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PubMed1995

Rupture of pyogenic liver abscess.

OBJECTIVE: Our objective was to study the clinical manifestations, course, treatment, and results obtained in 23 patients with ruptured pyogenic liver abscess and compare these findings with those of nonruptured cases. METHODS: Four hundred twenty-four patients with clinical diagnoses of pyogenic liver abscess were enrolled in the study. Among these, 23 patients had ruptured pyogenic liver abscess. The clinical manifestations, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, etiology of abscess, and results of the treatment were recorded. Qualitative data were analyzed by chi 2 test, and quantitative data were analyzed by Student's t test. RESULTS: Except for abdominal pain and septic shock, other symptoms, such as fever, chills, and jaundice, were similar in ruptured and nonruptured groups. Laboratory findings indicated that the group with ruptured liver abscess had higher levels of bilirubin, blood glucose, and aspartate aminotransferase than the non-ruptured group. Of the patients with ruptured abscess, 14 (60.9%) had diabetes mellitus and 15 (65.2%) were cryptogenic. Klebsiella pneumoniae was the bacteria most often isolated in both blood cultures and liver aspirates. Surgical intervention--draining the abscess and cleaning the abdominal cavity--was the only means of saving the patients' lives. The overall mortality rate was higher in this group (43.5%) than in the nonruptured group (15.5%). CONCLUSIONS: Ruptured pyogenic liver abscess should be suspected if septic shock and diffuse abdominal pain are found in a patient with pyogenic liver abscess, concurrent with high levels of bilirubin, aspartate aminotransferase, and blood glucose. Surgery is the only treatment for this condition.

Female↗
PubMed1980

Spontaneously healing pyogenic liver abscess.

We have presented an unusual case of pyogenic liver abscess due to gamma streptococci group D, which remained undiagnosed for about seven months, and which ruptured spontaneously into subcutaneous tissue, resulting in self-cure. Despite the large hepatic abscess seen on liver scan and ultrasound, results of liver function tests remained normal. A mass seen on liver scan or ultrasound in patients with a malignancy does not necessarily indicate metastasis, and a more aggressive approach is required to treat a potentially curable disease.

Diagnosis, Differential↗
PubMed1973

Anaerobic liver abscess complicating radiation enteritis.

Multifocal liver abscess developed in a 68-year-old woman with radiation enteritis. Two strains of Bacteroides fragilis were cultured from the liver and blood. Surgical drainage was not possible, and in spite of appropriate antibiotic therapy the patient died.

Aged↗
PubMed1998

Biochemical and ribotypic comparison of Actinomyces pyogenes and A pyogenes-like organisms from liver abscesses, ruminal wall, and ruminal contents of cattle.

OBJECTIVE: To isolate Actinomyces pyogenes and A pyogenes-like (APL) organisms from the ruminal wall and ruminal contents of cattle and compare them with isolates from liver abscesses from the same animals, using ribosomal DNA restriction fragment length polymorphism analysis or ribotyping. PROCEDURE: Specimens of liver abscesses, ruminal walls, and ruminal contents were collected from 59 cattle at slaughter. All beta-hemolytic, pinpoint colonies that were gram positive, pleomorphic rod-shaped, and catalase negative, and that hydrolyzed casein and gelatin were presumptively identified as A pyogenes and were characterized biochemically, using an identification kit. The isolates that resembled A pyogenes but fermented mannitol or raffinose, or both, were called APL organisms. Isolates from the ruminal wall and ruminal contents were compared with liver abscess isolates from the same animal by use of ribotyping. RESULTS: Actinomyces pyogenes and APL organisms were isolated more frequently from the ruminal wall than from ruminal contents. Ruminal isolates of A pyogenes and APL had biochemical characteristics similar to those of the isolates from liver abscesses. Among 6 sets of isolates (4 A pyogenes and 2 APL), 2 isolates from liver abscesses had ribopatterns identical to the corresponding ruminal wall isolates. Also, the APL organisms isolated from the ruminal content matched with the corresponding liver abscess isolates for both sets of specimens tested. CONCLUSIONS: The ruminal wall may be the niche for A pyogenes and APL organisms in the rumen. The genetic similarity, on the basis of ribotyping among isolates from liver abscesses, the ruminal wall, and ruminal contents of the same animal suggests that A pyogenes and APL organisms that cause liver abscesses originate from the rumen.

Abscess↗
PubMed1983

Diagnosis and therapy of liver abscess by ultrasonographic imaging, puncture and drainage.

Liver abscesses in 19 patients were primarily diagnosed by real-time ultrasound. Characteristic features and changes in the course of disease are described. Fine needle puncture under ultrasonographic guidance confirmed the diagnosis and permitted bacteriologic examination. Ultrasonographically guided abscess drainage dramatically improved the clinical condition, and can be recommended as an alternative to surgical drainage.

Drainage↗
PubMedDate not supplied

Computed tomographic evaluation of an experimental model for pyogenic liver abscesses.

Computed tomography (CT) was used to evaluate 15 rabbits with experimentally induced liver abscesses. The animals were examined both before and after intravenous contrast injection. After sacrificing the animals, postfreeze CT scans were made to mark the abdomen for 1-cm thick whole body sections for correlating the gross pathology with the results of the CT scans. CT detected 15 abscesses in 13 of the 14 rabbits with true positive lesions. Ten abscesses less than 1.4 cm in diameter were not detected by CT. Contrast agent enhancement was helpful in 70% of the studies. These abscesses have characteristics similar to human liver abscesses, but there was more gas and calcium in the experimentally induced abscesses than is encountered in humans with hepatic abscesses. The model and its CT characteristics appear well suited for future studies in the diagnosis and treatment of liver abscesses.

Animals↗
PubMed2004

Liver abscess in Crohn's disease: a report of three cases.

Liver abscess is a rare complication of Crohn's disease and must be considered part of the differential diagnosis. We present three case reports and a review of the literature. The incidence of liver abscess is higher in patients with Crohn's disease than in the general population. Since Crohn's disease patients who present with a liver abscess generally do not respond to medical management alone, surgical or percutaneous drainage of the abscess is necessary.

Adult↗
PubMed1995

Leukemoid reaction in amoebic liver abscess.

A case of amoebic liver abscess with leukemoid reaction is described. This patient also had jaundice as the presenting feature. Therapy with metronidazole resulted in improved general condition and both blood picture and liver function tests also became normal.

Adult↗
PubMed2001

Pyogenic liver abscesses due to Klebsiella pneumoniae in a diabetic patient.

Pyogenic liver abscess due to Klebsiella pneumoniae is a rare clinical entity. It has emerged as an important infection complication in diabetics and its incidence in diabetics without intraabdominal or biliary tract infections is increasing. We present herein a case of multiple pyogenic liver abscesses due to K. pneumoniae in a diabetic patient and discuss clinical course, treatment and possible reasons for association between K. pneumoniae liver abscess and diabetes.

Diabetic Ketoacidosis↗
PubMedDate not supplied

Liver abscess due to acute cholecystitis. Report of five cases.

Acute cholecystitis is one of the most frequent causes of admissions to surgical departments. The development of liver abscesses is an uncommon and underrated complication of acute cholecystitis. In this study we report on our experience with the treatment of 5 cases of liver abscesses secondary to acute cholecystitis. All 5 cases were characterised by a lengthy period between the onset of acute cholecystitis symptoms and the subsequent diagnosis of a secondary liver abscess. In 4 out of 5 patients, admission for liver abscess occurred 12, 30, 50 and 120 days, respectively, after the acute cholecystitis episode. The liver abscesses were successfully treated with percutaneous drainage under US guidance (4 cases) and 4 patients underwent percutaneous cholecystostomy to treat the acute cholecystitis. After resolution of the acute phase, an elective cholecystectomy was performed in 4 out of 5 cases. Failure to diagnose acute cholecystitis at onset or inappropriate treatment of the condition could lead to the development of liver abscesses.

Acute Disease↗
PubMed1987

Amebic liver abscess with hepatoduodenal fistula.

Common complications of amebic liver abscesses include rupture into the thorax, pericardium, and peritoneum. Rupture into the gastrointestinal tract is extremely rare. We report a case of an amebic liver abscess rupturing into the duodenum, forming a wide fistulous tract. To our knowledge, this is the first case with radiological confirmation.

Duodenal Diseases↗
PubMed1982

Treatment of pyogenic liver abscesses by percutaneous needle aspiration.

Fifteen patients with solitary or multiple pyogenic liver abscesses diagnosed by ultrasound examination were treated by percutaneous aspiration under ultrasound guidance. The pus obtained was cultured immediately for aerobic and anaerobic organisms and appropriate antibiotic therapy was started. Anaerobic organisms were grown from this pus in nine patients. All patients improved after the aspiration and, apart from further aspirations in two cases, all abscesses healed without further intervention. No patient died from liver abscess or as a result of treatment. The technique is simple and harmless and is the method of choice for diagnosing and treating patients with pyogenic liver abscesses.

Adult↗
PubMed2005

Pyogenic liver abscesses with Escherichia coli: etiology, clinical course, outcome, and prognostic factors.

BACKGROUND: To investigate the clinical characteristics, outcome, and prognostic factors related to mortality in patients with Escherichia coli liver abscess. METHODS: We retrospectively analyzed 72 patients aged 18 years and older who were diagnosed as having E. coli liver abscesses from July 1996 to June 2002 at two medical centers in Taiwan. RESULTS: The overall mortality rate was 26.4%. The majority of E. coli liver abscesses was solitary, involved the right lobe of the liver, and comprised polymicrobial infections. The cause of the liver abscess involved the biliary system in 48 patients (66.7%). The most common concomitant diseases were diabetes mellitus (30.6%) and underlying malignancy (30.6%). Metastatic infection was found in 4 patients (5.6%). Multivariate analysis revealed that underlying malignancy (p = 0.034), profound hypoalbuminemia (<2.5 g/dl) (p = 0.008), and multiple abscesses (p = 0.004) were the most significantly prognostic factors for mortality. CONCLUSION: The predominant causes of E. coli liver abscess were biliary diseases. This report also highlights that E. coli liver abscess has a relatively high mortality rate, which is associated with underlying malignancy, multiple abscesses and profound hypoalbuminemia.

Adolescent↗
PubMed1997

Clinical and microbiological features of liver abscess after transarterial embolization for hepatocellular carcinoma.

OBJECTIVES: To present the clinical and microbiological features of liver abscess after transarterial embolization (TAE) for hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed records of 452 TAE procedures in 289 patients with HCC over a 2-yr period. RESULTS: Four men and one woman with a mean age of 68.4 yr were diagnosed with liver abscess 1-8 wk (mean 4.6 wk) after the embolization. The incidence was 1.1% (5/452). Common symptoms included fever, chills, and right upper quadrant pain. Serum aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase levels and leukocyte count were frequently elevated. All the abscesses appeared as areas of hypodensity on CT scan and hypoechogenicity on ultrasonogram. The areas contained gas in the embolized tumor, which led to the suspicion and finally the diagnosis of abscess. In contrast to predominance of gram-negative aerobes in sporadic pyogenic liver abscesses, the causative microorganism was predominantly gram positive (60%). All patients were treated with parenteral antibiotics plus percutaneous aspiration, drainage, or operation, but one patient died from the abscess. CONCLUSIONS: For patients receiving TAE for HCC, few specific clinical or radiological features could readily differentiate patients complicated with liver abscess from those without. This may delay a timely diagnosis and lead to significant morbidity. Hence, in patients with risk factors, including old age, previous biliary tract disease, large tumor size (>5 cm), and gas forming in the embolized tumor, aspiration of the suspected focal hepatic lesion should be performed as soon as possible.

Abdominal Pain↗
PubMed2005

An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm.

OBJECTIVE: To determine whether first-line treatment with percutaneous or surgical drainage of liver abscesses larger than 5 cm results in better clinical outcome. SUMMARY BACKGROUND DATA: Pyogenic liver abscesses larger than 5 cm are currently treated by intravenous antibiotics and either percutaneous (PD) or surgical drainage (SD). Percutaneous techniques have been increasingly performed in place of open drainage as first-line treatment. This paradigm shift has been fueled by the drive for low-risk and less-invasive procedures and the surgical option being reserved for percutaneous failures. Yet there is a lack of data to support percutaneous drainage over open surgical drainage as first-line treatment. METHODS: Over a 3-year period, 80 patients with liver abscesses larger than 5 cm amenable to PD and SD were included in the study. This situation was possible as 1 team of surgeons favored the use of PD and 1 team favored the use of SD as first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence of fever, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality. RESULTS: PD was performed in 36 patients and SD in 44 patients as first-line treatment. Clinical, laboratory, and abscess parameters were comparable in both groups. Sixty-four of 80 patients (80%) had multiloculated abscess. The time to defervescence of fever was not statistically significant (PD versus SD, 4.85 versus 4.38 days; P = 0.09). However, SD had less treatment failures (3 versus 10, P = 0.013), less requirement for secondary procedures (5 versus 13, P = 0.01), and shorter length of hospital stay (8 versus 11 days, P = 0.03). There was no difference in morbidity or mortality rates. CONCLUSIONS: The results of our study show that for large liver abscesses more than 5 cm, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment of large liver abscesses.

Adult↗
PubMedDate not supplied

Multiple large pyogenic liver abscesses of the tropics: a new entity.

BACKGROUND: Pyogenic liver abscesses most commonly occur in males in -he sixth decade, are usually associated with biliary tract disease, malignancy and immunosuppression and the mortality rate is high. We describe another form of pyogenic abscess occurring in females which, if treated aggressively, carries a much better prognosis. METHODS: Between 1986 and 1993 we treated 8 patients with multiple pyogenic liver abscesses. Diagnosis was established by ultrasound and CT scan followed by needle aspiration to confirm pus. Amoebic aetiology was excluded by a serology, poor response to metronidazole and biopsy of the abscess wall. RESULTS: The mean age of our patients was 30 +/- 7 years and there were 2 males and 6 females. They presented with fever and abdominal pain for more than 2 months, tender hepatomegaly, a raised ESR and alkaline phosphatase. US and CT scans showed multiple large abscesses in the right lobe. Histology suggested chronic inflammation and with no definite organism isolated except for visceral larva migrans in one case. All patients underwent surgery--deroofing with drainage was done in four, segmental hepatic resection in three and right hepatectomy in one. One patient had a recurrence and underwent repeated resection. Only one patient died and 7 did well with no recurrence at a mean followup of 24 +/- 27 months. CONCLUSIONS: Large multiple cryptogenic pyogenic abscesses of the liver occurring mostly in young females, which respond well to aggressive excisional surgery may constitute a distinct clinical entity.

Adult↗
PubMed2005

Causative agents of liver abscess in HIV-seropositive patients: a 10-year case series in Thai hospitalized patients.

Liver abscess is an important tropical gastrointestinal disorder. HIV seropositive patients show relative immunosuppression and are more susceptible to infection, including liver abscess. This retrospective case review was made on 23 patients who were diagnosed as HIV seropositive with liver abscess in Bangkok, Thailand. We demonstrated the high rate of amoebic liver abscess in our series (17.4%) from fresh smear with five cases of tuberculosis and one case of Nocardosis. The rates of positive bacterial culture were 17.4% from blood and 47.8% from pus. Gram-negative aerobes were the major abscess pathogens in our series. Among Gram-negative aerobes, Klebsiella was the most significant microorganism, followed by Escherichia coli and Pseudomonas aeruginosa.

AIDS-Related Opportunistic Infections↗
PubMed1990

Amebic liver abscess. An unusual presentation.

Amebic liver abscess responds readily to appropriate therapy, but diagnosis may be difficult. In the case described, the patient's signs and symptoms were atypical, suggesting a hematologic malignancy. The correct diagnosis was made only after ultrasound revealed a mass in the liver.

Adult↗