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PubMed1990

Management of pyogenic liver abscess in the era of computed tomography.

The advent of high-resolution imaging has allowed earlier diagnosis of pyogenic liver abscess. Because radiologically guided percutaneous drainage (PCD) of liver abscesses is controversial, the authors studied 40 patients with liver abscess admitted to the Toronto Hospital between 1982 and 1987 to determine the role of PCD versus operative drainage (OD). The diagnosis of pyogenic liver abscess was made at autopsy (4 patients), at laparotomy (6) or by radiologically guided aspiration of pus (30). Ultrasonography and computed tomography were highly sensitive (85% and 96% respectively) in detecting liver abscess. Of the 36 patients treated for liver abscess all received antibiotics intravenously; 31 also underwent a drainage procedure. Treatment with antibiotics alone was associated with a success rate of 80% and a death rate of 20%. The success rate for those who had PCD was 75% with a death rate of 13%; 2 patients in this group of 16 subsequently required OD for cure. In the 15 patients initially treated with OD, success and death rates were 87% and 13% respectively. For solitary abscesses, success rates wer comparable for PCD and OD (86% and 90% respectively). For unilobar multiple abscesses the success rate was 100% for both PCD and OD, but for bilobar multiple abscesses the rates were only 40% and 67% respectively. Complication rates were similar for both methods of drainage. The authors conclude that pyogenic liver abscess can now be safely and efficaciously managed with a combination of antibiotics and PCD.

Adult↗
PubMed1991

Pyogenic liver abscesses: a retrospective review of 24 cases.

OBJECTS: to review our experience of pyogenic liver abscess with attention to the value of ultrasound and computerised tomography, and the duration of antimicrobial therapy. METHOD: retrospective review of all pyogenic liver abscesses in Christchurch hospitals between 1972 and 1989. RESULTS: twenty-four cases were identified. The presentation of these cases was typical of those described in other series. Ultrasound scanning was positive in 69% of cases, and computerised tomography in 94%. Enteric organisms were isolated from blood or abscess cavities in all but two cases. Two patients died soon after admission and three were treated with antimicrobial therapy alone. The remainder underwent either a percutaneous or surgical drainage procedure, and received antimicrobial therapy. The antimicrobial therapy was clearly inappropriate in two patients. Eight patients (67%) with single abscesses received less than 10 days of antimicrobial therapy. Four patients (50%) with multiple abscesses received less than 18 days therapy. No patient relapsed. CONCLUSIONS: ultrasound is a convenient initial imaging technique, but may give false negative results. Computerised tomography should be done promptly if clinical suspicion of a liver abscess persists. Both surgical and percutaneous drainage techniques gave good results in combination with antimicrobial therapy. It is probably unnecessary to give prolonged courses of antimicrobial therapy following drainage of single liver abscess, provided there is rapid resolution. Multiple abscesses, or those which are not drained, may require longer courses of antimicrobial therapy.

Adolescent↗
PubMed1999

Pyogenic liver abscess: a review of 10 years' experience in management.

BACKGROUND: Over the past 15 years, diagnostic and interventional radiology techniques have allowed accurate localization of liver abscesses and image-guided percutaneous drainage. This review examines whether these technical advances improve clinical results and discusses the selection of treatment for patients with liver abscesses. METHODS: Ninety-eight patients were treated for pyogenic liver abscess (PLA) at the Royal Prince Alfred Hospital, Sydney, between January 1987 and June 1997. The hospital records were examined and clinical presentation, laboratory, radiological and microbiological findings were recorded. Associations between these findings and failure of initial non-operative management were determined using odds ratios with 95% confidence intervals. Independent predictors were then determined by logistic regression. This analysis was repeated to determine factors associated with mortality. RESULTS: Cholelithiasis and previous hepatobiliary surgery were the most frequently identifiable causes of PLA, each responsible in 15 patients. All 98 patients were treated with intravenous antibiotics and in 13 patients this was the only therapy. Of the remaining 85 patients, six proceeded straight to laparotomy and 79 had percutaneous drainage, of whom 15 required subsequent laparotomy. Factors predicting failure of initial non-operative management were unresolving jaundice, renal impairment secondary to clinical deterioration, multiloculation of the abscess, rupture on presentation and biliary communication. The overall hospital mortality rate was 8%. CONCLUSION: Pyogenic liver abscess remains a disease with significant mortality. Image-guided percutaneous drainage is appropriate treatment for single unilocular PLA. Surgical drainage is more likely to be required in patients who have abscess rupture, incomplete percutaneous drainage or who have uncorrected primary pathology.

Adolescent↗
PubMed2000

A study of the predisposition of Schistosomiasis mansoni to pyogenic liver abscess in experimentally infected mice.

In murine experimental model, the present work was carried out to study the possible predisposition of S. mansoni infection to pyogenic liver abscess, through a concurrent infection with Staphylococcus aureus. Pyogenic liver abscesses containing the bacterial organism were found in 85% of mice infected with concurrent early S. mansoni infection and S. aureus, in 35% of mice with late S. mansoni infection and the bacterial infection, and in 60% of mice with concurrent immunosuppressed late St. mansoni infection and staphylococcal infection. The early S. mansoni infection, immunosuppressed late schistosomiasis mansoni, and to a less extant late schistosomiasis mansoni, with concurrent bacterial infections can predispose to pyogenic liver abscess which has implicative effect on clinical cases.

Animals↗
PubMed1999

ERCP and pyogenic liver abscess.

BACKGROUND: Liver abscess is commonly biliary in origin. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in patients with pyogenic liver abscesses. METHODS: Between January 1986 and December 1997, 63 patients with pyogenic liver abscesses were referred for ERCP. Twenty-one patients had a history of previous biliary procedures including cholecystectomy (21), biliary-enteric bypass (9), surgical sphincteroplasty (5), and endoscopic sphincterotomy (2). Demographic data, clinical features, biochemical parameters, treatment, clinical progress, and follow-up were recorded and analyzed. RESULTS: Two patients required laparotomy and 61 patients underwent guided aspiration and/or drainage at a median interval of 3 days after presentation. ERCP was performed at a median of 8 days (range 1 to 69 days) after initial treatment and succeeded in 90% of cases with no associated complication or death. Abnormalities were shown in 29 (46%) patients: biliary obstruction due to stones or strictures (15), ductal dilatation alone (7), spontaneous choledochoduodenal fistula (3), communication between abscesses and biliary tree (3), and splaying of biliary ducts by space-occupying effect (2). No abnormality was found in 34 patients. Eight patients underwent endoscopic therapy including sphincterotomy (5), stone extraction (6), and nasobiliary drainage (2). Overall mortality rate from liver abscesses was 6%. CONCLUSIONS: ERCP is useful in the treatment of patients with pyogenic liver abscesses.

Adolescent↗
PubMed2002

Amoebic versus pyogenic liver abscess.

OBJECTIVES: To study the differences between the clinical presentation and complications of amoebic and pyogenic liver abscess. To correlate the diagnostic significance of Entamoeba Indirect Haemagglutination test (E.IHA) in establishing the diagnosis of amoebic liver abscess. DESIGN: Open cohort observational study. SETTING: Department of Medicine (Medical Unit II) Jinnah Postgraduate Medical Centre, Karachi. PARTICIPANTS: Fifty two patients aged 13-70 years admitted in Medical Unit II and diagnosed to have liver abscess. INTERVENTIONS: Group A comprised of patients clinically diagnosed to have amoebic liver abscess and received Metronidazole 500mg iv x 8 hourly for atleast 10 days or more if patient developed complications. Group B comprised of patients diagnosed to have pyogenic abscess and received Cefotaxime 1g iv x 8 hourly for the same duration or more if complicated (antibiotic reviewed in accordance with culture and sensitivity report). MAIN OUTCOME MEASURES: Differences in the clinical presentation, complications and diagnostic parameters between the two groups of patients. RESULTS: It was not possible to differentiate between amoebic and pyogenic liver abscess on clinical grounds, routine investigations and imaging techniques. Aspiration of pus, especially if the abscess was multiple, was most helpful in differentiating the two types of abscesses. Serological test of E.IHA was highly specific and sensitive for amoebic liver abscess. CONCLUSION: Majority of liver abscesses in Karachi are due to Entamoeba Histolytica. Pyogenic abscess though less frequent, must be excluded by pus aspiration and culture and sensitivity. E.IHA is a good rapid method of discriminating between the two types of abscesses.

Adolescent↗
PubMed2000

Hepatocellular carcinoma presenting as a pyogenic liver abscess in a patient with hemochromatosis.

Primary hemochromatosis is rare in Taiwan. Hepatocellular carcinoma (HCC) is endemic in Taiwan, but HCC with initial presentation as pyogenic liver abscess is unusual. We report a case of HCC presenting as pyogenic liver abscess in a hemochromatotic patient with cirrhosis. The patient underwent hepatectomy and had a smooth postoperative course. Unfortunately, he died of pneumonia eight months after surgery. HCC should be considered in the differential diagnosis in hemochromatotic patients with a pyogenic liver abscess.

Aged↗
PubMed1994

[Pyogenic liver abscess. Experience with 50 cases].

During the last years the diagnosis and treatment of pyogenic liver abscess has changed substantially. The aim of this work is to report a retrospective analysis of 50 patients aged 24 to 87 years old, that presented with a pyogenic liver abscess and were treated in the last 13 years. The sensitivity for diagnosis of ultrasound examination, CAT scan and angiography was 68, 89 and 75% respectively. The origin of the abscess was detected at the biliary tree in 46% and remained unknown in 38%. Thirty one patients were operated, 13 were subjected to percutaneous drainage and 5 were treated only with antimicrobials. Forty percent of patients had a septic complication and 4 (8%) died. Mean hospital stay was 31 days for operated patients and 21 for the rest. The abscess recurred in seven patients and two of these had a gallbladder carcinoma. It is concluded that percutaneous drainage is an alternative to surgical treatment that must be accompanied by a careful diagnostic workup.

Adult↗
PubMed1983

Perineal Crohn's disease complicated by pyogenic liver abscess during metronidazole therapy.

A patient with ileal and perineal Crohn's disease developed a pyogenic liver abscess caused by Streptococcus milleri. The perineal process had been treated with high-dose metronidazole for the preceding 6 mo, and culture of a perianal abscess 2 mo before admission revealed heavy growth of Streptococcus milleri (which was misidentified as an anaerobic Peptostreptococcus). This case illustrates the difficulty in correctly identifying Streptococcus milleri, the most frequent isolate from pyogenic liver abscesses. Furthermore, the events suggest that metronidazole therapy can allow overgrowth of this organism in perineal abscesses which, in turn, may predispose to the development of purulent foci such as liver abscesses. This effect on the bacterial ecology of the perineum should be considered when opting for metronidazole therapy of perineal Crohn's disease.

Adult↗
PubMed1997

Solitary and multiple pyogenic liver abscesses: characteristics of the patients and efficacy of percutaneous drainage.

OBJECTIVES: Although percutaneous drainage has emerged as one of the first line of therapies for pyogenic liver abscesses, the presence of multiple abscesses may warrant surgical drainage, which remains controversial in the literature. We studied whether the multiplicity of the lesions influences the outcome of the treatment. METHODS: Ultrasonography-guided percutaneous drainage was carried out in 48 patients with pyogenic liver abscesses. The abscesses were solitary in 38 patients and multiple (two to seven lesions) in 10 patients. Clinical characteristics and the efficacy of the treatment were compared between these two groups. RESULTS: Biliary diseases and malignancies were more frequently observed in the solitary cases than multiple cases. A past history of surgery for cholelithiasis was seen exclusively in the multiple cases. E. coli was more frequently cultured from the abscesses in the multiple cases. Three of the multiple cases required more than a single catheter. All of the multiple cases and 36 of the 38 solitary cases were successfully treated. Two patients died of biliary peritonitis as a complication of the procedure, and three died of other underlining diseases. CONCLUSION: Ultrasonography-guided percutaneous drainage is effective even in patients with multiple pyogenic liver abscesses by adding catheters to obtain sufficient drainage.

Adult↗
PubMed2004

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

Adult↗
PubMedDate not supplied

[Pyogenic liver abscesses: analysis of 36 cases treated by percutaneous drainage].

Thirty-six patients with pyogenic liver abscess treated by percutaneous drainage plus antibiotic therapy were reviewed. The most frequent symptoms were fever (75%) and pain (72.2%), and the most common physical signs were liver enlargement (58.3%) and jaundice (33.3%). The mean time interval from admission to diagnosis was 16 days. CT scans and ultrasonography were diagnostic in 100% of the patients. The percutaneous drainage was effective in one attempt in 19 patients, two attempts in 8, three attempts in 8 patients and more than four attempts in only one patient. There were three patients with hemoperitoneum (8.7%) as a post-drainage complication, one of them needed to be treated surgically. Mean hospital stay was of 24.8 days and the mortality rate was 5.5%. Percutaneous drainage plus antibiotic therapy is then an efficient therapeutic approach to the treatment of pyogenic liver abscess.

Adolescent↗
PubMed1984

Pyogenic liver abscess--a neglected diagnosis.

Twenty-five patients with pyogenic liver abscess admitted to the Royal Brisbane Hospital between 1970 and 1982 have been reviewed. The mortality rate was 32%; however, all patients who were diagnosed before death survived. In seven patients there was a history of biliary obstruction or biliary surgery of whom six died. The mean age of the patients who died was significantly higher than those surviving and it is suggested that this resulted from overdiagnosis of malignancy in the elderly, some hesitancy in investigating older patients, and a tendency to attribute multiple space-filling defects to metastatic tumour. If liver biopsy or even exploratory laparotomy have failed to confirm the diagnosis of hepatic abscess the clinician should not discard the possibility. It is concluded that the continuing high mortality from liver abscess is in large part due to lack of clinical awareness and failure in diagnosis rather than to inadequate therapy.

Age Factors↗
PubMed1989

[Pyogenic liver abscess. Review of 33 cases].

Thirty three cases of pyogenic liver abscess, (24 single and 9 multiple), diagnosed in our department during the past 6 years, were reviewed. Mean patient age was 54 years with a male predominance over females (1.5:1). The most frequently encountered underlying pathology was bile duct disease (33%), followed by previous liver disease (21%). Causal pathology could not be found in 4 cases (12%). The most frequent sign was fever (76%). Diagnosis was made by clinical picture and complementary exam (echography, CT scan and hepatic gammagraphy) in 29 cases (88%). Blood and pus cultures were positive in 47 and 67% of cases respectively. Thirty nine per cent of microbial abscesses were polymicrobial. E. coli and S. milleri were the most frequently isolated. No micro-organism were identified in 5 cases (15%). Antibiotic treatment was given to 33 patients. Surgical drainage was performed in 24 cases and percutaneous drainage in 7 patients. Two patients received antibiotics exclusively. Five patients died (15%), three of whom had a multiple abscess (33%) and the other two had a single abscess (8%). The efficacy of percutaneous drainage for diagnosis and treatment is analyzed reviewing recent literature.

Adolescent↗
PubMed1994

Pyogenic liver abscess in children.

Our center's experience with 15 pyogenic liver abscesses in 14 children from 1979 to 1992 showed an incidence of 20 per 100,000 pediatric hospital admissions. Eight of the 15 liver abscesses were cryptogenic in origin. The clinical features and laboratory findings were non-specific. Improved imaging techniques such as real time sonography and computed tomography made early diagnosis feasible. Klebsiella pneumoniae was the most common pathogen in this study. Drainage combined with antibiotics provides the most important treatment for this disease. Before 1986, surgery was frequently used, but now percutaneous drainage is preferred. Surgery may be reserved for those who respond poorly to percutaneous drainage and medical treatment. One of the 14 patients in this study died.

Adolescent↗
PubMed1983

Biliobronchial fistula following pyogenic liver abscess.

A 65-year-old man with malaise, chills and fever was found to have a pyogenic liver abscess. A fistula from the abscess to the bronchial tree was confirmed by bronchoscopy and thoracotomy. In spite of adequate drainage of the abscess, respiratory function deteriorated and the patient died 1 month after operation. Biliobronchial fistula resulting from a pyogenic liver abscess is rare and has not recently been reported in the English or French literature. Reports dating back to the first published case in 1857 are reviewed. Early supradiaphragmatic excision of the fistulous tract and drainage of the hepatic abscess are recommended.

Aged↗
PubMed1985

Pyogenic liver abscess in children: a report of three patients and review of the literature.

Three children with pyogenic liver abscess seen over a period of 2 years are reported. Their immune status was normal and no underlying causes were detected. The clinical picture was characterized by fever, abdominal pain and tender hepatomegaly. Abscesses were solitary in two children and multiple in the third. One child died within 12 h of admission, the other two recovered completely. Recent literature on pyogenic liver abscess is reviewed.

Child↗