Pyogenic liver abscesses: Diminished role for operative treatment

BackgroundPyogenic liver abscess is a rare but potentially serious condition. It has traditionally been treated by open drainage; however interventional radiology is now becoming the standard of care.MethodsAll cases of liver abscesses admitted to a tertiary hospital over thirteen years (1995–2007) were retrospectively reviewed. Patient demographics, length of hospital stay, predisposing factors as well as cultured organisms were evaluated. Imaging techniques as well as patient management were also recorded.ResultsThere were 66 hospital admissions of 61 patients with liver abscesses, 0.032% (66/205,079) of the total hospital admissions for the time period. Mean age was 61 years (range 26–90 years), male (36/61) 59%: female (25/61) 41%. Average hospital stay was 23 days (Range 1–84 days) and there were no deaths. 39 of 61 patients (64%) had a single abscess (90% right lobe). 20 of 61 patients (33%) had undergone a recent intra-abdominal procedure. Escherichia coli (10/61) and Enterococci (8/61) were the most frequent organisms isolated. Radiological intervention was performed in 50 of 61 (82%, 51% ultrasound and 31% CT guided). 9 of 61 (15%) were managed conservatively, while one case was managed surgically and another with endoscopic sphincterotomy and stent placement.ConclusionsPyogenic liver abscesses are uncommon, and while associated with significant morbidity and prolonged hospital stay, mortality is now rare. Radiological intervention and anti-microbial therapy are the mainstay of treatment, and operative intervention is now rarely required.     

Pyogenic liver abscesses: have changes in management improved the outcome?

Pyogenic liver abscess is a serious condition with a high mortality rate. New diagnostic techniques have improved the diagnostic accuracy. Alternative therapeutic methods to open surgical drainage, such as percutaneous drainage and in certain cases antibiotics alone, are now available. Have changes in management of liver abscesses at our hospital improved the outcome? Two 5-year periods (I: n = 12; II: n = 14) were compared concerning diagnostic procedures, principles of treatment, and outcome. A shift from scintigraphy in the first period (I) to ultrasonography (US) in the second period (II) as prime diagnostic procedure was obvious. In I open surgical drainage dominated. 4/12, major surgical risks, were treated by anti-aerobic drugs alone, and died. In II US-guided percutaneous drainage was performed in 7/14, together with antibiotics active against aerobes as well as anaerobes, without complications. 4/14 were treated by an antibiotic combination alone and only 3/14 were treated by open surgical drainage. The change in management during these two periods has resulted in improved diagnostic and therapeutic routines as demonstrated by reduction in mortality rate.     

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.

     

Diagnosis of liver abscesses

The author observed 298 patients with abscesses of the liver of different etiology. The frequency of symptoms detected by clinical, laboratory abd roentgenological examinations is analysed. The value of special methods of examination (such as scanning and radiography of the liver, electrorentgenoscanography, echography, laparoscopy) is shown.