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PubMedDate not supplied

[Liver abscess: diagnosis and treatment. Study of a series of 22 cases].

Twenty-two cases of abscess of the liver are reported. Eighteen were due to pyogenic organisms and four to amebas. The diagnosis was established based on clinical and laboratory evaluations and, above all, on ultrasonography with aspiration of the lesion. The causative organism was recovered from the aspirate in 33.3% of cases. Seventeen patients were treated by percutaneous aspiration. Two patients required insertion of a drain because of a biliary fistula. The success rate of percutaneous aspiration with or without drainage was 88.2% in our series. The two patients who had surgery had loculated abscesses with thick pus. In conclusion, the diagnosis and treatment of hepatic abscesses have benefited from advances in imaging techniques; in particular, aspiration or drainage can be performed simply under ultrasonographic guidance.

Adult↗

PubMed2006

Liver abscess associated with hepatic artery pseudoaneurysm with arteriovenous fistula: imaging and interventional management.

Hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. Hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.

Aneurysm, False↗

PubMed1993

[An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses].

A patient presented with gas in the portal vein and miliary liver abscesses due to perforation of a sigmoid diverticulitis abscess. The outcome was favorable after surgical treatment. Gas in the portal vein, a sign of extreme seriousness, is generally the result of intestinal necrosis from ileo-mesenteric artery infarction, responsible for more than 75% of deaths. Diagnosis of this exceptional complication, suggested from a straight abdominal film, was confirmed by hepatic ultrasound and scan imaging. Urgent surgical intervention can hopefully, as in the present case, result in the patient's survival.

Aged↗

PubMed1987

Multiple listerial liver abscesses.

Hepatic involvement in listeriosis is uncommon in adults. Cases previously reported include three presenting as acute hepatitis and three of listerial liver abscesses found at necropsy. We report a case of multiple listerial liver abscesses. We believe this to be the first time this diagnosis has been made in a living patient.

Aged↗

PubMed1993

Gas-containing liver abscesses: assessment by ultrasound (US) and computed tomography (CT).

Single gas-containing pyogenic liver abscesses in 11 patients were studied by ultrasound and computed tomography (CT). On ultrasound, all abscesses were predominantly echogenic compared to the normal liver parenchyma. The gas collections appeared as hyperreflective areas arranged in clusters associated with acoustic shadowing and ring-down artifacts. Ten abscesses (90%) had ill-defined margins on ultrasound, causing underestimation of their sizes in these patients. All abscesses were shown to be multiloculated and had clearly defined borders on CT, not appreciated or mistaken for multiplicity of abscesses on ultrasound. Ultrasound may be inadequate in the evaluation of gas-containing liver abscesses, as they have complex echotexture in addition to ring-down artifacts, acoustic shadows and poorly-defined margins; leading to underestimation of abscess size, difficulty in identifying loculations and erroneous interpretation of multiplicity of abscess cavities.

Adult↗

PubMed2005

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses.

We report on a case of Churg-Strauss syndrome (CSS) with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone, after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

Adult↗

PubMed1987

Successful non-surgical management of pyogenic liver abscess.

A 5-month-old infant presented with high fever, irritability, and poor feeding. Examination revealed an enlarged liver and neutropaenia. Ultrasonography was unhelpful, but a diagnosis of liver abscess was confirmed by computed tomography on day 4 of the illness. Gallium scan was normal on day 4 but showed a resolving liver abscess on day 6. Staphylococcus aureus was grown in blood culture. The infant recovered with antibiotic treatment alone.

Chloramphenicol↗

PubMed1999

Common presentations of amebic liver abscess.

STUDY OBJECTIVE: The most common extraintestinal manifestation of Entamoeba histolytica, the agent of amebiasis, is a hepatic abscess. This infection is common throughout the world and can be associated with life-threatening consequences. Given the often nonspecific nature of the complaints related to an amebic abscess, a retrospective review of patients with confirmed disease was done to recognize the most common patterns of presentation. METHODS: A retrospective case series was conducted of all patients with confirmed amebic liver abscess over a 5-year period. All available emergency department and inpatient records were reviewed. Age, sex, country of origin, chief complaint (including duration), vital signs, and physical and laboratory findings were recorded. The use of ultrasonography, computed tomography scan, chest radiograph, and serum antibodies was noted, as well as the final ED diagnosis. RESULTS: Seventy-five patients were reviewed; mean patient age was 35.5 years, 80% were male, and Mexico was the country of origin for 64%. The most common complaint was fever (77%), followed by abdominal pain (72%), which was most often located in the right upper quadrant. Cough (16%), chest pain (19%), and chest radiographic abnormalities (57%) were also common. The majority of patients (69%) had symptoms for less than 13 days. The WBC count was the most consistent laboratory abnormality (83%), whereas the liver aminotransferase, alkaline phosphatase, and bilirubin levels were often normal. Most patients received their diagnoses on the basis of ultrasonography (85%), followed by a confirmatory serum antibody titer (88%). The diagnosis of amebic liver abscess was correctly made in the ED in 31.5% of the patients, with the most common misdiagnoses being cholecystitis (16.4%), hepatitis (12.3%), and pneumonia (9.6%). CONCLUSION: Patients with amebic liver abscess do present to EDs in the southwestern United States, especially in areas with a high immigrant population from endemic areas. Patients with complaints of fever and right upper quadrant abdominal pain, especially men of Hispanic origin, warrant a high degree of vigilance. Whereas most laboratory studies are unhelpful, the diagnosis can often be made in the ED by means of a bedside ultrasonographic test. Treatment should be initiated with metronidazole with disposition to an inpatient medical service.

Abdominal Pain↗

PubMed1995

Percutaneous catheter drainage of amebic liver abscesses with and without intrahepatic biliary communication: a comparative study.

Influence of communication with the intrahepatic biliary system on the clinical picture of amebic liver abscesses in 33 consecutive patients resistant to medical therapy, and their response to percutaneous catheter drainage was evaluated. Abscess-biliary communication was found in 27% of the sample. Patients with abscesses communicating with the biliary tree presented more frequently with jaundice (67% vs. 0%, P < 0.005), with a longer duration of illness (median 20 vs. 12 days, P < 0.001), had larger lesions (median 600 vs. 320 ml, P < 0.001) and required catheter drainage for longer periods (median 17 vs. 6.5 days, P < 0.000001). However the presence of a biliary communication did not materially affect the cure rate with catheter drainage (89% vs 100%, P > or = 0.05). In conclusion, an abscess-biliary communication is not uncommon in refractory amebic liver abscesses, and can be clinically detected by the presence of jaundice. Though a prolonged period of drainage may be necessary in the presence of this complication, catheter drainage can be expected to result in cure.

Adult↗

PubMed1991

Protection of gerbils from amebic liver abscess by immunization with the galactose-specific adherence lectin of Entamoeba histolytica.

No protective antigens from Entamoeba histolytica have been previously defined. We tested the ability of the galactose-specific adherence lectin of E. histolytica to elicit a protective immune response in conjunction with Freund's incomplete and complete adjuvants. The gerbil (Meriones unguiculatus) model of an experimental amebic liver abscess was used. Gerbils were immunized intraperitoneally or subcutaneously with 10 micrograms of the affinity-purified lectin in complete Freund's adjuvant and then at 2 and 4 weeks with 10 micrograms of the lectin in incomplete Freund's adjuvant. All of the immunized animals developed antilectin antibody titers of greater than 1/1,024 as measured by a radioimmunoassay. The gerbil antilectin antibodies were shown by Western immunoblotting to be directed to the heavy subunit but not the light subunit of the lectin. Immune gerbil sera inhibited amebic adherence by 100% at a 1/10 dilution. Immune and control gerbils were challenged at 6 weeks by the intrahepatic injection of 5 x 10(5) E. histolytica trophozoites. Four independent trials demonstrated complete protection from amebic liver abscess formation in 67% of lectin-immunized gerbils. Unexpectedly, liver abscess weights were significantly higher in the gerbils that failed to become immune than in the control animals. Our results demonstrate that the galactose lectin is a protective antigen and provide an immune-animal model to study the mechanisms of protection and potential disease exacerbation conferred by the antilectin immune response.

Animals↗

PubMed2003

[Minimally invasive surgery of liver abscesses].

Results of the examination and treatment of 49 patients with abscesses of the liver are presented. Clinical-laboratory findings, specific features of localization, sizes and genesis of the disease are described. The criteria of the conservative and open surgical methods of treatment of abscesses of the liver are established, the advantages and shortcomings of USI for diagnosis of the disease are shown. An analysis of the data obtained allowed a conclusion that the percutaneous drainage under the ultrasonic control is an effective and perspective method of treatment, but requires further investigation, improvement and wide introduction into practice.

Adult↗

PubMed2002

Primary liver abscess caused by one clone of Klebsiella pneumoniae with two colonial morphotypes and resistotypes.

Two diabetic patients with primary liver abscess, who initially responded unsatisfactorily to intravenous ceftriaxone or cefoxitin treatment and had abscess drainage, were found to be infected with a single clone of Klebsiella pneumoniae with two different colonial morphotypes and resistotypes. Primary liver abscess caused by second-generation cephalosporin-resistant K. pneumoniae strains may be an emerging problem in Taiwan.

Adult↗

PubMedDate not supplied

Evaluation of treatments for liver abscess: significance of intra-arterial antibiotic injection therapy.

Various treatments were performed in 14 patients with liver abscess, and their clinical effects were compared. The treatments were intra-arterial antibiotic infusion therapy (Group A, 4 patients), intra-arterial infusion therapy plus percutaneous drainage of the abscess (Group B, 4 patients), and intravenous antibiotics alone (Group C, 6 patients). The period from the beginning of treatment to negative conversion of CRP* (period until cure) was compared among the groups. Groups A and B had received intravenous antibiotics for a mean of 10 days and 16 days, respectively, but the treatment was ineffective. The mean period until cure from the beginning of intra-arterial infusion therapy was 36 days for Group A and 18 days for Group B. In Group C, the mean period until cure was 28 days. All patients recovered, and recurrence was observed in only one patient. Although liver abscess can be treated successfully in many patients by intravenous antibiotics alone, intra-arterial therapy is effective in those in whom intravenous therapy is not effective.

Adult↗

PubMed1986

[Clinico-microbiological diagnosis of non-clostridial anaerobic infections in diseases of the biliary tract and liver abscess].

The three-years experience of clinico-experimental examinations of 150 patients with various surgical diseases of bile ducts and abscesses of the liver is summed up. In 24 of them (16%) participation of non-sporulating anaerobes in the infection process was shown. The greatest etiological role of these pathogenic agents was found in purulent cholangitis and cholangitic abscesses of the liver. It was noted that the efficiency and reliability of microbiological diagnostics of biliary infection greatly depended on perfection of the methods used.

Adolescent↗

PubMed1993

Fusobacterium necrophorum septicemia complicated by liver abscess. A case report.

A previously healthy 27-year-old man developed Fusobacterium necrophorum septicemia complicated by a solitary liver abscess. This is an unusual course of necrobacillosis, in addition to Fusobacterium necrophorum being a rare cause of anaerobic liver abscesses. The patient was treated with percutaneous drainage and a prolonged course of ampicillin and metronidazole therapy. He had a successful recovery.

Adult↗

PubMed1990

Amebic liver abscess: review of twenty-nine cases with an evaluation of imaging techniques.

Twenty-nine patients with amebic liver abscess were reviewed retrospectively. In twenty-six of twenty-eight patients, ultrasonography demonstrated the abscess. An elevated indirect hemagglutination titre confirmed the diagnosis in twenty-seven of twenty-eight patients. All patients recovered with specific chemotherapy. In evaluating clinically suspected amebic liver abscess, ultrasonography is a cost-effective, readily available, and reliable imaging method. If needed, computed tomography provides confirmation. Needle aspiration or catheter drainage have questionable value unless the diagnosis is in doubt or extrahepatic spread is present. The indirect hemagglutination test shows an elevated titre in most patients with liver infestation. By inducing a prompt recovery, antiamebic chemotherapy can confirm a suspected clinical diagnosis.

Adult↗

PubMed1995

[Presentation, diagnosis and treatment of pyogenic liver abscess: analysis of a series of 63 cases].

BACKGROUND: The aim of this study was to know the clinical, etiopathogenic and microbiologic characteristics of pyogenic liver abscesses (PLA). METHODS: A retrospective analysis of the cases of PLA diagnosed from 1978 to 1992 in the Internal Medicine, Infectious Disease, and Gastrointestinal Surgery Departments of the Hospital de Bellvitge in Barcelona, Spain was performed. RESULTS: A total of 63 cases of PLA (43 males and 20 females, mean age 54 +/- 19 years) were analyzed. The most frequent clinical and analytical data included fever (92%), leucocytosis (84%) and abnormal levels of alkaline phosphatase (81%). The PLA were single in 65% and multiple in 35%. Echography was diagnostic in 91% of the cases. A positive culture of the abscess was obtained in 40 cases, being monomicrobial in 27 cases (67.5%). Eleven of the 13 polymicrobial cultures were from single PLA. The most frequent bacteria found were the enterobacteria (44%) followed by the microaerophilic streptococci (28%) and the anaerobes (17%). The PLA was of biliary origin in 31.8%, contiguous in 12.7% and unknown in 38%. Percutaneous drainage was performed in 34 patients (54%). Mortality attributable to the abscess was 3%. CONCLUSIONS: The clinical presentation of pyogenic liver abscess has not varied over time. There has, however, been a change with respect to its epidemiology and therapeutic management. At present, the possibility of rapid diagnosis and image guided percutaneous drainage offers a better prognosis for this disease.

Adolescent↗

PubMed1997

Epidemiological aspects of liver abscesses in children in the Western Cape Province of South Africa.

A high incidence (28 per 100,000 admissions) of liver abscesses is reported in children from the Western Cape Province of South Africa. Of a total of 84 childhood hepatic abscesses over a 10-year period, 51 per cent (43 patients) were primary pyogenic, 30 per cent (25 patients) amoebic, 2 per cent (two patients) Ascaris, and 17 per cent (14 patients) were culture negative. Protein calorie malnutrition was evident in 56 per cent of cases. Amoebic abscesses originated in patients from rural areas, whereas pyogenic abscesses occurred in patients from urban and periurban environments. Staphylococcus aureus was cultured in 85 per cent of pyogenic liver abscesses. Gram negative organisms were identified in four cases of amoebic hepatic abscess where secondary infection occurred. Co-existing parasites of Ascaris lumbricoides and Trichuris trichiura were identified in the stools of 31 per cent of patients. A low (4.8 per cent) mortality is reported for this series.

Chi-Square Distribution↗