondralgia and fever. On examination, she was febrile and ill-appearing. Laboratory tests showed white-cell count of 11.0 × 10/L and C-reactive protein level of 175.5 mg/L. We suspected cholecystitis, but contrast-enhanced computed tomography revealed an abscess at the ligamentum teres hepatis (LTH) that extended to the hepatic fissure (Fig. 1). We performed ultrasound-guided needle aspiration, and 8 mL of pus was obtained. Pus culture grew Serratia marcescens. She was treated conservatively because of advanced age and recovered after 8 weeks of antibiotics treatment. She has no recurrence. LTH is a remnant of the left fetal umbilical vein. The neonate’s umbilical vein is obliterated and replaced by the LTH in a week of birth. Including the present case, only 18 cases of abscess formation of the LTH are identified in the English literature, indicating the rarity of this disease. Most cases occur in the elderly and children. It may occur secondary to pancreatitis or biliary tract infections, but some cases are idiopathic as in our case. Computed tomography is the most important tool for diagnosis. The most common initial presentations of LTH abscess are fever, abdominal pain, and vomiting, thus it can be initially misdiagnosed as biliary tract infections, pancreatitis, or hepatic abscess. It is crucial, however, to differentiate between LTH abscess and hepatic abscess because the utility of antibiotics for LTH abscess remains doubtful. LTH abscess formation is easily relapsed with conservative treatment and may progress to generalized peritonitis, thus surgery should be performed regardless of the size of the abscess immediately after the diagnosis.