Pyogenic liver abscess: aetiology, clinical manifestations and management.
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The authors report a case of a large monolocular liver abscess in a patient with gallbladder and choledocic stones and biliary stent, complicated by rupture into the peritoneal cavity, that required surgical treatment. Surgical exploration versus other approach results the choice treatment, as shown by resolution of the pathology.
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We report a case of Streptococcus milleri in a patient with a history of hypertension, alcohol abuse, and tobacco smoking. S. milleri is associated with liver abscesses much more frequently than other streptococci.
From 1984 to 1998, a total of 2158 patients underwent hepatobiliary and pancreatic surgery, and 12 patients developed liver abscess after hepatobiliary and pancreatic surgery; thus, the incidence of liver abscess was 0.6%. The main reasons for liver abscess were anastomotic stricture in 5 patients, obstruction of percutaneous transhepatic biliary drainage (PTBD) tube in 3 patients, and portal vein and hepatic artery obstruction due to intraoperative radiation in 1 patient, transportal chemotherapy in 1 patient, chemo-lipiodolization in 1 patient, and unknown in 1 patient. Ten of the 12 patients initially underwent percutaneous transhepatic abscess drainage of whom 2 patients subsequently received surgical drainage. The other 2 patients were treated with antibiotics only. Eight of the 12 patients were cured, but 4 patients died. The reasons for death were sepsis in 3 patients and liver failure due to portal vein and hepatic artery obstruction in 1 patient. Our results indicate that liver abscess should be taken into consideration for patients with risk factors.
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The object of this open-label, randomized, comparative study was to evaluate the efficacy and safety of fleroxacin versus conventional therapy (cefazolin plus gentamicin/cephalexin) in the treatment of patients with bacterial liver abscess. Thirty-one adult patients (26 men and 5 women) received fleroxacin 400 mg orally once daily for 3 weeks, and 30 adult patients (21 men and 9 women) received conventional therapy for 3 to 4 weeks. Patients was assessed on day 3 of treatment, thereafter every week during treatment, and at 7 to 14 days (compulsory follow-up) after treatment for assessment of bacteriologic, clinical, and safety parameters. A total of 20 patients in the fleroxacin group and 22 patients in the conventional therapy group were evaluated. Klebsiella pneumoniae was the predominant pathogen isolated in all evaluable cases. Bacteriologic cure was achieved in 14 (70%) of 20 patients on fleroxacin therapy compared with 18 (81.8%) of 22 patients on conventional therapy (p=0.48). Clinical cure was achieved in 12 (60%) and 18 (81.8%) patients, and improvement in 2 (10%) and 1 (4.5%) patients in the fleroxacin and conventional therapy group, respectively. Most of adverse effects were of mild intensity. Oral fleroxacin once-daily administration is an effective, alternative treatment of bacterial liver abscess.
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In the last 7 years 53 patients with liver abscesses were treated at surgical clinic of Charité. Since November 1982 we treated in 27 cases with solitary and multiloculary liver abscesses by percutaneous drainage of the abscess diameter more than 3 to 4 cm. 12 patients with multiloculary small biliary liver abscesses were treated by antibiotics. The bacteriological examination were performed after CT-supported puncture of the abscess. Seven patients with complicated abscesses could not be healed with CT-drainage. Surgical drainage via laparotomy was necessary. The diagnostic clarification of the dignity is important in every case. The lethality of all treated liver abscesses was 5.6% and the causes of death were the existing basic diseases.
32 CT-guided percutaneous drainages of bacterial liver abscesses in 25 patients accomplished definitive sanitation in 18 of them (72%). In 7 cases surgical revision was required. Percutaneous drainage of abscesses was able to achieve a temporal improvement in these cases and therefore was an effective pre-surgical measure. There were no complications primarily due to the method itself. The average dwell-time of catheters during drainage of curative percutaneous drainage was 22.5 days. The new therapy concept has proven to be of little discomfort and complications together with high therapeutic effectiveness.
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