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Results for “Liver Abscess, Pyogenic”

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PubMed1990

Specificity of crude and purified Fasciola antigens in immunodiagnosis of human fascioliasis.

A study has been done to find the effect of purification of crude antigens extracted from adult F. gigantica and F. hepatica on the cross reactions encountered in C.I.E.P., I.H.A. and E.L.I.S.A. serological techniques with sera o other parasitic and non-parasitic diseases. It was performed on 75 patients and 20 healthy controls. It was found that sera of many diseases may cross-react with crude Fasciola antigen in serological diagnosis. These diseases include schistosomiasis, hydatidosis, amoebic liver abscess, heterophyiasis, trichinosis, non parasitic liver diseases (liver neoplasms, pyogenic liver abscess, viral hepatitis and acute leukaemic) and rheumatoid arthritis. Partial purification of crude Fasciola antigens is a suitable method to avoid cross reactivity when using C.I.E.P. or to diminish them when using E.L.I.S.A. No need for this purification when using I.H.A. So using partially purified adult Fasciola antigens C.I.E.P. was the most specific test (100%) of followed by C.L.I.S.A. then I.H.A.

Animals↗
PubMed2000

Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter.

BACKGROUND: It is universally recognized that the most frequent cause of hepatic abscess is biliary disease. The aim of this study was to determine the efficacy of endoscopic drainage and local antibiotic lavage via nasobiliary catheter in the treatment of liver abscesses of biliary origin. METHOD: From January 1994 to December 1995, twenty-two cases of pyogenic liver abscess were treated. Diagnosis was established with ultrasound, computed tomography, endoscopic retrograde cholangiography, and laboratory tests. All patients were assigned prospectively to endoscopic or other non-surgical forms of therapy, depending on the etiology of the pyogenic process. Patients in whom this treatment failed underwent surgical drainage. Twenty patients had hepatic abscesses of biliary origin. In this subgroup, a nasobiliary catheter was placed into the biliary tree for continuous antibiotic lavage (infusion technique: 1 to 1.5 mL/min for 8 to 10 days) after endoscopic sphincterotomy. Two patients had hepatic abscesses of hematogenous and amebic origin, respectively. They were treated only with the appropriate systemic antibiotics. RESULTS: Nineteen patients of the biliary subgroup (95%) and the two patients with non-biliary disease (100%) had complete resolution of the abscesses. "Salvage" surgical drainage was required in only one patient (4.5%). There was no treatment related mortality. CONCLUSION: Endoscopic sphincterotomy and local antibiotic lavage via an endoscopically placed nasobiliary catheter is a safe and effective treatment for biliary liver abscesses. It should be considered as first-line treatment in this subgroup of patients with liver abscesses. Percutaneous or surgical drainage modalities should be reserved for patients in whom endoscopic treatment fails.

Aged↗
PubMed2003

[Liver abscess: a practical approach].

The management of a liver abscess suspected on the basis of clinical and radiological findings is radically different depending on its amoebic or pyogenic etiology. Medical management is usually enough to treat amoebic abscess, the prognosis of which is excellent while percutaneous aspiration puncture, drainage and antibiotics is the rule in pyogenic abscess, the prognosis of which depends on the quickness of diagnosis and risk factors associated. This article first relates a case of liver abscess we had in our service and then propose, on the basis of a literature review, a synthesis of the different characteristics, diagnostic and therapeutic approaches and follow-up of amoebic and pyogenic liver abscesses.

Adult↗
PubMed1999

Life-threatening pica: liver abscess from perforating foreign body.

A case is presented of a patient with a psychiatric illness and pica who developed a pyogenic liver abscess due to perforation of the duodenum by a pen. This report emphasizes the importance of ultrasound and computed tomography in making a rapid diagnosis. The relative superiority of ultrasound was revealed because an anaesthetic was not required for scanning, and in addition to the liver abscess, the precise location of the perforating foreign body was demonstrated.

Adult↗
PubMed1996

[MRT of experimental liver abscesses: a comparison of a new blood pool contrast medium with gadolinium-DTPA in animal experiments].

PURPOSE: In an experimental pyogenic liver abscess model, the signal intensities were compared intraindividually and interindividually after the application of a new blood pool contrast agent, 24-gadolinium-DTPA (diethylenetriamine-pentaacetic acid) cascade polymer, and after the application of gadopentetate dimeglumine. METHODS: In 20 rabbits with experimentally induced liver abscesses, the relative signal intensities of the liver, abscess centre, abscess wall and portal vein were assessed before and between 30 seconds and 60 minutes after injection of a 25 mumol/kg dose of gadolinium polymer and of 100 mumol/kg of gadolinium-DTPA, respectively. Measurements were performed at 1.5 Tesla, using a head coil and a Flash-2-D sequence. RESULTS: The interindividual comparison (unpaired T-test, p < 0.05) yielded significant differences of the relative signal intensities of the abscess centre (at any time point after contrast-media application), abscess wall (between 15 and 60 minutes after contrast media application), and portal vein (between 30 seconds and 7.5 minutes after contrast media application). The interindividual comparison showed a significantly higher abscess centre-liver contrast (between 30 seconds and 12.5 minutes after contrast media application) and a significantly higher abscess wall-centre contrast (between two and 7.5 minutes after contrast media application) after the application of gadolinium polymer compared with gadopentetate dimeglumine. CONCLUSION: In this animal model, the higher abscess centre-liver contrast after the application of gadolinium polymer was the basis for a better and prolonged visibility of the abscesses, as compared with images acquired after injection of gadopentetate dimeglumine.

Animals↗
PubMed2002

A note on clinical presentations of amebic liver abscess: an overview from 62 Thai patients.

BACKGROUND: Amebic liver abscess is a tropical disease with a wide spectrum of clinical presentations. Given the often nonspecific nature of the complaints related to amebic abscess, a retrospective review of patients with confirmed disease to recognize the most common patterns of presentation is useful. Here, we study the clinical presentations of 62 Thai patients with amebic liver abscess. We also compare the clinical presentations of Anti HIV seronegative and Anti HIV seropositive patients. METHODS: A retrospective case review was carried out for 62 Thai patients who had been diagnosed with amebic liver abscess. Clinical information was collected, including symptoms and signs, location and number of abscesses. The Anti HIV serology laboratory investigation was also reviewed. RESULTS: According to our study, the common clinical symptoms and signs are abdominal pain (85.5 %), fever and chills (74.2 %), and abdominal tenderness (69.4 %). The location of the abscess was predominantly in the right lobe (74.2 %), and most of patients had a single abscess (77.4 %). Similar trends in clinical presentations were observed in both Anti HIV seropositive and Anti HIV seronegative subjects. CONCLUSIONS: In conclusion, the clinical presentations of our amebic liver abscess patients were similar to those in previous reports. A similarity to those in the pyogenic liver abscess patients can be observed. Nevertheless, we could not detect important significant differences in the clinical presentations between Anti HIV seropositive and Anti HIV seronegative groups of patients.

Adolescent↗
PubMedDate not supplied

Risk factors for and clinical findings of liver abscess after biliary-intestinal anastomosis.

BACKGROUND/AIMS: Aggressive treatment for malignancy of the biliary tract has resulted in an increased incidence of pyogenic liver abscess. We retrospectively studied risk factors for and clinical findings of the liver abscess. METHODOLOGY: The subjects were 45 patients who underwent pancreatoduodenectomy (group A), 38 patients who underwent liver resection with biliary-intestinal anastomosis (group B), and 55 patients who underwent biliary-intestinal anastomosis alone (group C) during the past 13 years. We retrospectively studied risk factors by univariate and multivariate analyses. RESULTS: Liver abscess occurred in 6 patients in group A and 4 in group B. No patient developed liver abscess in group C. The incidence of liver abscess was significantly higher in groups A and B than in group C (p = 0.0068 and p = 0.0253, respectively). The incidence was significantly higher in patients who underwent anastomosis with subsegmental bile ducts (p = 0.0264). The incidence was significantly higher in patients with vascular reconstruction (p = 0.0254). Abscess or biliary drainage and administration of antibiotics were performed. Five patients died secondary to multiple organ failure. CONCLUSIONS: Pancreatoduodenectomy or liver resection with biliary-intestinal anastomosis, anastomosis with subsegmental bile ducts, and vascular reconstruction are risk factors for refractory liver abscesses after biliary-intestinal anastomosis.

Adult↗
PubMed1995

Pyogenic hepatic abscess: results of current management.

From 1980 to 1991, 56 cases of pyogenic liver abscess were treated at the Cleveland Clinic. The most frequently used treatment was percutaneous catheter drainage of the abscess under computed tomography (CT) guidance (39 patients), followed by CT-guided aspiration without catheter drainage (10 patients). Six patients were initially treated by open operative drainage; another five were operated upon after CT guided drainage had failed. One patient with advanced pancreatic cancer was treated with antibiotics only. The overall mortality rate was 12.5% (7/56). It is clear that the preferred method of treatment for pyogenic hepatic abscess is now CT guided catheter drainage. Operative drainage is reserved for patients who fail to respond to percutaneous drainage or in whom surgery is indicated for other purposes. Aspiration without catheter drainage is a modality that needs further evaluation to define its indications.

Adult↗
PubMed1989

Liver abscess. The need for complete gastrointestinal evaluation.

The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation.

Adult↗
PubMed2005

Pyogenic hepatic abscess after percutaneous liver biopsy in a patient with sickle cell disease.

Liver abscess is a rare complication of liver biopsy but has not been reported in a patient with sickle cell disease (SCD) undergoing this procedure. The authors report the case of a child with SCD, on treatment with chronic transfusions and desferrioxamine, who developed a delayed liver abscess after a liver biopsy in which Avitene, a topical hemostatic agent, was used. This is the first description of a liver abscess as a possible complication of liver biopsy in a child with SCD. The presence of a hepatic abscess should be considered in the differential diagnosis of atypical abdominal pain in patients with SCD.

Abdominal Pain↗
PubMedDate not supplied

Irrigation of liver abscess: proposal of a novel method and possible indications.

We present here two suggestive cases in considering the advantages and disadvantages of irrigation of pyogenic liver abscess: one patient developed an intrahepatic hematoma as an unusual sequela, while the other was successfully treated by abscess irrigation, overcoming failure of percutaneous catheter drainage and the patient's seriously ill condition. Based on these cases, we propose a novel method of liver abscess irrigation via percutaneous drainage tubes with the following three characteristics: 1) use of a drip infusion apparatus for irrigant instillation and drainage in order to avoid elevation of pressure in the abscess, a source of potential life-threatening sequelae, 2) addition of contrast medium to irrigant, and 3) employment of computed tomography in dynamic equilibrium of irrigant in order to evaluate the efficacy of current irrigation. Of interest was the parenchymal enhancement around the irrigated liver abscess revealed by computed tomography with this method, which suggested that dissemination of abscess contents may be inevitable with irrigation. Although the indications for liver abscess irrigation must be considered carefully given the critical sequelae potentially associated with it, the method we present can be used as a second-line trial exclusively for liver abscesses refractory to first-line treatment with percutaneous catheter drainage or needle aspiration, since it can be used not only as a therapeutic procedure with mechanical washing or dilution of abscess contents but also as a diagnostic aid enabling more effective subsequent treatment by defining the areas in which drainage and irrigation is not effective.

Aged↗
PubMed1993

Pyogenic hepatic abscess.

We reviewed the clinical courses of 37 patients treated for pyogenic liver abscesses. These abscesses were cryptogenic in 38% of the patients, associated with biliary tract or intra-abdominal disease processes in 48%, and hematogenous in 11%. Computed tomography was more accurate (96%) in diagnosing a hepatic abscess than ultrasonography (82%). The majority of the patients were treated initially with percutaneous drainage (18) or needle aspiration drainage (5); treatment failure occurred in 9 of these 23 patients (39%). In contrast, there were no treatment failures in the 9 patients treated with primary operation. Overall, 4 of the 37 patients died (a mortality rate of 11%) but 2 of them died of underlying malignant disease rather than the liver abscess.

Adolescent↗
PubMedDate not supplied

Occult liver abscess following clinically unsuspected ingestion of foreign bodies.

Two uncommon cases of foreign body (a wooden clothespin and a toothpick) perforation of the gur with associated pyogenic liver abscesses are presented. These cases illustrate the difficulties of preoperative diagnosis. The lack of history of ingestion of foreign bodies, variable clinical presentation of the conditions and radiolucent natures of the foreign bodies all play a role in impeding the diagnosis preoperatively. This report emphasizes the role of ultrasound and computed tomographic scan in evaluating similar cases. Any patient with known risk factors for ingestion of foreign body should arouse suspicion and be investigated further.

Adult↗
PubMed2006

[A case of primary neuroendocrine carcinoma of liver presenting with liver abscess].

Primary hepatic neuroendocrine cell carcinoma is a very rare tumor. We experienced a 75-year-old woman with primary hepatic neuroendocrine carcinoma presenting with pyogenic liver abscess. Abdominal CT scan revealed a multiseptated liver abscess and an enlarged lymph node in portocaval portion. We performed percutaneous drainage of the liver abscess, but the amount of drained pus did not decrease after 20 days. The follow-up abdominal CT scan showed that the cystic portion of liver abscess had been replaced by the solid tumor. Microscopic examination of the tumor tissue showed nests of epithelial cells with uniform round hyperchromatic nuclei and high nuclear to cytoplasmic ratio. Immunohistochemical staining was strongly positive for synaptophysin and chromogranin A.

Aged↗
PubMed1995

A case of gas-containing liver abscess associated with emphysematous change in the gallbladder.

We describe a 77-year-old man with diabetes mellitus who developed a large gas-containing pyogenic liver abscess after admission. Mild elevation of serum biliary enzyme levels suggested probable biliary trouble on admission. Ultrasonography and computed tomography showed a large abscess of the liver with gas formation and the presence of gas within the lumina of the gallbladder and biliary tract when the patient had fever, leukocytosis and evidence of hepato-renal dysfunction. These findings suggest that the large liver abscess may have developed as a result of emphysematous cholecystitis.

Aged↗
PubMedDate not supplied

Ultrasound-guided percutaneous drainage of liver abscess in children.

This study's purpose was to investigate the effectiveness of ultrasound-guided percutaneous drainage (US-PD) as treatment modality for pediatric pyogenic liver abscess when compared with other modalities. Ten consecutive patients, aged from 2 months to 22 years, were enrolled in this study. In addition to antibiotics, US-PD was attempted in each case unless the procedure was judged unsuitable. Six patients were treated with US-PD while four were not, for various reasons. US-PD was performed under an intravenous anesthesia and with the aid of real-time sonography. An indwelling pigtail catheter was usually inserted during US-PD. Fever subsided within one to six days, but the abscess cavity closed later. Failure to respond to US-PD may relate to the huge size of abscess cavity; surgical drainage provides an option. A trend toward a shorter hospital stay and defervescence day was found in the US-PD group than in the non-US-PD group. Prognosis was generally good and none in this series died of this disease or the procedure. Klebsiella pneumoniae was the pathogen most frequently encountered. Seven of the ten patients had underlying disease, and hemoglobinopathy was frequently associated. In conclusion, adequate drainage is recommended as the most effective treatment modality for pediatric liver abscess, and US-PD is the first choice.

Adolescent↗