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PubMedDate not supplied

Percutaneous management of hepatic abscess: a perspective by interventional radiologists.

Techniques for treating hepatic abscess have evolved rapidly during the past decade. For many years, the traditional treatment was surgical drainage. The development of modern imaging modalities, such as CT and US, has not only made the diagnosis more certain, but has also introduced a variety of percutaneous treatment options. Pyogenic hepatic abscess is now accepted as a medical/radiologic disease requiring surgical intervention only for correctable offending causes or for failed radiologic evacuation. Drainage via an indwelling catheter has been the traditional method of percutaneous treatment. However, indwelling catheters have disadvantages, including patient discomfort, the nuisance of catheter maintenance, and postprocedural complications. The technique of simple aspiration and intracavitary antibiotics as advocated by McFadzian et al, with excellent results confirmed by Giorgio et al, is a promising alternative to prolonged catheter drainage, and may be the biggest advancement in the management of hepatic abscess in 80 years. Surgeons have recently accepted radiologic drainage; now we need to see if interventional radiologists and surgeons will accept evacuation without indwelling catheter drainage. The role of interventional techniques for nonpyogenic hepatic abscesses will vary considerably. Mortality will still occur in the pyogenic varieties but should be related to underlying disease rather than the abscess itself.

Drainage↗
PubMed1987

Medical treatment of hepatic amebic abscess: rare need for percutaneous drainage.

Although amebic liver abscess can virtually always be successfully treated medically, percutaneous drainage has been advocated recently. In 96 recently treated patients, therapeutic aspiration and percutaneous drainage were rarely needed. Most cases were correctly diagnosed by means of clinical, laboratory, and sonographic findings. Abscesses in only 13 (13.5%) patients were diagnostically aspirated. An abscess in one patient was therapeutically aspirated because the patient was responding slowly to medical therapy. No patient required catheter drainage. The key to successful amebic abscess management is medical therapy. Therapeutic drainage is rarely needed. Successfully treated patients occasionally respond slowly to medical therapy, and successfully treated amebic abscesses may enlarge or become bizarre-appearing on sonograms. This should not prompt therapeutic drainage. Diagnostic aspiration is appropriate when amebic and pyogenic abscesses are indistinguishable using clinical and imaging findings. Rare indications for therapeutic aspiration or drainage include pyogenic superinfection and large, juxtacardiac abscesses (potential intrapericardial rupture).

Chloroquine↗
PubMed2002

Liver abscess in adults: ten years experience in a UK centre.

BACKGROUND: The epidemiology and management of liver abscess (LA) have evolved over time. AIM: To examine our experience over 10 years in a UK teaching centre. DESIGN: Retrospective review of patient records. METHODS: We reviewed the records of all patients aged >16 years discharged from Royal Hallamshire Hospital with a diagnosis of LA between April 1988 and December 1999. RESULTS: There were 69 patients with LA (65 pyogenic, 4 amoebic), giving a crude annual incidence rate of 2.3/100,000/year (18.15/100,000 hospital admissions). Median age was 64 years. Single lesions were found in 41 patients, multiple lesions in 28. Pre-admission, patients were symptomatic for a median 14 days, with the most common symptoms and signs being fever and abdominal pain/tenderness. Pathogens were identified in 74% and predisposing aetiology in 92% of those undergoing investigation. Spread of infection to the liver via the portal venous system was the commonest route of infection (46%), most frequently in patients aged >/=60 years (p=0.019). Abdominal ultrasound (US) was diagnostic for LA in >90% of cases. Treatment with anti-microbial therapy plus interventional radiology was optimal. The case fatality rate was 12.3%, mainly from associated underlying pathology. DISCUSSION: LA is commonly associated with underlying gastrointestinal pathology. Seeking out this underlying aetiology is an integral part of management. We recommend US as the first-line diagnostic tool with guided intervention plus antibiotic(s) as first-line treatment. Prognosis depends chiefly on the underlying pathology.

Adolescent↗
PubMed1990

[Perforation of malignant tumor of the gallbladder].

Perforative complications in 13 of 274 (4.7%) patients with carcinoma of the gallbladder are analysed. The author describes the specific features of the clinical course of this complication depending on certain factors associated with growth of the tumor and development of the pyogenic process, the types and outcomes of the operations.

Adult↗
PubMedDate not supplied

[Hepatic abscess: image-guided percutaneous drainage. Technique and indications].

Six patients underwent image-guided percutaneous drainage of liver abscesses at the Instituto Nacional de la Nutricion (a tertiary care referral center in Mexico City) in a seven month period. These patients were closely followed in order to evaluate appropriate indications for percutaneous drainage as well as techniques, complications and clinical evolution. Our study group included five males and one female; their mean age was 44.4 years (28-63) and the mean hospitalization time 24.3 days (10-34). We found multiple liver abscesses in three patients, and solitary abscesses in three, two in the left lobe and one in the right lobe. Considering the largest diameter, mean abscess size was 13.7 cm. The most important clinical symptoms were: fever, abdominal pain and malaise, and the most significant laboratory abnormalities were anemia, hypoalbuminemia, leukocytosis and high alkaline phosphatase serum levels. Etiology could be determined in three cases, two were pyogenic abscesses and one amebic. Percutaneous drainage was successful in five out of our six patients (83.3%). Complications included one subcapsular hematoma, without hemodynamic consequences, and one patient with severe upper gastrointestinal tract hemorrhage who required surgery, but we could not entirely demonstrate that the bleeding episode was directly related to the percutaneous drainage.

Adult↗
PubMed2006

Solitary actinomycotic abscesses of liver: report of two cases.

Hepatic actinomycotic abscesses are rare and secondary to other intra-abdominal infections. History of intra-abdominal surgery is a principal contributing factor for the abscess formation. Patients with hepatic actinomycotic abscess may suffer from fever, malaise, abdominal pain and bodyweight loss. The clinical progress of actinomycotic abscess is more indolent than the usual course of other pyogenic abscess. It is sometimes diagnosed as malignancy. This report consists of two cases of hepatic actinomycotic abscess mimicking tumours. Laboratory data revealed elevated alkaline phosphatase and leucocytosis. The abdominal computed tomography scan showed multiloculated lesions with peripheral contrast enhancement appearance. Diagnosis confirmation was based on the typical histologic feature of sulfur granules with inflammatory process by echo-guided fine needle biopsy or surgical specimen. These two cases were resolved with extended courses of intravenous and oral penicillin treatment.

Actinomycosis↗
PubMed1982

Comparison of indirect fluorescent-antibody amoebic serology with counterimmunoelectrophoresis and indirect hemagglutination amoebic serologies.

Patients ranged from those with no prior diagnosis of or suspected exposure to Entamoeba histolytica to those with proven amoebic liver abscesses (extraintestinal disease). A comparison of serologies from patients with proven and suspected amoebiasis or possible past exposure revealed good correlation between the indirect fluorescent antibody (IFA) procedure and the other methods used, counterimmunoelectrophoresis and indirect hemagglutination. Titers from patients with proven extraintestinal amoebiasis were in the expected high range previously reported by other authors. Patients with clinical histories suggestive of exposure to E. histolytica but no proven disease had lower titers which indicated possible background exposure. The IFA procedure provides a rapid method of antibody detection; results obtained on an emergency basis provide essential information in making the diagnosis of amoebic abscess, pyogenic abscess, or tumor. The IFA procedure is rapid, reliable reproducible, and relatively inexpensive to perform, provided a good source of antigen is consistently available.

Amebiasis↗
PubMed1985

Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage.

Medical therapy is standard for intrahepatic amebic abscess and generally is effective. However, we have encountered a group of patients in whom percutaneous aspiration and drainage was indicated due to uncertainty of diagnosis or clinical deterioration of the patient. Twenty such patients underwent percutaneous drainage with ultrasound or CT guidance, and each patient was cured (appropriate antibiotics were administered concomitantly). The specific indications for intervention were to differentiate pyogenic from amebic abscess, pain and imminent rupture, poor response to medical therapy, false-negative results of serologic tests, noncompliance with medical treatment, left lobe abscess, and pregnancy. Diagnosis of amebiasis from examination of the fluid was seldom possible, while findings from core biopsy of the wall of the abscess led to diagnosis in three cases. Recurrence necessitating redrainage occurred in three patients; in each, catheters were removed the same day drainage was performed. There were three minor complications. Differences from percutaneous management of pyogenic abscesses included more rapid removal of catheters (four days), more frequent use of US guidance, and more common use of the prone angled approach to avoid pleural contamination. Catheter drainage may be curative and may expedite care for problematic amebic liver abscesses in selected cases.

Adult↗
PubMed1988

Infected echinococcal cyst. A common cause of pyogenic hepatic abscess.

Twenty-one cases of hepatic abscesses treated during a period of four years (from 1981 to 1985) at the University of Patras, Greece, are presented. This material includes 10 cases with abscesses caused by suppurated echinococcal cysts, corresponding to 21% of the total number of 47 cases of echinococcal cysts of the liver treated at our department during the same period. A preoperative diagnosis of the suppurated echinococcal cysts by conventional laboratory methods was not reliable. Because of the high frequency of echinococcal disease in our region and the risk of contamination of the peritoneal cavity from echinococcal parasites if the cyst is punctured, the new therapeutic techniques of treating hepatic abscesses by percutaneous drainage have not been applied. The exclusive method of treatment used was surgical drainage which had a satisfactory outcome and a mortality rate as low as 9%.

Adult↗
PubMed1996

[An unusual case of pyogenic hepatic abscess rupturing into the pericardial cavity].

A rare case of pyogenic hepatic abscess that ruptured into the pericardial cavity is reported. A 50-year-old female who had been admitted for cholangitis associated with bi-lateral stricture of bile duct and intrahepatic stones, presented a pyogenic hepatic abscess in the left lobe on an abdominal computed tomography (CT). Percutaneous transhepatic abscess drainage (PTAD) was performed. But during PTAD-graphy five days later, cardiac tamponade developed secondarily to rapid accumulation of contrast medium in the pericardial cavity flowing from liver abscess. An emergency subxiphoid pericardectomy was performed and she made a good recovery. Unfortunately seven months later, she died of septicemia caused by a newly developed abscess in the right lobe of the liver.

Drainage↗
PubMed1998

Pyogenic hepatic abscess. A 10-year population-based retrospective study.

A 10-year retrospective survey was undertaken of patients with pyogenic hepatic abscesses (PHA). Fifty-two patients fulfilled the criteria of PHA, equivalent to a mean annual incidence of 11/1,000,000. The main symptom was fever. Laboratory tests were compatible with infection, slightly elevated alkaline phosphatase being the only test pointing towards the liver as the focus of infection. Forty-one patients (79%, 95% CL, 68-90%) had positive cultures from aspirated pus, with a total of 79 isolates. Enteric Gram-negative rods accounted for 45% and anaerobic bacteria for 31% of PHA isolates. Gram-positive cocci, predominantly non-haemolytic streptococci, were the third largest group (19%), but were rare among blood isolates. Positive blood cultures were found in 21 patients (40%, 95% CL, 27-54%), with a total of 28 isolates. Percutaneous drainage was performed in 26, percutaneous needle aspiration in 10, combinations thereof in 5, and abdominal surgery in 5. Forty-nine patients received systemic antibiotic therapy, four of whom were treated with antibiotics only. Seven recurrences occurred and the overall case fatality rate was 6% (95%, CL 0-12%), which might reflect a low rate of underlying malignant diseases in our study material.

Adolescent↗
PubMed1985

Abscesses and caseous lymphadenitis in goats in tropical semi-arid north-east Brazil.

This study reports the incidence of abscesses in relation to Corynebacterium pseudotuberculosis infection in goats in north-east Brazil. Among 656 goats examined periodically over almost two years 41.6% were found with superficially palpable abscesses. Most of the infected areas were in the anterior half of the body in front of the pre-scapular region; the inguinal region formed the other prominent area. Among 486 dead or slaughtered goats, 56 (11.5%) revealed abscesses in the internal organs. Lungs and epididymis were affected most, liver, spleen, udder and lateropharyngeal nodes were next in order and kidneys and mediastinal nodes were least affected. Thus the overall incidence of external and internal abscesses was 28.8%; of all the abscesses 27.7% were due to C. pseudotuberculosis and the rest due to infections of Corynebacterium pyogenes and several species of streptococci or staphylococci. The growth of C. pseudotuberculosis-infected and non-infected goats was of the same order and it seems that caseous lymphadenitis is not the cause of much financial loss in north-east Brazil but in view of its high incidence remedial measures should be considered necessary in regions where the goat meat industry is likely to become more intensive and important.

Abscess↗
PubMedDate not supplied

[Percutaneous drainage of hepatic pyogenic abscess: management efficacy].

OBJECTIVE: To show the success of percutaneous drainage combined with an antibiotic therapy in the management of hepatic pyogenic abscess. EQUIPMENT AND METHODS: Health histories of 24 patients diagnosed with hepatic pyogenic abscess were evaluated in the Unit of Vascular and Intervention Radiology (URVI) of the Eduardo Rebagliatti Martins Hospital and were checked, during the time period beginning in January 2001 and ending in June 2002. 23 patients underwent percutaneous drainage, guided by echography. RESULTS: A total of 36 abscesses were found, with an average diameter of 6,78 cm (3-18cm); the most common location was on the right (78%). In 37,5% of the patients, the cause of the abscess could not be determined; in 33,3%, the cause was determined after surgical intervention, primarily cholecystectomy (12,5%). Pseudomona (12,5%) was the species most found in cultivation. Only 28 abscesses were drained percutaneously. On average, drainage lasted 15,8 days, and there was an average of 3,6 controls per patient. There was 89,30% overall success for the procedure with three documented errors. CONCLUSION: Percutaneous drainage in conjunction with proper antibiotic coverage is efficient in the management of hepatic pyogenic collections, and its use must be generalized.

Adult↗
PubMed1980

Microorganisms associated with abscesses of sheep and goats in the south of Iran.

A total of 86 abscesses (45 and 41) abscesses of sheep and goats, respectively) were examined for their causal agents; 44 of these abscesses were located subcutaneously, and the remaining 42 were in lungs, livers, intestines, and udders. A total of 23 different types of microorganisms were isolated from 78 abscesses; bacteria were not detected in the remaining eight abscesses. Microorganisms isolated were: species of the genera Corynebacterium, Staphylococcus, and Streptococcus and Pasteurella, Escherichia coli, and other gram-negative rods. Peptostreptococcus anaerobius and Eubacterium tortuosum were isolated in pure culture from one abscess each in goats. Two to four different microorganisms were associated with 25 of the 86 abscesses. It was determined that 11 isolates of Corynebacterium pyogenes, 2 isolates of Pasteurella haemolytica, 1 of P multocida, and 1 of C pseudotuberculosis were lethal to mice. Two of the C pyogenes isolates from subcutaneous spreading abscesses of goats were pathogenic for rabbits; these two isolates produced similar suppurative inflammation in goats experimentally, but did not cause death. As determined by experimental inoculation, goats were more susceptible than sheep to the two isolates. In nature, subcutaneous abscesses of goats associated with C pyogenes were of a more diffusive type which resulted in generalization of the infection and death of the animals. Postmortem examination of ten goats dying of field infection showed the presence of larvae of the warble-fly Przhevalskiana silenus at the site of infection.

Abscess↗
PubMed1987

Recurrent pyogenic cholangitis: ultrasound evaluation compared with endoscopic retrograde cholangiopancreatography.

Fifty cases of recurrent pyogenic cholangitis among Chinese in Hong Kong were studied by ultrasound and compared with endoscopic retrograde cholangiopancreatography. The sensitivity of ultrasound detection of both dilated intrahepatic biliary ducts and intrahepatic calculi is 67% as compared with endoscopic retrograde cholangiopancreatography. A negative study, therefore, does not rule out the presence of such pathological features. A dilated common duct is present in virtually every case of recurrent pyogenic cholangitis and ultrasound is very accurate in its detection. Furthermore, ultrasound is able to provide additional information which can be missed with endoscopic retrograde cholangiopancreatography. Prominent periportal echogenicity, concomitant abscesses and tumours are examples in this series. Such findings bear significance on the management of patients with recurrent pyogenic cholangitis.

Cholangiopancreatography, Endoscopic Retrograde↗