Are Pyogenic Liver Abscesses Still a Surgical Concern? A Western Experience

Abstract

Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.

Pyogenic Liver Abscess: Prospective Evaluation Of USG Guided Percutaneous Therapeutic Aspiration

“…Thirty six percent patients had nausea and or vomiting ( Figure No.01). Our study result is similar to study by Barbara Alkofer and his colleagues [15]. But other study results are different.…”

Presentation and Management of Pyogenic Liver Abscess in Surgery Department: About 34 Cases

“…In recent years, a more conservative approach has been adopted and needle aspiration or percutaneous continuous catheter drainage in combination with parenteral antibiotics is considered the gold standard treatment [1,4,13,20,21] . The most commonly used antibiotics were fluoroquinolones, the third-generation cephalosporins with metronidazole and an aminoglycoside [4,19,22] .…”

“…Yu et al found that intermittent needle aspiration was probably as effective as continuous catheter drainage for the treatment of PLA [25] . It's indicated in following situations [4,19] : (1) Patients who continued to be febrile even after 48-72 h of adequate medical treatment; (2) Liver abscess more than 6 cm in size; (3) Clinical or ultrasonographic features suggesting impending perforation. disseminate and in the other case the abscess was associated with a cholecystitis).…”

“…Ali et al report a mean length of hospital stay of 20±22 days (range: 1-82 days) [5] . The outcome was generally favorable and the mortality rate in developed countries ranges from 2 to 12% and can be up to 19% in some series [1,2] . Mangukiya et al and Ali et al report a rate of 1.5% and 2% respectively [4,5] , in our study the rate was 3%.…”

“…It can develop as a complication of abdominal and biliary infections, or following hematogenous bacterial seeding of the liver. It is a rare condition but with significant mortality up to 19 % [1,2] . Its diagnostic is based in clinical features and biological findings and confirmed by imaging.…”