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PubMed1992

Percutaneous debridement of complex pyogenic liver abscesses.

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous debridement using an instrument specially designed for that purpose. Four patients were chronically ill but stable, while the other two were septic, hypotensive and considered to be life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. Contrast enhanced CT of the abdomen in all cases revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases, resulting in complete healing within 12 days. Follow-up for 1-4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well developed external capsule and internal septations, and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses. This preliminary experience makes the authors to conclude that percutaneous debridement of pyogenic liver abscesses is a safe and curative procedure in selected cases of life-threatening chronic liver abscesses.

Debridement↗
PubMed1984

Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage.

The presenting features, modes of treatment and clinical course were reviewed for 55 patients with pyogenic liver abscess, seen at Duke University Medical Center over a 15-year period. Thirty-three patients had a solitary abscess and 22 had multiple abscesses. Most patients were between the ages of 40 and 60 years. Males predominated, 2.4:1. Major underlying conditions included biliary tract disease, malignancy and colonic disease. Eight patients, each with a solitary abscess, had no identifiable underlying condition. Symptoms and signs were nonspecific: fever, chills, focal abdominal tenderness and hepatomegaly were common. A raised serum alkaline phosphatase level was the most consistent abnormal laboratory finding. CT with contrast enhancement, radioisotope scanning and ultrasonography all accurately defined solitary hepatic abscesses. However, CT scan was more successful than other imaging techniques in detecting multiple abscesses. In seven patients the diagnosis was made only at laparotomy. Overall, a diagnosis of liver abscess was made in 50 living patients (91%). Microorganisms were recovered from pus and/or blood cultures of 44 patients (80%). Most common were enteric gram-negative facultative rods, anaerobic gram-negative rods, and microaerophilic streptococci. Single abscesses were more likely than multiple abscesses to contain more than one organism. All patients received antibiotics; the choice of antibiotic does not appear to be critical provided the regimen has a broad spectrum including activity against anaerobes. Surgical or percutaneous drainage was successful when attempted in all patients with a single abscess, but the outcome was less favorable in those with multiple abscesses. Percutaneous drainage is currently replacing open operative drainage as the method of choice. Overall mortality in patients with single abscesses was 15% (5/33) and in those with multiple abscesses 41% (9/22).

Adolescent↗
PubMed2001

Pyogenic liver abscess: an audit of 10 years' experience and analysis of risk factors.

BACKGROUND/AIMS: Despite continuous improvement in image modalities, availability of potent antibiotics and advancement in the knowledge and treatment of pyogenic liver abscess, mortality remains high. The high mortality rate has underlined the important role of prognostic factors and prompts a number of studies to identify the risk factors. The present study aims to audit our experience in managing patients with pyogenic hepatic abscess during the period of 1989-1999, and to document changes in etiology, bacteriology and outcome, and to identify any risk factor associated with mortality. METHODS: One hundred and thirty-three patients with pyogenic hepatic abscess were studied to determine the demographic characteristics, clinical features, laboratory, bacteriological findings, methods of treatment, final outcome and risk factor analysis. All patients were treated with parenteral antibiotics. One hundred and twelve patients were subjected to ultrasound-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in all patients. Laparotomy was done in 21 patients. RESULTS: The overall hospital mortality rate was 6% (8/133). Biliary tract disease was the most frequently identified cause. Leukocytosis, hypoalbuminemia and hyperbilirubinemia were common laboratory findings. The most common microorganism cultured was Klebsiella pneumoniae. The most common concomitant disease was diabetes mellitus. On univariate analysis, large abscess, diabetes mellitus and sepsis were significantly associated with hospital mortality. On multivariate logistic regression analysis, the presence of sepsis (p = 0.0031) was found to be an independent risk factor. CONCLUSIONS: In addition to early diagnosis and prompt treatment, making every effort to treat patients with adverse prognostic factors and systemic complications, the hospital mortality rate will be decreased significantly.

Adult↗
PubMed1995

Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance.

PURPOSE: To determine the efficacy of percutaneous needle aspiration (PNA) with antibiotic therapy in treatment for pyogenic liver abscess (PLA). MATERIALS AND METHODS: One hundred fifteen patients (59 male; 56 female; age range, 16-86 years; mean age, 45.3 years) with 147 PLAs (mean diameter, 6.8 cm; range, 3-16 cm) underwent PNA with ultrasound (US) guidance and antibiotic therapy. Needle caliber (22-16 gauge) was tailored to PLA volume. If necessary, PNA was repeated every 3-7 days. RESULTS: Three hundred one PNAs were performed (range, 1-4 per patient; mean, 2.2 per patient). A single puncture was sufficient in 57 patients. Cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in 113 patients (98.3%). Two patients with large PLAs required surgery. Patients were hospitalized 7-24 days (mean, 9 days). In the last eight patients, all abscesses were evacuated in one session. Neither complications nor deaths ensued. Recurrence of PLA was not observed in any patient during follow-up (6-36 months). CONCLUSION: US-guided PNA with antibiotic therapy in treatment for PLA is a valid alternative to prolonged catheter drainage.

Anti-Bacterial Agents↗
PubMed1999

Pyogenic Liver Abscess.

The percutaneous approach-specifically, ultrasound-guided percutaneous catheter drainage-associated with intravenous administration of antibiotics is the therapy of choice in patients with single or multiple pyogenic liver abscesses. The initial empiric antibiotic therapy should be modified based on results of blood and pus cultures. Surgery should be reserved for patients in whom antibiotic therapy and percutaneous drainage is unsuccessful.

Journal Article↗
PubMed1999

[Pyogenic liver abscess: changes in etiology, diagnosis and treatment over 18 years].

BACKGROUND: There are no detailed studies in our country on the impact of modern imaging techniques on diagnosis, treatment and prognosis of pyogenic liver abscesses. MATERIAL AND METHODS: All patients with the diagnosis of PLA from 1981 to 1998 were included in the study. The study was divided in two periods: 1981 to 1989 and 1990 to 1998. RESULTS: Compared with the first time period, the following was observed from 1990 to 1998: the mean age was higher (52 versus 65 years, p = 0.006), infections with identified source increased (33% versus 74%, p = 0.003), diagnosis was earlier (13 versus 3 days, p = 0.0002), modern imaging techniques were used more frequently (17% versus 96%, p = 0.002), the proportion of recovered microorganisms increased (53% versus 88%, p = 0.002), as well as use of percutaneous drainage (0% versus 37%, p = 0.002) and the prognosis was better (mortality rate 40% versus 10%, p = 0.01). CONCLUSIONS: Relevant changes were observed among patients in our hospital in the nineties regarding epidemiology, management and prognosis of PLAs. Part of these changes are due to a higher use of new imaging techniques.

Adult↗
PubMed1979

Leiomyoma of the duodenum presenting as a pyogenic liver abscess.

Leiomyoma of the duodenum is a rare condition which is most often diagnosed only as an incidental finding at post-mortem. It may present clinically with pain or haemorrhage. A case is described of degeneration of a leiomyoma of the fourth part of the duodenum giving rise to pyogenic liver abscess. There is no previous report of this association in the literature.

Duodenal Neoplasms↗
PubMedDate not supplied

Pyogenic liver abscesses complicated with abscess-duodenum fistula in a child: report of one case.

A 12-year-old girl with liver abscesses was confirmed to have a rare complication, abscess-duodenal fistula formation, which was demonstrated on performing fluoroscope-guided percutaneous drainage. She was successfully treated with percutaneous drainage and antibiotics. The incidence, etiology, diagnosis and clinical management of pyogenic liver abscess in children are discussed.

Anti-Bacterial Agents↗
PubMed2002

Pyogenic liver abscess -- 20 years' experience. Comparison of results of treatment in two periods.

BACKGROUND AND AIMS: Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study. PATIENTS/METHODS: In two equal periods between 01.01.1982 and 31.03.2001, 56 patients (37 males and 19 females) with pyogenic liver abscess were treated. Image-guided percutaneous drainage was performed in 22.2%/20.6% of the patients; the remainder were treated with open drainage with or without biliary tract reconstruction and liver resection. For antibiotic perfusion of the liver an umbilical vein cannula was inserted in 40.7%/24.1%. Microbiological findings, types of therapy, complications and mortality, etiology, patient characteristics, symptoms, and laboratory data were investigated. The results in the two groups were compared and analyzed statistically. RESULTS: The most common cause of abscess, biliary disease, was seen more often in the second period. Solitary liver abscesses were more frequent. The only characteristic biochemical finding was an elevated alkaline phosphatase level. There were more positive cultures in the second period (70.4%/79.3%), and the number of Escherichia coli or Enterobacter aerogenes infections also increased. In the first period the mortality was 18.5%, whereas in the second no patients were lost. CONCLUSION: We suggest the importance of individualized therapy based on an early and exact diagnosis. The first treatment step should be image-guided drainage, but under well-defined circumstances open drainage can also be performed with good results.

Adult↗
PubMed1991

[Experience with the management of pyogenic liver abscesses by percutaneous transhepatic puncture and drainage].

The authors treated forty-two patients with liver abscesses guided by computer tomography or ultrasound percutaneous transhepatic puncture or drainage from January 1 1983, to 1989 December 31. Closed aspiration or drainage was done in 42 patients altogether 56 times. Three patients died (3/42 = 7.2%), postdrainage complications happened in 9 cases (9/42 = 21.4). Operative intervention was necessary in 11 patient after the percutaneous procedure (11/42 = 26.2%). The authors wrote about the technics particularly of the percutaneous puncture or drainage. The authors are considering the method as an effective treatment for pyogenic liver abscesses if the personal and technical circumstances are given.

Drainage↗
PubMedDate not supplied

[Computerized axial tomography, ultrasonography and percutaneous drainage in the diagnosis and treatment of pyogenic abscess of the liver].

Pyogenic liver abscesses in 20 adult patients were reviewed to evaluate if computed tomography (CT), ultrasonography (US) and percutaneous catheter drainage have improved prognosis of this disease. The average delay in diagnosis was 16 days. The CT sensitivity was 94% while the US sensitivity was 78%. The response to treatment with open surgery was compared to percutaneous drainage. Eleven patients were surgically drained with complications in 58% of them. Eight were treated with percutaneous drainage and no complication appeared as a result of treatment. One was found at autopsy. Days of hospitalization in surgically drained patients were significantly higher (p less than 0.01) than percutaneous drained patients. Percutaneous catheter drainage is recommended as method of choice for treating patients with pyogenic liver abscesses.

Catheterization↗
PubMedDate not supplied

[Pyogenic liver abscess. A descriptive study of 35 cases].

Thirty-five patients with pyogenic hepatic abscess (PHA) attended over 13 years in a general hospital were studied. The aim of the study was to know the usefulness of the performance of opaque enema in patients with cryptogenic PHA and the prognosis of the patients treated with only antibiotics. The most frequent clinical and analytical manifestations were fever and leukocytosis. Other less frequent findings were abdominal pain, hepatomegaly and elevated alkaline phosphatase and aspartate aminotransferase levels. One third of the patients presented radiologic alterations at the base of the right hemithorax. Colon studies in the patients with cryptogenic PHA performed to discard another origin of the abscess demonstrated very low profitability. Abdominal echography showed adequate sensitivity (0.85) in the diagnosis of PHA and allowed percutaneous drainage to be performed in most of the cases. The patients who were treated with only antibiotics presented a significantly worse prognosis than those treated with antibiotics and drainage (p = 0.03). Drainage of the PHA also allowed a decrease in the length of fever duration.

Adult↗
PubMed1992

[Pyogenic liver abscess caused by Streptococcus milleri].

Streptococcus milleri is a facultative anaerobic pathogen of the viridans group associated with serious suppurative infections, mainly abscesses. We saw 3 cases of liver abscess due to this organism in 1990 in women aged 43, 59 and 67 years, respectively. The coccus was grown from blood cultures in 2 of the cases and from abscess drainage in the 3rd. The importance of prompt diagnosis of liver abscess by means of CT and ultrasonography is stressed. Conservative treatment consists of CT-guided percutaneous drainage, followed by prolonged antibiotic treatment. Such conservative measures avoid complex and sometimes hazardous surgical procedures.

Adult↗
PubMed1994

[Pyogenic liver abscess. Study of 20 patients treated with percutaneous drainage].

We conducted a descriptive study of pyogenous hepatic abscesses (PHA) and their treatment with percutaneous drainage and antibiotherapy in the general hospital of Galdácano between 1989 and 1992. We assessed prevalence, clinical characteristics, responses to treatment, evolution and complications. We studied 20 PHAs in adults confirmed through puncture guided with echography and/or computerized tomography. We considered as causal germs those isolated in the abscess and/or hemocultures. All the patients were treated with catheter drainage and antibiotics. After discharge, follow-up and regular TC controls were performed at least for 6 months. The average age of the patients was 56 +/- 3 years and the men/women rate was 2.5:1. The most frequent origin of the infection was cholecystitis/cholangitis in 50% of patients and hydatidic cysts in 20%. Twelve patients had isolated abscess and 8 patients, multiple abscesses. The diagnostic sensitivity was 95% for the echography and 100% for CAT. The most frequent germs were E. Coli, Streptococcus, K. pneumoniae and Salmonella spp. In three cases, it was not possible to bacteriologically identified the germ. After drainage, the abscesses disappeared in 16 patients. The average duration of percutaneous drainage was 10 days. Three patients required surgery after drainage due to complications or incomplete drainage; two other patients required extirpation of hydatidic cysts. The mortality rate was 10%, although it was not related to PHA. We did not observe any differences between isolated or multiple abscesses with regard to prognosis. The drainage guided by echography and/or CT, associated to antibiotic therapy, is a successful technique for the treatment of PHAs in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Pyogenic liver abscesses--diagnostic and surgical problems].

The authors discuss the clinical-diagnostic and surgical problems in the treatment of the pyogenic hepatic abscesses. Eight patients, undergone the operation during the second period after 1971, were out of 18 patients operated (1951--1983) were analyzed in details. An inexplicable predomination of males and affection of all age groups is reported. The abscesses are cryptogenic in 2 of the patients, after operation of the hepaticbiliary system--in 2, after gastric operation--in 3, after abdominal trauma--in 1. The possible way of penetration of the infection is discussed. In was established that it parallel with the characteristic clinical picture and biochemical deviations, typical for the septic process, a definite diagnosis is made via echography and computer tomography, supported by scintigraphy, angiography, punching of the abscess, inspection graphy of the hepatic region. The treatment is difficult and complex: Antibiotic, generally tonizising and surgical. The choice of the operative approach denends on the localization, number of the abscesses and character (pyogenic, amebic, etc). The therapeutic tasks are discussed as well as the operation methods applied, punch-aspiration including. The risk of complications and lethality remain high, three patients were discharged healthy, with improvement--2, deceased--3 (sepsis, stress-ulcer, pulmonary embolism).

Adult↗
PubMed1989

[Treatment of pyogenic liver abscesses using percutaneous transparietal drainage].

Authors present their own experience with the method of external transparietal drainage of pyogenic hepatic abscesses. It is both effective and available method with minimum complications if performed in time. Mortality rate is much lower than in surgical drainage. Percutaneous drainage of hepatic abscesses depends on the possibility of their diagnostics by means of ultrasonography or computer tomography and access to special instruments.

Drainage↗