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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↗
PubMed1986

Pyogenic liver abscesses in nonimmunocompromised children.

Pyogenic liver abscesses are rare in previously healthy children. This review reports ten such cases of pyogenic abscess seen between 1963 and 1984. The mean age in these children was 6.3 years. One child died. Of the nine survivors, five had successful open surgical drainage. Two abscesses were drained percutaneously. Another abscess drained spontaneously into the biliary system, and one abscess was treated with antibiotics alone. The single most helpful diagnostic test was abdominal ultrasonography. Our experience is evaluated in the context of other reports of pyogenic abscesses in children.

Adolescent↗
PubMed1977

Intraperitoneal rupture of amebic liver abscess.

The traditional management of amebic liver abscess which has ruptured into the peritoneal cavity has been conservative and 70% to 90% fatal. Laparotomy with complete toilet of the abscess and the peritoneal cavity has shown encouraging results. A comparative study of the management of 36 cases of intraperitoneal rupture of amebic liver abscess was carried out. Twenty-one cases were treated by laparotomy with 85.5% survival. Mortality for 15 cases treated conservatively was 80%. We believe that intraperitoneal rupture of amebic liver abscess can now be treated by laparotomy with much better results than were possible before the advent of drugs such as metronidazole.

Adult↗
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↗
PubMed1989

Unusual presentation of amoebic liver abscess.

Two cases of amoebic liver abscess are described. The unusual, purely left pleuritic, presentation in the first patient is emphasised. Amoebic liver abscess should still be thought of in any patient presenting with an acute febrile illness, upper abdominal and or thoracic manifestations and polymorphonuclear leucocytosis. Such a consideration should obviate unnecessary morbidity, mortality and the injudicious use of ineffective therapeutic agents.

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↗
PubMed1977

[Cryptogenic liver abscess (author's transl)].

The successful treatment of two patients with cryptogenic liver abscess, a special type of pyogenic abscess, is reported. Quick diagnosis by methods which do not distress the patient, e. g. scintigraphy and echography, leads to a decisive improvement in the prognosis. Opinions are given on the differential diagnosis of cryptogenic, pyogenic and parasitic (amebic) liver abscesses. The good chances for treatment of cryptogenic abscesses compared with the secondary pyogenic liver abscesses are to be found not least in their usually solitary appearance. This is shown particularly clearly in the classification of the patients operated on for pyogenic liver abscess in our hospital in the last ten years into multiple and solitary liver abscess. As in the pyogenic abscess, so in the primary cyptogenic liver abscess is transperitoneal open drainage the method of choice for treatment.

Diagnosis, Differential↗
PubMed1997

Neutrophils play a critical role in early resistance to amebic liver abscesses in severe combined immunodeficient mice.

Animal models of liver abscess formation with Entamoeba histolytica suggest that the neutrophil is the first cell of the host immune system to interact with the invading ameba. In vitro studies have suggested that lysis of neutrophils by virulent amebae may exacerbate the damage seen in amebic liver abscesses. To investigate the role of neutrophils in vivo, we used the severe combined immunodeficient (SCID) mouse model of amebic liver abscess formation and compared liver damage in neutrophil-depleted and control mice. We found that neutrophil-depleted animals have significantly larger amebic liver abscesses at early stages of infection and that abscesses in neutrophil-depleted SCID mice lack the prominent inflammatory cell ring seen in amebic liver abscesses in control SCID mice. These data suggest that neutrophils play a protective role in the early host response to amebic infection of the liver.

Animals↗
PubMed1993

Amebic liver abscess in children.

Although amebic liver abscess can be a cause of significant morbidity and mortality in all ages, there are few reports dealing with this entity in children. Twenty-four children with amebic liver abscess, ages ranging between 3 weeks and 14.5 years, were managed at the Aga Khan University Hospital, Karachi, Pakistan, between November, 1987, and October, 1992. The most frequent presentation was high grade fever and right upper quadrant pain, associated with tender hepatomegaly, leukocytosis and an elevated erythrocyte sedimentation rate. The diagnosis was confirmed by elevated indirect hemagglutination titers and ultrasonography of the liver. Unlike the experience in adult patients none of the patients had concomitant jaundice, and significant derangement of liver enzymes was unusual. The abscesses were likely to be solitary (22 of 24 patients). There were no deaths despite a mean delay of 15 days before presentation to our hospital. A high index of suspicion, early institution of metronidazole therapy and aspiration of abscesses with potential to rupture are believed to have contributed to the better outcome in these children when compared with results in previous reports.

Adolescent↗
PubMed1989

Clinical profile of 100 cases of liver abscess.

One hundred patients with liver abscess were studied for clinical features and complications. They were diagnosed by radiography, ultrasonography, serology and by needle aspiration. A variety of interesting clinical, haematological and ultrasonographic findings were observed. Literature on liver abscess was reviewed and results compared.

Adult↗
PubMed1989

Actinomycetes in pyogenic liver abscess.

Three patients with pyogenic liver abscesses had actinomycetes cultured from aspirated pus, although it is unusual for hepatic actinomycosis to present in this way. The spectrum of bacteria found in liver abscesses appears to be changing, with the increased isolation of anaerobes partly due to improved techniques. It is important to recognise the presence of actinomycetes so that appropriate chemotherapy can be given.

Actinomyces↗
PubMed1990

Ultrasonically guided percutaneous treatment of liver abscesses.

Twenty-two patients with liver abscesses demonstrated by ultrasonography (US) were treated over a nine-year period. The diagnosis was in all cases verified by puncture. The patients were treated by US-guided puncture or catheter drainage. Seventeen patients (77%) were cured without surgical drainage. Four patients were cured after subsequent surgical intervention. One patient died later of pancreatic carcinoma. There were no complications from the US-guided therapy. For the treatment of liver abscesses we recommend US-guided drainage as the first choice. Close collaboration between surgeon and radiologist is mandatory since some of these patients still need surgical treatment.

Drainage↗
PubMed1997

Laparoscopic management of ruptured pyogenic liver abscess.

Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically. The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples. A thorough peritoneal lavage could be also performed. The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.

Aged↗
PubMed1997

Tropical liver abscess.

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.

Adult↗
PubMed1985

Vagus indigestion syndrome resulting from a liver abscess in dairy cows.

A liver abscess resulted in vagal indigestion in 8 dairy cattle. There was cessation of transport of digesta through the omasum. Clinical signs were of variable duration and included abdominal distention and bradycardia. Medical therapy had not been effective. Left paralumbar fossa celiotomy and rumenotomy permitted detection of the liver abscess. A second surgery from a ventral approach allowed drainage of the abscess by insertion of a catheter through the abdominal wall.

Abomasum↗
PubMed1985

Cholestasis in amoebic liver abscess.

Two hundred and thirty six patients with amoebic liver abscess were investigated for cholestasis, its mechanism and the natural course of the disease. Cholestasis was seen in 29% of cases and it presented with some unusual features: it was frequently seen in young men (mean age 38.6 +/- 6.3 years) (87%) with acute onset (69%) and was associated with signs of peritonism, or peritonitis (28%), splenomegaly (12%) and hepatic encephalopathy (coma 13%). Raised diaphragm was seen only in 37% of cases. Alcoholism may have contributed to the cholestasis in 37% of cases. Multiple (43%) and single (32%) large liver abscesses, especially on the inferior surface of the liver (25%), were common in jaundiced patients with amoebic liver abscess, while size and number of abscesses were directly related to the raised serum bilirubin concentrations. Bromsulphalein excretion (BSP) was found to be significantly reduced (p less than 0.01) in patients with jaundice (60%). Retrograde injection of contrast media into the common bile duct during six necropsies showed compression by amoebic liver abscess on the hepatic ducts. The mortality (43%) and the complications were significantly higher (p less than 0.001) in patients with jaundice. The aspiration/surgical drainage of amoebic liver abscess together with a combination of metronidazole and di-iodohydroxyquinoline was more effective than either metronidazole alone, or dehydroemetine with chloroquine.

Adolescent↗
PubMed1995

Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens.

A retrospective study on patients with pyogenic liver abscesses was conducted to clarify the different clinical presentations among patients with Klebsiella pneumoniae abscesses and those with non-K. pneumoniae abscesses. From 1981 to 1993, the medical records of 146 adults with culture-confirmed pyogenic liver abscesses who attended Tri-Service General Hospital in Taipei were studied. Abscesses due to K. pneumoniae accounted for 114 (78%) of pyogenic liver abscesses. When compared to patients with non-K. pneumoniae abscesses, patients with K. pneumoniae liver abscesses had significantly higher proportions of monomicrobial infections, unknown sources of infection and solitary abscesses. Patients with K. pneumoniae liver abscesses were found to have diabetes mellitus more often than patients with non-K. pneumoniae liver abscesses (66% vs 19%). Septicemia was found more frequently in patients with K. pneumoniae liver abscesses than in patients with non-K. pneumoniae liver abscesses (50% vs 27%). The clinical presentations among the two groups were, otherwise, not significantly different. Regardless of the microbial etiology, patients with diabetes mellitus had longer periods of fever after treatment and hospitalization than patients without diabetes. The reason for the high relative frequency of liver abscesses in Taiwan and its more frequent occurrence in diabetes mellitus remains unclear.

Adult↗