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PubMed1987

Liver abscess. Review of a 12-year experience.

Experience with liver abscess was reviewed to determine whether new trends in treatment have altered clinical outcome. Thirty-one cases of liver abscess were identified from 1973 to 1985. In this group there were ten deaths for a mortality rate of 32 per cent; the primary disease accounted for seven deaths. Significant predictors of liver abscess mortality were multiple abscesses, elevated bilirubin levels, and underlying disease. Percutaneous drainage was effective in three of four patients and should be attempted before operative intervention in selected patients.

Female↗
PubMed1992

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases.

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Adult↗
PubMed1995

Pyogenic liver abscess: warning indicator of silent colonic cancer. Report of a case and review of the literature.

PURPOSE: Carcinoma of the colon, manifested clinically as an enterococcal hepatic abscess, in the absence of liver metastases, is very uncommon. However, having treated a patient with such a condition, we would like to draw the attention of surgeons to this possibility. Most reports describe secondary infections of hepatic metastases only in patients with a known malignancy. However, increased awareness of colonic cancer as an underlying cause of pyogenic liver abscesses will afford earlier diagnosis and treatment. METHODS: The case was analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: A 66-year-old woman presented with abdominal pain, fever, and chills. Imaging scans revealed a solitary liver abscess, which was successfully treated with percutaneous drainage and broad-spectrum intravenous antibiotics. Pus cultures grew Streptococcus faecalis. A search for the underlying cause led to the discovery of an adenocarcinoma of the sigmoid colon. CONCLUSIONS: An aggressive search for the underlying cause of pyogenic liver abscesses should be an integral part of the definitive treatment of this disease. After prevailing etiologies have been excluded, silent colonic cancer should be considered.

Adenocarcinoma↗
PubMed1991

Liver abscess as the initial manifestation of colonic Crohn's disease: report of a case.

Liver abscess is a rare complication of Crohn's disease and in most of the reported cases, the diagnosis of Crohn's disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohn's disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohn's disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohn's disease should be included in the differential diagnosis of diseases causing liver abscess.

Adult↗
PubMed2001

[Clinical features in six patients with liver abscess caused by Streptococcus milleri].

Among 39 patients with pyogenic liver abscess who were admitted to our institute, six (15%) were infected by Streptococcus milleri (S. milleri). We investigated clinical features of these six patients. There were five males and one female, aged 43-81 years old (mean: 61). Five of the six patients had underlying illness. All patients had fever, and three of them complained of abdominal pain. Three patients had mixed infections; particularly intraoral anaerobes, Fusobacterium, were found in two of the three patients. There were no differences in clinical features between patients with S. milleri liver abscess and those with other bacterial liver abscess. In conclusion, on selecting antibiotics for the treatment of liver abscess, it is necessary to consider the S. milleri and intraoral anaerobes.

Adult↗
PubMed2004

Liver abscess complicating transcatheter arterial embolization: a rare but serious complication. A retrospective study after 3878 procedures.

OBJECTIVES: Liver abscess is one of the complications of transcatheter arterial embolization (TAE) for hepatocellular carcinoma. We studied the clinical features and analysed the incidence, risk factors, helpful clinical clues, culture profiles and predictive factors of post-TAE liver abscess. The influence of abscess development on the evolution of the tumour process was also studied. METHODS: We retrospectively reviewed records of 3878 TAE procedures performed over a 6 year period. RESULTS: Ten cases of liver abscess developed in nine patients (eight males and one female). The incidence was 0.26% (10 episodes/3878 procedures). The main clinical presentations included fever (91.7%), chills (50%) and abdominal pain (33.3%). All but one febrile patient presented fever in a recurrent form. The positive culture rates were 41.7% for blood and 83.3% for pus. Gram negative bacteria were found in 80% of blood cultures and 68% of pus cultures. Polymicrobial infections were encountered in 60% of the blood cultures and 70% of pus cultures. Management included antibiotics, drainage and operation. Four patients died due to the direct complications of liver abscess. One patient experienced total tumour resolution after successful treatment for liver abscess. Patients with larger liver abscesses and patients with greater age carried higher mortality rates. CONCLUSIONS: Liver abscess is a rare complication after TAE for hepatocellular carcinoma. Recurrent fevers after an initial symptom free interval should arouse suspicion of an abscess. The mortality is high and a large abscess and higher age predict an unfavourable outcome. Abscess formation can lead to complete tumour resolution.

Adult↗
PubMed1995

[Detection of pathogenic Entamoeba histolytica DNA in liver abscess aspirates with polymerase chain reaction].

Polymerase chain reaction (PCR) was used to diagnose amebic liver abscess by detecting pathogenic Entamoeba histolytica DNA in liver aspirates from patients with liver abscess. Oligonucleotide primers specific for gene encoding of the 30,000 molecule of pathogenic Entamoeba histolytica were used in the test. Liver aspirates from 23 cases with amebic liver abscess as evidenced by typical clinical findings or very high titres of anti-E. Histolytica antibodies with ELISA were found to be positive with PCR. Fourteen control samples (3 cases of bacterial liver abscess, 1 of liver cancer and 10 of abscess in other sites) were all negative to PCR. The results suggest that PCR is a sensitive and useful method for diagnosing amebic liver abscess.

Animals↗
PubMed1986

Liver abscess in Crohn's disease. Report of four cases and review of the literature.

Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed. The incidence of liver abscess in patients with Crohn's disease (114-297 per 100,000) appears to be higher than that of liver abscess in the general population (8-16 per 100,000). Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed. In comparison to patients with liver abscess in the general population, patients with Crohn's disease and liver abscess are considerably younger, are more likely to have multiple rather than solitary abscesses, and usually have a predisposing intraabdominal focus of infection, rather than a biliary one. Streptococci, especially Streptococcus milleri, are the most frequent cause of liver abscess in patients with Crohn's disease. Liver scanning should be performed routinely in patients with Crohn's disease in whom a febrile illness cannot be completely explained by bowel disease, or in whom fever does not respond to drainage of intraabdominal abscesses.

Adult↗
PubMedDate not supplied

Liver abscess due to clostridium septicum. A case report and review of the literature.

The onset of liver abscess due to Clostridium septicum -an anaerobic gram-positive bacillus- is a rare condition, generally arising in cancer patients. The radiological picture is that of gas-containing pyogenic abscess, that predominates within preexisting liver metastases. We report a case of a 50-year-old patient with metastatic colon cancer who was referred with multiple Clostridium septicum liver abscesses. The patient underwent parenteral antibiotherapy as well as transcutaneous drainage of the largest liver abscess. However the outcome was unfavorable in a clinical picture of liver failure that was likely due to disease progression rather than sepsis. Clostridium septicum liver abscess is a life-threatening condition that occurs in fragile patients, mostly with metastatic cancers. A review of the reported cases is presented and treatment options are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Experimental anaerobic liver abscess: observations on treatment.

Various treatment modalities for solitary anaerobic liver abscesses were evaluated in a recently-described rabbit model. In the first phase of the experiment, 35 rabbits with liver abscesses induced with Bacteroides fragilis and Fusobacterium necrophorum were randomized into four groups: surgical drainage alone, drainage plus clindamycin 150 mg IM 8-hourly, clindamycin alone, and untreated controls. Serum clindamycin concentrations in rabbits were similar to those achieved in humans. The survival of rabbits receiving antibiotic chemotherapy alone was significantly better than controls, whereas the survival of those having surgical drainage with or without chemotherapy was not. However, successful surgical drainage was followed by weight gain in surviving rabbits. In the second phase of the experiment 18 rabbits with abscesses were randomized into the same groups. Aspirates of pus from all rabbits receiving clindamycin were sterile by day 7 of treatment, but high bacterial counts were still present in the abscess cavities of control rabbits and of those undergoing drainage alone. These findings illustrate the application of a new model for pyogenic liver abscess in laboratory investigation. Their relevance to management of human pyogenic liver abscesses remains to be assessed.

Animals↗
PubMed1993

The changing patterns of liver abscess during the past 20 years--a study of 482 cases.

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.

Adult↗
PubMed2000

Identification of a major cluster of Klebsiella pneumoniae isolates from patients with liver abscess in Taiwan.

Klebsiella pneumoniae has emerged as the leading liver abscess pathogen in Taiwan, with the percentage rising from 30% in the 1980s to over 80% in the 1990s. Most of the patients with K. pneumoniae liver abscess are diabetic and without biliary tract disease. Some patients develop serious extrahepatic complications such as endophthalmitis, meningitis, lung abscess, and necrotizing fasciitis. Pulsed-field gel electrophoresis (PFGE) was used for cluster analysis of 96 isolates from patients with liver abscess and 60 isolates from patients with other diseases. A total of 136 PFGE types were identified. Among the 96 liver abscess-associated isolates, 60 (62.5%) were classified in major cluster A. Cluster A included 41 PFGE types (types 1 to 41) which had a genetic similarity of at least 72.4% +/- 9.4%. The PFGE patterns of cluster A strains are so similar that they could have originated from the same ancestor. This study demonstrates that cluster A plays an important role in the high incidence of K. pneumoniae liver abscess in Taiwan.

Cluster Analysis↗
PubMed2004

Factors influencing colonic involvement in patients with amebic liver abscess.

BACKGROUND: The frequency of colonic involvement in patients with amebic liver abscess has not been studied in detail. The factors influencing colonic involvement also are unknown. METHODS: Seventy-one patients with amebic liver abscess were studied. Colonoscopy was performed in all patients. RESULTS: Abdominal pain and fever were the most common presenting manifestations. Ten patients (14%) had diarrhea at admission. Ten other patients had a history of diarrhea during the preceding 2 months. Thirty-nine (55%) patients had colonic ulcers. Colonic ulcers were present in 18 of the 20 (90%) patients with ongoing diarrhea or a history of recent diarrhea, and in 21 of 51 (41%) patients without diarrhea (p<0.001). Thirty (42%) patients had small, discrete ulcers in the cecum, the ascending colon, or the region of the hepatic flexure. Nine patients had large, multiple ulcers with surrounding inflammation. In these patients, the ulcers were present either in the left colon (n=7) or throughout the colon (n=2). The mean (standard deviation) age of patients with 5 or more ulcers was significantly greater than that of patients with fewer than 5 ulcers (49.8 [14.6] years vs. 37 [11.7] years; p<0.05). Multiple ulcers were noted in 7 of the 10 patients (70%) with diarrhea at admission and in two of the 61 patients (3%) in whom diarrhea was not a presenting symptom (p<0.001). No association was noted between the location of the abscess in the liver and the colonic lesions. CONCLUSIONS: Colonic ulcers are a common finding, occurring in more than half of patients with amebic liver abscess. They are more likely to be present if the patient has diarrhea as a presenting symptom or has had diarrhea in the recent past. Multiple, large, and left-sided ulcers are more common in elderly patients and in those in whom diarrhea is the presenting symptom. However, there is no association between the location of the abscess in the liver and colonic lesions.

Adolescent↗
PubMed1991

Septic endophthalmitis associated with bacteremia and liver abscess caused by Klebsiella pneumoniae.

Pyogenic liver abscess is a serious clinical problem associated with severe complications in 10-20% of cases. Metastatic septic endophthalmitis is a rare complication associated with liver abscess. Despite appropriate treatment the outcome is devastating. We will review in this case presentation some important aspects of the etiology, diagnosis and treatment recommendations for septic endophthalmitis.

Bacteremia↗
PubMed2003

Supra infection of amoebic liver abscess consequent to acute appendicitis. Clinical case.

Amoebic liver abscess is the most common extra-intestinal manifestation of amebiasis with approximately 10% of the world's population infected by this parasite. Actually, incidence of this infection is also increasing in industrialized countries, as a consequence of the more frequent immigration or travelling. Only 3-10% of patients with intestinal amebiasis develop liver abscess. A clinical case of suprainfection of amoebic liver abscess consequent on acute appendicitis is presented.

Acute Disease↗
PubMed1984

Liver abscess: complication of a ventriculoperitoneal shunt.

Liver abscess is a previously unreported complication of ventriculoperitoneal shunting. We present such a case, which was diagnosed by computed tomography (CT) and managed by CT-guided percutaneous catheter drainage of the liver abscess, appropriate antibiotics, and shunt externalization.

Adult↗
PubMed1991

Amebic liver abscess: a 15-year experience.

Amebic liver abscess is increasingly common in the United States, particularly in the West and Southwest, due to increased immigration from Southeast Asia, Mexico, and Central America. The presentation, course, and treatment of 50 patients treated for amebic liver abscess at a county-community hospital in San Jose, California, between 1974 and 1988 is reviewed. The typical patient is an immigrant, usually a Hispanic male, 20-40 yr old, who presents with fever, right upper quadrant pain, leukocytosis, abnormal serum transaminases and alkaline phosphatase, and a defect on hepatic imaging study. Available serologic testing (i.e., indirect hemagglutinin antibody) is sensitive and confirms the diagnosis. Most patients respond rapidly and completely to oral metronidazole. The data, compared with other studies, indicate no major change in presentation or management, except for decreasing need to aspirate the abscess for diagnosis.

Adult↗
PubMed1995

[Liver abscess caused by Streptococcus anginosus].

Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases. We report the case of a 77-year-old female with gastric cancer and liver abscesses by Streptococcus anginosus.

Adenocarcinoma↗