Pyogenic abscess of the liver

The author records the case histories of 27 patients suffering from liver abscess admitted during the period 1946-60 to the Radcliffe Infirmary, Oxford. Seventeen were examples of multiple and 10 of single abscess. In most cases the primary source was determinable. Despite there being only one survivor of the 10 patients with a solitary abscess, the author considers the condition easily curable if recognized early.     

Pyogenic liver abscess in the elderly

Seventeen patients over the age of 60 years, admitted to the Aberdeen Teaching Hospitals between 1980 and mid-1988, were diagnosed as having pyogenic liver abscess. Eleven were women and the mean age was 73.5 years. The diagnosis of liver abscess was made by needle aspiration in seven patients and was an unexpected finding at laparotomy in three. Six patients were thought to be suffering from advanced malignant disease until autopsy. The overall fatality was 53%. Misleading results from special investigations reduced the chance of a correct diagnosis in several patients. Even in frail elderly patients, a filling defect in the liver should not be attributed to metastatic malignancy when there is no known primary site, until liver abscess has been excluded by aspiration biopsy under ultrasound or computerized tomographic scan guidance. The high fatality of pyogenic liver abscess seems to be at least in part due to a lack of clinical suspicion.     

Pyogenic liver abscess caused by hypermucoviscous Klebsiella pneumoniae

Community-acquired primary pyogenic liver abscess (PLA) caused by Klebsiella pneumoniae is an emerging infectious entity, with cases reported in the scientific literature over the past 15 y mainly from Taiwan and Asia, but also from Europe and North America. We describe a case of PLA caused by the hypermucoviscous, K1 capsular serotype of Klebsiella pneumoniae in a Canadian man and highlight the unique features of this increasingly common cause of liver abscess.     

Pyogenic hepatic abscess

Presented is a case of spontaneous pyogenic hepatic abscess in a previously healthy young man without associated risk factors. This disease entity has a low incidence, however, it is associated with significant morbidity and mortality if diagnosis and treatment are delayed.     

细菌性肝脓肿58例

目的:总结分析细菌性肝脓肿的临床特征及相关实验室检查结果,为该病的诊断和合理治疗提供依据.方法:总结我院2000-06/2011-12的58例确诊细菌性肝脓肿患者的临床资料,回顾性分析该病的临床特征、实验室检查、影像学、病原学及治疗特点.结果:58例细菌性肝脓肿患者最常见的临床表现为畏寒发热(94.8%)及右上腹痛(58.6%).糖尿病(46.5%)为最常见的合并症.血清碱性磷酸酶(77.6%)、白细胞(70.7%)和纤维蛋白原(60%)升高最常见.最常见的细菌为肺炎克雷伯菌(17.2%).脓肿多为单个(86.2%),肝右叶居多(81.1%).所有患者均选用联合抗生素治疗,其中26例患者(44.8%)行穿刺抽脓或置管引流,3例患者(5.2%)行手术治疗,1例患者(1.7%)死亡.结论:患者临床表现为畏寒发热、右上腹痛时应高度警惕细菌性肝脓肿可能,尤其是糖尿病、胆管疾病及恶性肿瘤患者.病原学仅在部分患者出现阳性结果,而血清碱性磷酸酶、白细胞和纤维蛋白原升高更常见,可能对临床诊断具有提示意义.抗感染结合穿刺抽脓或置管引流是临床安全有效的治疗手段.     

Pyogenic liver abscess associated with large colonic tubulovillous adenoma

Pyogenic liver abscesses usually occur in associationwith a variety of diseases.Rarely,liver abscess has beenreported as the presenting manifestation of colonic tubu-lovillous adenoma.We report two cases of pyogenic liverabscess without hepatobiliary disease or other obviousetiologies except that one had a history of diabetesmellitus(DM).The pathogen in the patient with DM wasKlebsiella pneurnonia(KP).In both of the patients,ileusdeveloped about two to three weeks after the diagnosisof liver abscess.Colonoscopy revealed large polypoidtumors with pathological findings of tubulovillousadenoma in both cases.Two lessons were learned fromthese two cases:(1)an underlying cause should beaggressively investigated in patients with cryptogenicliver abscess;(2)DM could be one of the etiologies butnot necessarily the only cause of KP liver abscess.     

Pyogenic liver abscess as a complication of Crohn's disease

Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis and treatment is delayed. Intra-abdominal abscesses, fistulous disease, and steroid therapy have all been reported to be important predisposing factors in the pathogenesis of this entity. We present a patient with Crohn's disease in whom multiple abscesses were encountered in the right lobe of the liver. The diagnosis of liver abscess was established by abdominal computed tomography and the patient was treated by percutaneous catheter drainage. Awareness of this rare complication is important because diagnosis is difficult to make and a high index of suspicion is required. Once suspected, aggressive diagnostic workup and treatment is indicated. Most patients with liver abscess can be successfully managed by percutaneous catheter drainage combined with antibiotic therapy if it is diagnosed before extensive necrosis has occurred.     

Pyogenic liver abscess：An audit of 10 years’experience

AIM: To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS: A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre, were reviewed. Amoebic and hydatid abscesses were excluded. Demographic, clinical, radiological, and microbiological characteristics, as well as surgical/radiological interventions, were recorded.RESULTS: Sixty-three patients (42 males, 21 females) aged 65 (± 14) years [mean ± (SD)] had prodromal symptoms for a median (interquartile range; IQR) of 7 (5-14) d. Only 59% of patients were febrile at presentation; however, the serum C-reactive protein was elevated in all 47 in whom it was measured. Liver function tests were non-specifically abnormal. 67% of patients had a solitary abscess, while 32% had > 3 abscesses with a median (IQR) diameter of 6.3 (4-9) cm. Causative organisms were: Streptococcus milleri 25%, Klebsiella pneumoniae 21%, and Escherichia coli 16%. A presumptive cryptogenic cause was most common (34%). Four patients died in this series: one from sepsis, two from advanced cancer, and one from acute myocardial infarction. The initial procedure was radiological aspiration ± drainage in 54 and surgery in two patients. 17% underwent surgical management during their hospitalization. Serum hypoalbuminaemia [mean (95% CI): 32 (29-35) g/L vs 28 (25-31) g/L, P = 0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION: PLA is a diagnostic challenge, because the presentation of this condition is non-specific. Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs; However, a small proportion of patients still require surgical drainage.     

Pyogenic liver abscess as the first manifestation of hepatobiliary malignancy

BACKGROUND:Pyogenic liver abscess(PLA)is commonly seen in patients in the Far East.Similarly,hepatobiliary neoplasms are also common.PLA as the initial manifestation of hepatobiliary neoplasms is extremely rare. METHOD:Three patients with PLA were identified from the ward registion files and were retrospectively reviewed. RESULTS:These patients(two men aged 74 and 80 years, and one woman aged 35 years)were treated(in the right lobe in two patients and in the left lobe in one)and subsequently followed up for...