Single and Multiple Pyogenic Liver Abscesses: Etiology, Clinical Course, and Outcome

Abstract

Background: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. Methods: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. Results: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. Conclusions: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes

“…This is consistent with the fact that every recurrence was ipsilateral to the first event. Mortality in our series was 7.8%, similar to that reported in the 16,17,22,27,28 studies have analyzed risk factors for mortality, including the presence of active oncologic 17,22,26,29,30 renal failure, 17,18,22,26,29 hiperbilirrubinemia, 17,29,30 hypoalbuminemia, 17,29 MDRB isolation 17,29 and multiple abscesses 17,22,26,29,30 with inconsistent results. In our series, factors associated with mortality in univariate analysis included biliary disease, multiple abscesses, the bilateral liver involvement, and bilirrubinemia >5 mg/dL.…”

Liver Abscess: An Institutional Review at Gandaki Medical College Teaching Hospital

“…Half of the pyogenic liver abscesses are multicentric and three-fourth are located on right lobe. In this study, 77% lesions are located on right side which is in accordance with similar results from Alvarez et al 15 and Wong et al 16 . Regarding multicentricity, one third of patients in this study had multiple lesions, as also reported by other studies 9,11 .…”

A study of clinical presentation, diagnostic difficulties and various treatment modalities of liver abscess

“…USG is usually the initial study of choice with reported sensitivity of 83% to 95% for diagnosis of PLA. 11,12 A mature abscess with pus has distinct wall and become hypoechoic. 13 CT scan is highly sensitive in detecting small PLA.…”