Pyogenic liver abscess

The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.     

Pyogenic liver abscess

Pyogenic liver abscess has been recognized since ancient times and it continues to be associated with substantial morbidity and mortality. This paper is a summary of the clinical manifestations of pyogenic hepatic abscess.

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Résumé Les abcès pyogènes du foie sont connus depuis l’antiquité. La morbidité et la mortalité sont lourdes. L’article résume les manifestations cliniques de ces abcès.

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Dr. Howard is the recipient of Research Career Award Number 7 KO4 AI 00394-04.     

Pyogenic liver abscess

Experience with 34 patients with pyogenic liver abscess is reviewed to evaluate the impact of percutaneous drainage and duration of antibiotic therapy on results of treatment. Patients with shock, adult respiratory distress syndrome, disseminated intravascular coagulation, jaundice, severe hypoalbuminemia, and diabetes had a poor prognosis. Percutaneous drainage was used successfully in 4 of 6 patients, but its use did not affect mortality rate or length of hospital stay. Percutaneous drainage may be the procedure of choice for selected patients. Half of our patients received antibiotics for 2 weeks or less with no abscess recurrences in this group. Long-term antibiotics may not be necessary after adequate surgical or percutaneous abscess drainage.

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Resumen Se revisó la experiencia con treinta y cuatro pacientes con absceso piogénico del hígado con el fin de evaluar el impacto del drenaje percutáneo y la duración de la terapia antibiótica sobre los resultados del tratamiento. Los pacientes con shock, síndrome de dificultad respiratoria del adulto, coagulación diseminada intravascular, ictericia, hipoalbuminemia severa, y diabetes exhibieron un mal pronóstico. El drenaje percutáneo fue utilizado exitosamente en 4 de 6 pacientes pero su uso no modificó la tasa de mortalidad ni la duración de la hospitalización. El drenaje percutáneo puede ser el procedimiento de elecctión en casos seleccionados. La mitad de nuestros pacientes recibió antibióticos por 2 semanas o menos, sin que se presentara recurrencia del absceso. La antibioticoterapia a largo plazo puede ser innecesaria una vez realizado un adecuado drenaje, quirúrgico o percutáneo, del absceso.

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Résumé Nous avons analysé notre expérience des abcès hépatiques pyogènes pour déterminer l'influence du drainage percutané et de la durée de l'antibiothérapie sur les résultats du traitement. On observait un mauvais pronostic chez les patients ayant eu un choc, un syndrome de détresse respiratoire de l'adulte, une coagulopathie vasculaire disséminée, un ictère, une hypoalbuminémie et/ou un diabète. Le drainage percutané a été utilisé avec succès chez 4 des 6 patients mais n'a influencé ni la mortalité ni la durée d'hospitalisation. Le drainage percutané a été le procédé de choix chez un groupe de patients sélectionnés. La moitié des patients avaient reçu des antibiotiques 2 semaines ou moins sans récidive. Une utilisation prolongée des antibiotiques n'est pas nécessaire si l'abcès a été correctement drainé chirurgicalement ou par voie percutanée.

     

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.     

Pyogenic liver abscess. Modern treatment

Historically, open surgical drainage has been the treatment of choice for pyogenic liver abscess. The records of 54 patients with pyogenic liver abscess were reviewed to determine whether earlier diagnosis with current imaging tests and definitive treatment with antibiotics, aspiration, or catheter drainage was an effective alternative to open drainage. Twenty-nine patients were treated with broad-spectrum antibiotics and diagnostic aspiration. Twenty-three (79%) recovered uneventfully, and six required catheter or operative drainage. Twenty-three patients (including five who failed aspiration) underwent drainage with percutaneously placed catheters. Nineteen (83%) recovered; four required open surgical drainage. Of seven patients who required open surgical drainage, six recovered. One (2%) of the 54 patients died following failed aspiration and catheter and surgical drainage. Four patients were successfully treated with antibiotics alone without aspiration. These results confirm that pyogenic liver abscess can be successfully treated with broad-spectrum antibiotics and aspiration or percutaneous catheter drainage. Open surgical drainage is reserved for patients in whom treatment fails or who require celiotomy for concurrent disease.     

Pyogenic liver abscess – 20 years' experience

BACKGROUND AND AIMS: Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study. PATIENTS/METHODS: In two equal periods between 01.01.1982 and 31.03.2001, 56 patients (37 males and 19 females) with pyogenic liver abscess were treated. Image-guided percutaneous drainage was performed in 22.2%/20.6% of the patients; the remainder were treated with open drainage with or without biliary tract reconstruction and liver resection. For antibiotic perfusion of the liver an umbilical vein cannula was inserted in 40.7%/24.1%. Microbiological findings, types of therapy, complications and mortality, etiology, patient characteristics, symptoms, and laboratory data were investigated. The results in the two groups were compared and analyzed statistically. RESULTS: The most common cause of abscess, biliary disease, was seen more often in the second period. Solitary liver abscesses were more frequent. The only characteristic biochemical finding was an elevated alkaline phosphatase level. There were more positive cultures in the second period (70.4%/79.3%), and the number of Escherichia coli or Enterobacter aerogenes infections also increased. In the first period the mortality was 18.5%, whereas in the second no patients were lost. CONCLUSION: We suggest the importance of individualized therapy based on an early and exact diagnosis. The first treatment step should be image-guided drainage, but under well-defined circumstances open drainage can also be performed with good results.     

Pyogenic liver abscess complicated by endogenous endophthalmitis

Background: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. Methods: Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. Results: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. Conclusion: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.     

Pyogenic liver abscess. Diagnostic and therapeutic strategies.

A retrospective review of 26 adult patients admitted to University of California, Davis, Medical Center (UCDMC) with pyogenic liver abscess (1980-1986) was performed to ascertain the impact of rapid diagnosis and percutaneous drainage. Ultrasonographic examinations and computed tomography (CT) scans were highly sensitive and noninvasive imaging modalities. Sixteen patients had solitary abscesses and seven had multiple microscopic abscesses. The median time interval from admission to diagnosis and therapy was 2 and 3 days, respectively. Origin of the abscess was determined in 22 patients, the biliary tree being the most common source. Medical therapy was successful in three patients with microabscesses but failed in two. Nine patients had percutaneous drainage; two required repetitive percutaneous catheter placement, and two proceeded to surgical drainage. Twelve patients had surgical drainage; one required repetitive surgical drainage. Postdrainage complications were minimal in all groups. Overall mortality role was 11.5% (two patients). Deaths were related to delay in diagnosis, gram-negative sepsis at presentation, and biliary origin of the abscess.     

Pyogenic liver abscess: an improvement in prognosis

Forty-six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 +/- 71 days). In seven patients the diagnosis was not made until post-mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28 +/- 20 days, P less than 0.01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P less than 0.05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high-risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P less than 0.001).     

肝胆胰术后迟发性出血的诊治分析

目的 探讨肝胆胰术后迟发性出血的原因和诊断治疗方法。方法 回顾性分析宁夏回族自治区人民医院2015年1月至2022年3月收治的13例肝胆胰腺术后出血患者的临床资料和诊治方法,总结其出血的原因和治疗经验。结果 13例患者均有失血性休克临床表现,其中8例为消化道出血：7例为肝动脉分支假性动脉瘤破裂,1例为胆道出血;5例腹腔出血。13例患者动脉造影明确出血部位后行出血部位动脉栓塞治疗,12例出血停止痊愈。另1例患者动脉栓塞治疗失败后,行开腹行肝右动脉结扎止血术后止血。结论 假性动脉瘤形成、胰漏和腹腔感染是肝胆胰患者术后迟发性出血的主要原因。血管造影术是诊断患者术后出血重要的检查方法,动脉栓塞术是治疗术后出血的有效方法。