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PubMedDate not supplied

[Giant liver abscess due to nearly asymptomatic choledocholithiasis].

Solitary pyogenic liver abscess is usually caused by a metastatic infection through the portal blood flow or through the hepatic arterial blood flow from extra-abdominal pyogenic foci. Besides, it may be the result of local inflammatory diseases, such as cholecystitis, hydatid cyst, haematomas particularly with retained foreign bodies, etc. Suppurative cholangitis usually causes multiple pyogenic liver abscesses. Solitary pyogenic abscess is rarely caused by cholangitis, but practically always by suppurative cholangitis. Giant pyogenic liver abscess due to asymptomatic or mild cholangitis is a rarity. We present on a 63 year old man who developed a giant solitary pyogenic liver abscess in whom no other possible cause could be found or anticipated except practically almost asymptomatic choledocholithiasis accompanied with mild elevation of bilirubin content, alkaline phosphatase and gamma-GT. The patient was successfully treated operatively. Over 1800 ml. of pus was aspirated from the abscess cavity. Operative cholangiography performed in spite of the absence of gall bladder stones undilated and noninflamed common bile duct stone showed a small nonobstructing distal common bile duct stone. The duct was not dilated, the bile was clear and there were no signs of cholangitis in the inside of the common bile duct. Cholecystectomy and abscess cavity drainage led to uneventful recovery. The patient has been symptom-free for more than 3.5 years.

Gallstones↗
PubMed1993

Role of anaerobic bacteria in liver abscesses in children.

Aspirates from pyogenic liver abscesses obtained from 14 children were cultured for aerobic and anaerobic bacteria. Of 29 organisms that were recovered, 17 were anaerobic and 12 were aerobic or facultative. The predominant organisms were Peptostreptococcus spp. (5 isolates). Bacteroides fragilis group (4), Fusobacterium spp. (3) and Staphylococcus aureus (4). Aerobic or facultative bacteria only were recovered in five cases, anaerobic bacteria only in four and mixed aerobic and anaerobic bacteria in five. Anaerobic bacteria were recovered in liver abscesses that were associated with other infection in which these organisms were predominant (i.e. abdominal infection, abscesses). This study highlights the potential importance of anaerobic bacteria in pyogenic liver abscess.

Adolescent↗
PubMed1993

[Surgical-radiologic interventional treatment in liver abscess with Streptococcus anginosus Milleri].

Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases. Out of a retrospective study (1984-1991) of 44 patients (f 43%, m 57%) with pyogenic liver abscesses and 12 patients (f 17%, m 83%) with amebic liver abscesses we present 5 patients with multifocal lesions due to Streptococcus anginosus Milleri--a special group concerning therapy and course of disease. The therapy was high-dose i.v. antibiotic therapy in all 5 cases and additional percutaneous drainage with pig-tail catheters--inserted under CT guidance--in 4 cases (1-5 catheters, time of drainage 6-63 days). The duration of hospitalisation was 15-73 days (median 45), intravenous antibiotic treatment lasted 4-40 days. After discharge oral antibiotics were continued for 14-42 days.

AIDS-Related Opportunistic Infections↗
PubMed1985

Hepatobronchial fistula with percutaneous pyogenic abscess drainage of the liver.

Percutaneous abscess drainage has been successfully used in the treatment of hepatic abscesses. We present a case of a posttraumatic pyogenic liver abscess treated by CT-guided percutaneous catheter drainage with an unusual complication of a hepatobronchial fistula. Patient management and the subtle roentgenographic features of this case are presented. Early signs of hepatobronchial fistula including paroxysms of coughing and a peculiar metallic taste during the performance of an abscessogram are reported.

Adult↗
PubMed2005

[Comparison of liver abscess between diabetic patients and non-diabetic patients].

BACKGROUND/AIMS: Klebsiella pneumoniae is emerging as the leading cause for liver abscess although the most common pathogen was Escherichia coli in the past. Patients with diabetes mellitus are more likely to have a pyogenic liver abscess with gas forming infection; a gas forming pyogenic liver abscess carries a higher morbidity and mortality than the non-gas forming group. This study was conducted to clarify the clinical presentation and prognostic factors for pyogenic liver abscess in diabetic patients compared with non-diabetic patients. METHODS: Medical records of 140 cases of patients treated for pyogenic liver abscess from January 1995 through January 2004 were reviewed retrospectively in detail. RESULTS: Among 140 cases of pyogenic liver abscess, underlying diabetes was present in 26.4% (37/140). The clinical presentation between the two groups was not significantly different. The most common organism for the pyogenic abscess was K. pneumoniae in both groups. A gas forming liver abscess was discovered in only the diabetic liver abscess group, 6 of 37 patients (16%). CONCLUSIONS: K. pneumoniae was the most common organism cultured in both diabetic and non-diabetic liver abscess. Gas forming liver abscess was more common in diabetic patients than non-diabetic patients. Diabetic patients had more complications than non-diabetic patients.

Adult↗
PubMed1998

[Partial hepatectomy after post-traumatic liver abscess].

Post-traumatic pyogenic liver abscess is a rare disease. We present the case of a 38-year-old man with multilocular liver abscess and pleural empyema following blunt abdominal trauma. The patient had a prodrome lasting 3 months before presenting in our department. The therapy included partial hepatectomy and pleural drainage. Clinical signs, diagnosis and possible therapy are discussed in this case report.

Adult↗
PubMed2002

Clinicopathological analysis of liver abscess in Japan.

Currently, pyogenic liver abscess is not frequent, but it is a severe infectious disease. However a strategy for the effective treatment of liver abscess is not established. We analyzed 75 cases of liver abscess over an eight year period and evaluated their prognosis, any associated underlying disease, or the effect of percutaneous transhepatic abscess drainage (PTAD). For all 75 cases, laboratory data were analyzed and imaging studies were performed. Next, PTAD and antibiotic administration were started on these cases as first choice treatments. These treatments were continued until the laboratory data of the patient were restored to within the normal range. Those cases that were PTAD non-effective or required operation for underlying diseases, underwent operations. Of the total 75 cases, 63 survived after treatment and 12 cases died. Bacteria were detected in 50 cases and Klebsiella pneumoniae was detected in 31 of these 50 cases, but 25 out of 75 cases were negative. The biliary system was the main route of infection. PTAD was effective, especially in cases that were complicated with disseminated intravascular coagulation (DIC) or acute renal failure (ARF). PTAD is an effective treatment for liver abscess, it is especially useful in the restoration of severe general conditions as indicated by this study.

Acute Kidney Injury↗
PubMed2000

Heptaobiliary infections.

Although cholangitis is the most prevalent hepatobiliary infectious process, liver abscess represents the most serious and conspicuous hepatobiliary infection. Amebic liver abscess typically occurs in individuals from endemic areas or those traveling to endemic areas. It is associated with an excellent prognosis when managed expediently with antiamebic antibiotics. Recent reports emphasize a possible association between amebic liver abscess and HIV infection. Drainage or surgery for amebic liver abscess is rarely necessary. In contrast, pyogenic liver abscess is associated with significant morbidity and mortality, although the prognosis of patients with this hepatobiliary infection has improved in recent years. Pyogenic liver abscess occurs most often in patients without identifiable predisposing factors, but when identified, they are most often biliary tract-related. Management of pyogenic liver abscess has historically been surgical, but in recent years, there has been a dramatic shift toward noninvasive management, particularly involving strategies based on percutaneous drainage techniques.

Journal Article↗
PubMed1998

Primary liver abscess due to Klebsiella pneumoniae in Taiwan.

Pyogenic liver abscess is an uncommon complication of intra-abdominal or biliary tract infection and is usually a polymicrobial infection associated with high mortality and high rates of relapse. However, over the past 15 years, we have observed a new clinical syndrome in Taiwan: liver abscesses caused by a single microorganism, Klebsiella pneumoniae. We reviewed 182 cases of pyogenic liver abscess during the period September 1990 to June 1996; 160 of these cases were caused by K. pneumoniae alone, and 22 were polymicrobial. When patients with K. pneumoniae liver abscess were compared with those who had polymicrobial liver abscess, we found higher incidences of diabetes or glucose intolerance (75% vs. 4.5%) and metastatic infections (11.9% vs. 0) and lower rates of intra-abdominal abnormalities (0.6% vs. 95.5%), mortality (11.3% vs. 41%), and relapse (4.4% vs. 41%) in the former group. Liver abscess caused by K. pneumoniae is a new clinical syndrome that has emerged as an important infectious complication in diabetic patients in Taiwan.

Female↗
PubMedDate not supplied

Hepatic abscess.

Hepatic abscess--amebic or pyogenic--can be diagnosed with great accuracy by either ultrasonography or computed tomographic (CT) scanning. Ultrasound is the modality of choice and will detect almost 100% of abscesses. Confirmation of a diagnosis of amebic liver abscess is made by the indirect hemagglutination test that should be positive in almost 100% of cases. Cultures of pus from the abscess and from the blood must be obtained in cases of pyogenic liver abscess. A positive culture of pus from the abscess has been achieved in 90% of cases. Ultrasound or CT guidance is utilized in aspiration of a hepatic abscess. In the treatment of an amebic liver abscess, metronidazole is the amebicide of choice. Open drainage is contraindicated. For cases that fail to respond to therapy with amebicides, closed drainage guided by CT or ultrasound is performed. Secondary bacterial infection of an amebic liver abscess is an extremely rare event. The identification and determination of the antibiotic sensitivity of organisms responsible for pyogenic liver abscess is a crucially important step. Unless a celiotomy is necessary to correct an intraabdominal process or the abscess is extremely large, the initial treatment of pyogenic liver abscess is a 2 week course of appropriate antibiotics followed by a 1 month course of oral antibiotics. The majority of pyogenic liver abscesses will respond to such treatment. If drainage of a pyogenic abscess is required, the preferable technique is with a percutaneous CT- or ultrasound-directed catheter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Pyogenic and amebic liver abscess.

Amebic liver abscess is more common than pyogenic liver abscess on a global scale. In the United States, pyogenic liver abscess is more frequently seen. The epidemiology, etiology, microbiology, clinical features, natural history, diagnostic studies, and treatment of pyogenic and amebic liver abscess are discussed.

Adult↗
PubMed2006

[A case of Salmonella liver abscess].

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.

Humans↗
PubMed2005

Solitary liver abscess in a healthy child presenting with fever of unknown origin.

Pyogenic liver abscess is rarely encountered in normal children. We report a case of solitary pyogenic liver abscess in a healthy child aged 8 months. He presented with fever of unknown origin and mild hepatomegaly. Full recovery was achieved by surgical intervention and prolonged antibiotic treatment. Management and recommended treatment in children with liver abscess are presented.

Fever of Unknown Origin↗
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↗
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↗
PubMed2003

Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures.

Although rare, pyogenic liver abscesses are potentially fatal. We evaluated the predictive value of Gram stain of liver abscess aspirates and temporally associated blood cultures. Gram stains detected bacteria in 79% of the liver abscesses tested. The sensitivity and specificity of Gram stain of the liver abscesses were 90% and 100% for Gram-positive cocci (GPC) and 52% and 94% for Gram-negative bacilli (GNB). The sensitivities of the blood cultures for any GPC and GNB present in the liver abscess were 30% and 39%, respectively. Although, Gram stains and blood cultures offer incomplete detection of the microbial contents of pyogenic liver abscesses, both tests should always accompany liver abscess cultures.

Bacteriological Techniques↗
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↗