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PubMed1989

[Results of the treatment of pyogenic hepatic abscess over a 10-year period].

The experience of the Hospital Clínico de la Universidad de Chile in the treatment of pyogenic liver abscess, during various periods of the last decade is presented. Fifty six cases treated by means of three therapeutic options are reviewed retrospectively. The overall mortality during period was of 27% and it decreased to 19% if only the last three years were taken into account. There were no significant changes comparing surgical treatment in different periods. Fourteen patients were managed with percutaneous drainage, with therapeutic success in 85% of cases and one death. Five cases were treated only with antibiotics; results were good in four of them. The different mortality figures were analyzed concluding that they belonged to man comparable universes because of the unavoidable patient selection. Surgery was reserved for the more severe cases. Percutaneous drainage is the first choice treatment in patient with solitary abscess without a surgically treatable abdominal primary location.

Adult↗

PubMedDate not supplied

Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess.

BACKGROUND AND OBJECTIVE: Direct demonstration of Entamoeba histolytica by conventional microscopy and in vitro culture in pus obtained from amebic liver abscess (ALA) is often unsuccessful. We evaluated polymerase chain reaction (PCR) for detection of E. histolytica DNA in such pus. METHODS: Species-specific primers were used for the amplification of E. histolytica DNA from liver pus obtained from 30 patients with ALA. Patients with pyogenic liver abscess and sterile (autoclaved) pus spiked with Entamoeba dispar and bacteria (Escherichia coli, Klebsiella spp. and Bacteroides spp.) were used as negative controls. RESULTS: PCR was positive in 83% of pus specimens from patients with ALA, and was negative in all 25 pus specimens obtained from pyogenic abscess and autoclaved pus spiked with known bacteria. Sensitivity and specificity of PCR were 83% and 100%, respectively. The overall positivity of PCR was higher compared to serological tests. CONCLUSION: PCR may be a more reliable and better alternative diagnostic modality for ALA.

Animals↗

PubMed1995

Pyogenic hepatic abscess after pancreatic resection for chronic pancreatitis.

Seventeen patients underwent surgery for alcohol-induced chronic pancreatitis. Three patients later presented with pyogenic liver abscess. The time interval between surgery and presentation with hepatic abscess varied from 6 weeks to 3.5 years. All patients were diabetic, the presentation was insidious and all made an uneventful recovery, two with percutaneous drainage and one with antibiotics alone. The aetiology of this uncommon complication is discussed.

Adult↗

PubMed1976

Experience and reason--briefly recorded.

Solitary pyogenic hepatic abscesses were identified as the cause of fever, abdominal pain, and hepatomegaly in two otherwise normal children who were seen at St. Louis Children's Hospital during the past year. Liver function tests were normal and blood cultures were negative in both patients. These cases illustrate that pyogenic liver abscess may occur in normal children and should be considered whenever fever of unknown origin is associated with abdominal complaints. Only in this way can we hope to improve upon the results cited previously, namely that the majority of liver abscesses remain undiagnosed during life.

Child↗

PubMed1992

Pediatric liver cysts and abscesses.

Cystic liver lesions in children pose diagnostic and therapeutic dilemmas. When discovered during evaluation of abdominal distension, the likely cause is benign hepatic cyst. Surgical intervention aimed at resection is highly curative. Echinococcal disease, usually distinguishable from nonparasitic cystic disease, is rare in children in the United States. Therapy is aimed at sterilization and complete excision of hydatid tissue. Cystic liver lesions in septic children represent liver abscesses, pyogenic or amebic, which are frequently fatal if not diagnosed early and treated appropriately. Ultrasonography and computed tomography have simplified the diagnosis and treatment of these diseases, but a high index of suspicion is required because the signs and symptoms of liver abscess in children are nonspecific.

Child↗

PubMed1983

Tuberculous abscess of the liver. A case report.

Tuberculous abscess of the liver is rare. A case is reported and the southern African literature briefly reviewed. The clinical similarities to amoebic and pyogenic liver abscesses and primary or secondary neoplasms of the liver are emphasized. Laboratory tests and hepatic scintiscans may not assist in differentiating between these conditions.

Child, Preschool↗

PubMedDate not supplied

Neonatal solitary liver abscess: report of one case.

We report a case of a solitary liver abscess in a 5-week-old female. She was full term, and there were no predisposing events or immune deficiencies. The only sign of her disease was a gradually distended abdomen. A prior episode of fever with possible occult bacteremia was implicated in the development of her abscess. The abdominal sonography and magnetic resonance image (MRI) did not provide any definite preoperative diagnostic information. Surgical resection of the abscess and a short course of antibiotic therapy cured the disease. This patient was still well following 2 years of check-ups by sonography. The possibility of a pyogenic liver abscess should be considered in the differential diagnosis of neonatal hepatic mass. That is, even if there is not a definite diagnostic focus on finding an infection.

Abdomen↗

PubMed1996

Pyogenic hepatic abscess. Changing trends over 42 years.

OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14% vs. 26%). CONCLUSIONS: Significant changes have occurred in the etiology, diagnosis, bacteriology, treatment, and outcome patients with pyogenic hepatic abscesses over the past 4 decades. However, mortality remains high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results.

Age Distribution↗

PubMed1992

[Liver abscess formation after treatment of liver cancer by arterial injection using adriamycin/mitomycin C oil suspension (ADMOS)].

Of 210 patients with hepatocellular carcinoma (n = 135), metastatic liver cancer (n = 71) and cholangiocarcinoma (n = 4) who underwent intra-arterial infusion of adriamycin and/or mitomycin C oil suspension (ADMOS) and cisplatin, and both regimens, pyogenic liver abscess occurred in seven (3.3%). The percentages of abscess formation in the respective types of liver cancer were 0.8, 7.0 and 25%. These differences among the three types of liver cancer were attributed to the volume of the tumor vascular beds to be embolized, which might determine the relative amount or regional Lipiodol retention in the tumor and normal liver tissue. Four of seven patients with hepatic abscess had received the intra-arterial infusion of ADMOS, and their angiographic findings showed sequential decreases in the vascular beds of the tumor in comparison with those of previous infusion procedures; all had hypovascular liver tumors angiographically. We have never experienced this complication in other treatments such as embolization of the hepatic arteries and intra-arterial infusion of water-soluble anticancer drugs alone. These results suggest that the most important factor leading to abscess formation is the ischemic destruction of the intrahepatic ducts secondary to occlusion of the peribiliary arterial plexus by Lipiodol and/or the direct effects of anticancer drugs on these vessels. To avoid this complication, the volume of Lipiodol used for intraarterial infusion therapy should be carefully determined, especially when the patient has hypovascular tumors of the liver and a history of multiple previous intraarterial infusion procedures of anticancer drug. The use of ADMOS should be avoided in patients with hypovascular tumors of the liver such as secondary deposits and cholangiocarcinoma.

Adenoma, Bile Duct↗

PubMedDate not supplied

Intrahepatic abscess due to gallbladder perforation.

BACKGROUND: Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment. METHODS: The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis. RESULTS: Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions. CONCLUSION: Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.

Aged↗

PubMed1999

Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images.

The purpose of this study was to determine the magnetic resonance imaging (MRI) features of pyogenic hepatic abscesses on T1-weighted, T2-weighted, and serial gadolinium (Gd)-enhanced T1-weighted spoiled gradient-echo (SGE) images including images acquired in the immediate, intermediate, and late phases of enhancement. The MRI studies of 20 patients with pyogenic liver abscesses were retrospectively reviewed. All patients were examined on 1.5 (n = 19) and 1.0 (n = 1) T MR scanners. MR studies included T1-weighted, T2-weighted, and serial Gd-enhanced SGE images. The following determinations were made: signal intensity of the abscess cavity and perilesional liver tissue, and the presence of internal septations, layering material, or air in the abscess cavity. The pattern of enhancement of the abscess wall, internal septae and peri-abscess liver were evaluated on serial Gd-enhanced SGE images. A total of 53 abscesses were observed in the 20 patients. Fortyeight abscesses were hypointense on T1-weighted and hyperintense on T2-weighted images. Internal septations were present in four abscesses. Lower signal intensity material was observed in a dependent location on T2-weighted images in one abscess. Signal void foci of air located on the nondependent surface was observed in two abscesses. Two other abscesses contained signal void air that occupied the entire abscess cavity, observed on all imaging sequences. On serial gadolinium-enhanced images, all abscesses revealed early enhancement of the wall, which persisted with negligible change in degree of enhancement or thickness on delayed images. Abscess walls ranged in thickness from 2 to 5 mm. Internal septations ranged in thickness from 2 to 3 mm. Abscess walls and septations were relatively uniform in thickness with no evidence of focal nodularity. Periabscess liver tissue was mildly hypointense on T1-weighted and mildly hyperintense on T2-weighted images in 20 lesions, which were either circumferential (n = 12) or wedge-shaped (n = 8). All these regions enhanced more than the remainder of the liver on immediate post-gadolinium images and remained relatively hyperintense on late phase images. Periabscess liver parenchyma was isointense on both T1- and T2-weighted images in 18 lesions, and in these lesions wedge-shaped subsegmental (n = 6) or segmental (n = 12) enhancement was observed on immediate gadolinium-enhanced images, which faded to isointensity on intermediate phase images. No perilesional signal changes and enhancement difference was observed in 15 lesions. Characteristic features of abscesses include: intense mural enhancement on early gadolinium-enhanced images, which persists with negligible change in thickness and intensity on later post-gadolinium images, and the presence of periabscess increased enhancement on immediate post-gadolinium images. These MRI features may help to distinguish abscesses from other focal liver lesions during differential diagnosis.

Contrast Media↗

PubMedDate not supplied

Management of 240 cases of liver abscess.

The clinical features and surgical management of 240 cases of liver abscess admitted during a period of five years are presented. Incidence of liver abscess was 0.20 per cent of hospital admissions. A peak age incidence in the 4th decade, male preponderance, pain and fever were the striking features. The majority of the abscesses were localised to a single lobe (90.0%). The abscess was sited in the right lobe in 75.1 per cent, in the left lobe in 18.3 per cent and in both lobes in 6.7 per cent. Elevation and limitation of movement of the right dome of the diaphragm was present in 89.5 per cent of cases. Depending upon therapeutic response, aspiration or/and surgical drainage was undertaken. Aspiration was done in 169 patients and surgical drainage in 63 patients. Management of pyogenic liver abscess included early operative intervention preceded by appropriate antibiotic therapy. Surgical intervention is required less often in amoebic abscess and is recommended only after amoebicidal therapy. Open drainage is recommended for the cases associated with complications, left lobe abscess and big abscess.

Adolescent↗

PubMed1986

Liver abscess in Western Australia (1974-1983).

Over the 10 year period 1974-1983, 91 cases of liver abscess presented to the major teaching hospitals in Perth, Western Australia. Amoebic liver abscess (ALA) accounted for 37 (or 41%) of these cases, an incidence inflated by Perth's proximity to south-east Asia where amoebiasis is endemic. This frequent recent history of contact, the availability of sensitive and specific diagnostic serology and a clinical presentation usually suggesting pathology in the right upper quadrant, accounted for the consistently short delay in diagnosis of ALA. There were no deaths from ALA and a low incidence of complications such as secondary infection or rupture into the thorax. On the other hand, pyogenic liver abscess (PLA) commonly presented in a more non-specific manner and in an older age group, contributing to a long delay in diagnosis. Despite improvements in liver imaging techniques and advances in antibiotic and general supportive therapy, mortality for PLA remains high, 20% in this series. Fatal PLA was associated with multiple abscesses not amenable to drainage, increasing age, delay in diagnosis and the presence of septicaemia.

Adolescent↗

PubMed1987

Multiple Fusobacterium nucleatum liver abscesses. Association with a persistent abnormality in humoral immune function.

A previously healthy 29-year-old man developed multiple hepatic abscesses secondary to Fusobacterium nucleatum. No underlying local disease was found. The leading portal of entry for the bacterium may have been the oral cavity; 4 days before the onset of his illness he had had extensive dental work. Immunological evaluation during the illness and in late convalescence (16 weeks after onset) revealed a persistent B cell abnormality characterized by markedly depressed in vitro secretion of immunoglobulins in response to pokeweed mitogen; however, serum immunoglobulins and IgG subclasses were normal. Abnormal numbers of suppressor T cells (OKT8+) and increased suppressor function were also present. Anaerobic pyogenic liver abscesses may occur in the absence of obvious underlying disease, but this case suggests that there may be an association with in vitro abnormalities of the immune system.

Adult↗

PubMed2000

Direct amplification of Entamoeba histolytica DNA from amoebic liver abscess pus using polymerase chain reaction.

An important and serious complication of intestinal infection with Entamoeba histolytica is the involvement of the liver (hepatic amoebiasis). Hepatic amoebiasis is usually diagnosed by the clinical picture (pain in the right upper quadrant and fever), ultrasound examination and positive serology. However, none of these tests are definitive and the picture overlaps with pyogenic liver abscess caused by bacteria. It is for this reason that the feasibility of using polymerase chain reaction (PCR) for the detection of E. histolytica DNA in liver abscess pus was investigated. A comparative study was done to verify the sensitivity of ten pairs of primers specific for detecting E. histolytica in stools. Samples of liver abscess pus from 22 serology-positive patients were collected under ultrasound guidance; and these were used directly in PCR assays without any prior pre-treatment of the samples. Of the ten pairs of previously published primers tested, two pairs of primers (PI + P2 and P11 + P12) were found to give 100% sensitivity. Based on these results, we recommend that PCR assay can be successfully used to confirm the diagnosis of amoebic liver abscess with the primers identified.

Animals↗

PubMed2001

Pyogenic hepatic abscess: clues for diagnosis in the emergency room.

The objective of this paper is to describe the clinical and diagnostic characteristics of patients with pyogenic hepatic abscesses evaluated in the emergency room, and to know whether it is feasible to make an early diagnosis based on any of these characteristics. The setting was an urban, tertiary-care teaching hospital. This was a retrospective study of 63 adult patients admitted to our institution because of pyogenic liver abscesses from January 1991 to December 1998.

Abdomen↗

PubMed1995

Liver abscess in polycystic liver disease.

A case of an elderly female whose clinical manifestations were atypical in view of physiologic aging changes and multiple pathology commonly found in the geriatric group. The liver abscess had presented clinically and radiologically like a hepatic malignancy and pus was obtained during the process of liver biopsy. Even though anchovy-like pus suggested amebic in origin, the microscopic exam showed numerous polymorphonuclear leucocyte and the culture both from the blood and pus grew Klebsiella spp. as well as the study for E. histolytica antibody was also negative. Pyogenic liver abscess was the working diagnosis and indicated for surgical drainage. Adult polycystic liver disease was found intraoperatively and the liver pathology did reveal the presence of many amebae in the cavity of the right lobe of the liver. After the administration of ceftriaxone and metronidazole as well as the surgical drainage, the patient recovered uneventfully within sixteen days of admission.

Aged↗

PubMed1993

[Hepatic actinomycosis].

We present a case of primary liver actinomycosis in a patient who was operated on for a duodenal ulcus seven years before. A gastrectomy was performed. His gallbladder was also removed two years before. After the surgical treatment, followed by antibiotic and chemotherapeutic treatment, with the result of a pretended success, the patient developed a liver pyogenic abscess and portal hypertension. Authors emphasise the seriousness of the illness as well as its rarity even with an accurate treatment.

Actinomycosis↗