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. 1987 Dec;206(6):699–705. doi: 10.1097/00000658-198712000-00003

Pyogenic liver abscess. Diagnostic and therapeutic strategies.

E J Gyorffy 1, C F Frey 1, J Silva Jr 1, J McGahan 1
PMCID: PMC1493323  PMID: 3318726

Abstract

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.

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Selected References

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  1. Aeder M. I., Wellman J. L., Haaga J. R., Hau T. Role of surgical and percutaneous drainage in the treatment of abdominal abscesses. Arch Surg. 1983 Mar;118(3):273–280. doi: 10.1001/archsurg.1983.01390030005001. [DOI] [PubMed] [Google Scholar]
  2. Bartlett J. G., Onderdonk A. B., Louie T., Kasper D. L., Gorbach S. L. A review. Lessons from an animal model of intra-abdominal sepsis. Arch Surg. 1978 Jul;113(7):853–857. doi: 10.1001/archsurg.1978.01370190075013. [DOI] [PubMed] [Google Scholar]
  3. Berger L. A., Osborne D. R. Treatment of pyogenic liver abscesses by percutaneous needle aspiration. Lancet. 1982 Jan 16;1(8264):132–134. doi: 10.1016/s0140-6736(82)90381-6. [DOI] [PubMed] [Google Scholar]
  4. Bernardino M. E., Berkman W. A., Plemmons M., Sones P. J., Jr, Price R. B., Casarella W. J. Percutaneous drainage of multiseptated hepatic abscess. J Comput Assist Tomogr. 1984 Feb;8(1):38–41. doi: 10.1097/00004728-198402000-00008. [DOI] [PubMed] [Google Scholar]
  5. Bertel C. K., van Heerden J. A., Sheedy P. F., 2nd Treatment of pyogenic hepatic abscesses. Surgical vs percutaneous drainage. Arch Surg. 1986 May;121(5):554–558. doi: 10.1001/archsurg.1986.01400050072009. [DOI] [PubMed] [Google Scholar]
  6. Dietrick R. B. Experience with liver abscess. Am J Surg. 1984 Feb;147(2):288–291. doi: 10.1016/0002-9610(84)90109-0. [DOI] [PubMed] [Google Scholar]
  7. Ferrucci J. T., Jr, vanSonnenberg E. Intra-abdominal abscess. Radiological diagnosis and treatment. JAMA. 1981 Dec 11;246(23):2728–2733. [PubMed] [Google Scholar]
  8. Fischer M. G., Beaton H. L. Unsuspected hepatic abscess associated with biliary tract disease. Am J Surg. 1983 Nov;146(5):658–662. doi: 10.1016/0002-9610(83)90306-9. [DOI] [PubMed] [Google Scholar]
  9. Gerzof S. G., Johnson W. C., Robbins A. H., Nabseth D. C. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage. Am J Surg. 1985 Apr;149(4):487–494. doi: 10.1016/s0002-9610(85)80045-3. [DOI] [PubMed] [Google Scholar]
  10. Greenstein A. J., Lowenthal D., Hammer G. S., Schaffner F., Aufses A. H., Jr Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients. Am J Gastroenterol. 1984 Mar;79(3):217–226. [PubMed] [Google Scholar]
  11. Hawkins H. B., Cinti D. C., Lyons R. W. Pyogenic liver abscess: needle aspiration and antibiotic therapy. Conn Med. 1984 Jul;48(7):420–422. [PubMed] [Google Scholar]
  12. Herbert D. A., Fogel D. A., Rothman J., Wilson S., Simmons F., Ruskin J. Pyogenic liver abscesses: successful non-surgical therapy. Lancet. 1982 Jan 16;1(8264):134–136. doi: 10.1016/s0140-6736(82)90382-8. [DOI] [PubMed] [Google Scholar]
  13. Johnson R. D., Mueller P. R., Ferrucci J. T., Jr, Dawson S. L., Butch R. J., Papanicolaou N., vanSonnenberg E., Simeone J. F., Wittenberg J. Percutaneous drainage of pyogenic liver abscesses. AJR Am J Roentgenol. 1985 Mar;144(3):463–467. doi: 10.2214/ajr.144.3.463. [DOI] [PubMed] [Google Scholar]
  14. Kandel G., Marcon N. E. Pyogenic liver abscess: new concepts of an old disease. Am J Gastroenterol. 1984 Jan;79(1):65–71. [PubMed] [Google Scholar]
  15. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  16. Kraulis J. E., Bird B. L., Colapinto N. D. Percutaneous catheter drainage of liver abscess: an alternative to open drainage? Br J Surg. 1980 Jun;67(6):400–402. doi: 10.1002/bjs.1800670606. [DOI] [PubMed] [Google Scholar]
  17. Land M. A., Moinuddin M., Bisno A. L. Pyogenic liver abscess: changing epidemiology and prognosis. South Med J. 1985 Dec;78(12):1426–1430. doi: 10.1097/00007611-198512000-00007. [DOI] [PubMed] [Google Scholar]
  18. Maher J. A., Jr, Reynolds T. B., Yellin A. E. Successful medical treatment of pyogenic liver abscess. Gastroenterology. 1979 Oct;77(4 Pt 1):618–622. [PubMed] [Google Scholar]
  19. McCorkell S. J., Niles N. L. Pyogenic liver abscesses: another look at medical management. Lancet. 1985 Apr 6;1(8432):803–806. doi: 10.1016/s0140-6736(85)91457-6. [DOI] [PubMed] [Google Scholar]
  20. McDonald M. I., Corey G. R., Gallis H. A., Durack D. T. Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore) 1984 Sep;63(5):291–302. doi: 10.1097/00005792-198409000-00003. [DOI] [PubMed] [Google Scholar]
  21. McFADZEAN A. J., CHANG K. P., WONG C. C. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics; a report of 14 consecutive cases with recovery. Br J Surg. 1953 Sep;41(166):141–152. doi: 10.1002/bjs.18004116606. [DOI] [PubMed] [Google Scholar]
  22. Miedema B. W., Dineen P. The diagnosis and treatment of pyogenic liver abscesses. Ann Surg. 1984 Sep;200(3):328–335. doi: 10.1097/00000658-198409000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Neoptolemos J. P., Macpherson D. S. Pyogenic liver abscess. Br J Hosp Med. 1981 Jul;26(1):47–55. [PubMed] [Google Scholar]
  24. Pitt H. A., Zuidema G. D. Factors influencing mortality in the treatment of pyogenic hepatic abscess. Surg Gynecol Obstet. 1975 Feb;140(2):228–234. [PubMed] [Google Scholar]
  25. Rubin R. H., Swartz M. N., Malt R. Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Am J Med. 1974 Oct;57(4):601–610. doi: 10.1016/0002-9343(74)90012-6. [DOI] [PubMed] [Google Scholar]
  26. Rubinson H. A., Isikoff M. B., Hill M. C. Diagnostic imaging of hepatic abscesses: a retrospective analysis. AJR Am J Roentgenol. 1980 Oct;135(4):735–745. doi: 10.2214/ajr.135.4.735. [DOI] [PubMed] [Google Scholar]
  27. Sheinfeld A. M., Steiner A. E., Rivkin L. B., Dermer R. H., Shemesh O. N., Dolberg M. S. Transcutaneous drainage of abscesses of the liver guided by computed tomography scan. Surg Gynecol Obstet. 1982 Nov;155(5):662–666. [PubMed] [Google Scholar]
  28. Van der Spek P., Peters O., Claes H., Devis G. Percutaneous catheter drainage of solitary pyogenic liver abscess. Acta Clin Belg. 1984;39(6):363–367. doi: 10.1080/22953337.1984.11719034. [DOI] [PubMed] [Google Scholar]
  29. van Waes P. F., Feldberg M. A., Mali W. P., Ruijs S. H., Eenhoorn P. C., Buijs P. H., Kruis F. J., Ramos L. R. Management of loculated abscesses that are difficult to drain: a new approach. Radiology. 1983 Apr;147(1):57–63. doi: 10.1148/radiology.147.1.6828759. [DOI] [PubMed] [Google Scholar]
  30. vanSonnenberg E., Ferrucci J. T., Jr, Mueller P. R., Wittenberg J., Simeone J. F. Percutaneous drainage of abscesses and fluid collections: technique, results, and applications. Radiology. 1982 Jan;142(1):1–10. doi: 10.1148/radiology.142.1.7053517. [DOI] [PubMed] [Google Scholar]

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