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Ultrasound-guided percutaneous catheter drainage produced Enterococcus faecalis cultures, followed by 10 days targeted antibiotics, rapid improvement, marker normalization, and ultrasound-confirmed resolution without 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complication is described in the case report?","Question",{"text":63,"@type":64},"The case report describes a pyogenic liver abscess developing after ERCP for choledocholithiasis, treated successfully with percutaneous drainage.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the diagnosis and localization of the abscess confirmed?",{"text":68,"@type":64},"Imaging identified a 6-cm abscess in segment 7 of the liver, and abdominal ultrasound also documented liver and biliary findings during the diagnostic workup.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment approach led to recovery and avoidance of surgery?",{"text":72,"@type":64},"Ultrasound-guided percutaneous catheter drainage was performed, followed by 10 days of targeted antibiotic therapy based on culture results, resulting in rapid clinical improvement and ultrasound-confirmed 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Abscess: Successful Management of a Rare Complication—A Case Report  \nYavor Asenov1,2  | Georgi Jelev1,2 | Ivan Vasilev1,2  | Boris Kunev1,2  | Marin Parunev1,2 | Nikolay Penkov1,2 | Teophil Sedloev1,2 | Ivan Dimitrov1,2   \n1Department of Surgery, University Hospital “Tsaritsa Joanna – ISUL”, Medical University, Sofia, Bulgaria | 2Department of Gastroenterology, University  \nHospital “Tsaritsa Joanna – ISUL”, Medical University, Sofia, Bulgaria Correspondence: Ivan Dimitrov ([ivanvalentinovdimitrov@gmail.com](ivanvalentinovdimitrov@gmail.com))  \nReceived: 27 March 2025 | Revised: 23 October 2025 | Accepted: 21 December 2025  \nKeywords: biliary stent | endoscopic retrograde cholangiopancreatography (ERCP) | percutaneous drainage | post-ERCP liver abscess | pyogenic liver abscess  \nABSTRACT  \nEndoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is an established treatment for choledocholithiasis but may rarely lead to pyogenic liver abscess (PLA) . We report the case of a 72-year-old woman with a history of biliarystenting who presented with jaundice and cholestasis. ERCP with lithotripsy and sphincterotomy successfully cleared multiple stones, but she developed high fever and leukocytosis within 48 h. Imaging revealed a 6-cm abscess in segment 7 of the liver. Ultrasound-guided percutaneous catheter drainage was performed, yielding purulent material that cultured Enterococcus faecalis. The patient received a total of 10 days of targeted antibiotic therapy, with rapid defervescence, normalization of inflammatory markers, and ultrasound-confirmed resolution of the abscess. She was discharged in stable condition, without recurrence. This case highlights the value of percutaneous drainage as a minimally invasive and effective management option for post-ERCP PLA and emphasizes the importance of structured long-term follow-up in patients with biliary stents.  \n1 | Introduction  \nEndoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) remains the gold standard for bile duct stone management, offering effective and minimally invasive biliary decompression and stone extraction [1] . Although generally safe, ERCP with ES carries inherent risks, including rare but potentially life-threatening complications such as pyogenic liver abscess (PLA), particularly in patients with a disrupted hepatobiliary barrier [2] . The cumulative incidence of  \nPLA after ES has been reported as approximately 2.4% at 5 years and 3.9% at 10 years [3] . Management strategies continue to evolve, but timely diagnosis and effective source control remain essential, with minimally invasive drainage playing a central role in most patients.  \nHere, we report a case of a unilocular liver abscess developing after ERCP for choledocholithiasis, successfully treated with percutaneous drainage. This case highlights the interplay of pathophysiology, risk factors, and clinical decision-making in  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.  \nClinical Case Reports, 2026; 14:e71814 1 of 6  \n[https://doi.org/10.1002/ccr3.71814](https://doi.org/10.1002/ccr3.71814)  \nKey Clinical Message  \nLiver abscess following ERCP is a rare complication that requires prompt recognition. This case demonstrates that ultrasound-guided percutaneous drainage combined with antibiotics can lead to full recovery and avoid surgical intervention.  \npost-ERCP PLA and reinforces the role of percutaneous techniques as a cornerstone in the management of post-procedural hepatobiliary infections.  \n2 | Case Presentation  \n2.1 | Patient History and Presenting Symptoms  \nWe present the case of a 72-year-old female admitted to th","cbCain9hIlAuGqXm","https://ap.wps.com/l/cbCain9hIlAuGqXm","pdf",603720,"English","# Abstract\n# Introduction\n# Case Presentation\n## Patient History and Presenting Symptoms\n## Diagnostic Workup\n## Key Clinical Message","[{\"question\":\"What complication is described in the case report?\",\"answer\":\"The case report describes a pyogenic liver abscess developing after ERCP for choledocholithiasis, treated successfully with percutaneous drainage.\"},{\"question\":\"How was the diagnosis and localization of the abscess confirmed?\",\"answer\":\"Imaging identified a 6-cm abscess in segment 7 of the liver, and abdominal ultrasound also documented liver and biliary findings during the diagnostic workup.\"},{\"question\":\"What treatment approach led to recovery and avoidance of surgery?\",\"answer\":\"Ultrasound-guided percutaneous catheter drainage was performed, followed by 10 days of targeted antibiotic therapy based on culture results, resulting in rapid clinical improvement and ultrasound-confirmed resolution.\"}]","Percutaneous Drainage of a Post-ERCP Liver Abscess: Successful Management of a Rare Complication - A Case Report | PDF",1790679875,15]