図１〜図５までの△は被膜下の，図４〜図８の▲は肝実質内のガスと低吸収値の液体でニボーを形成し，不整形で膿瘍であろう．図１〜図７の肝中央部の液貯留（↑）は，図３でdensityは１が42.7 HU，２が38.4 HUと30以上だから血腫，bilio-hematomaまたは感染した血腫で，bilomaは20以下といわれるので単純な bilomaではない．図Aのごとく経皮的経肝的ドレナージで膿が排出され，1ヶ月で治癒退院した．膿培養からはα-streptococcusが検出された．

参考症例（感染性biloma）：63歳男性．運転中の交通事故で右胸腹部を打撲し来院した．血圧：170/88mmHg，脈拍：96/分．腹部全体に軽度の圧痛があるが軟．

肝右葉に損傷があり，図２と図３でextravasationと思われる造影剤の貯留（△）を認める．血管造影でextravasation（図６：▲）が確認され塞栓術で止血に成功した．2週間後に38度台の発熱が出現した（下段の図７〜図１２）．肝損傷部と肝外（図１１と図１２：※）に低濃度の液貯留を認めるが，図８でガス（↑）を認め，感染を強く示唆する．図９と図１０の白矢印は脂肪組織が存在する部位だから，ガスか脂肪組織か判断不可能である．経皮的ドレナージで胆汁が排出され，まもなく解熱した．胆汁の培養でE.coli が検出された．

文献考察：保存的治療後の外傷性肝膿瘍の頻度は1．5％で，すべてAAST grade III以上の症例
Langenbecks Arch Surg. 2003 Jan;387(9-10):343-7.
Liver abscess after non-operative management of blunt liver injury.
Hsieh CH, Chen RJ, Fang JF, Lin BC, Hsu YP, Kao JL, Kao YC, Yu PC, Kang SC, Wang YC.

BACKGROUND: The non-operative management of blunt liver trauma can be applied in almost 80% of patients with this type of injury, with the advantages of the need for fewer blood transfusions, less intra-abdominal sepsis, and a better survival rate, than with the operative approach. However, liver abscess, as a known complication of the non-operative management of blunt liver trauma, is discussed infrequently. Therefore, we herein review our experience and describe this complication in detail. MATERIALS AND METHODS: From 1995 to 2001, 674 patients were admitted to our hospital due to blunt hepatic trauma. Among these patients, 279 underwent laparotomy and the remaining 395 patients were treated non-operatively. Twenty-two patients were identified as having liver abscess, with 16 of them belonging to the operative group, and six to the non-operative group. A retrospective review of these six patients and their characteristics, as well as pathogenesis, diagnosis, and the management of the liver abscesses, was conducted. RESULTS: These six patients were all male, with a median age of 19.5 years (range 3-24). The median injury severity score was 16.5 (range 9-25); three patients sustained grade-3 hepatic injury, and the other three were grade 4. The main diagnostic tool was abdominal computed tomography, and the abscesses took a median of 6 days (range 1-12) to form and be diagnosed. The abscesses were usually caused by infection from mixed organisms, and an abscess resulting from Clostridium infection developed within 1 day after injury. These abscesses were treated with antibiotics and drainage, and the median length of hospital stay was 26 days (range 8-44), without mortality or long-term morbidity. CONCLUSION: Liver abscess as a complication of the non-operative management of blunt hepatic trauma is a rare entity, with an incidence of 1.5% (6/395). It is usually seen in severe liver injury (grade 3 and above), but all our patients were all treated successfully, with no mortality. However, prolonged hospitalization may be required in this patient group.　PMID: 12536329