Results of Treatments for Pyogenic Liver Abscesses

Choi, Young Cheol; Chung, Woo Shik; Chang, Tae Soo

Abstract

Pyogenic liver abscess has been a life-threatening disease with a uniformly fatal outcome if left untreated. Changes in the etiology, clinical manifestations, methods of diagnosis, treatment and prognosis of pyogenic liver abscess have occurred slowly, but continuously, over the past century. Modern imaging techniques, improved drainage procedures, and appropriate antibiotic therapy have substantially reduced the mortality and the morbidity. A review of 103 patients with pyogenic liver abscess who were treated at Masan Samsung Hospital over a 5-year period from January 1992 to December 1996 was undertaken to characterize recent trends in diagnosis and management. There were 60 males and 43 females whose ages ranged from 11 to 85 years (mean 62.3 years). The peak age was in the 6th decade. Pyogenic liver abscess more often involved the right lobe (65.1%) than the left lobe (26.2%), and a single abscess was encountered more often than multiple abscesses in a 2.2:1 ratio. Upper abdominal pain, fever, and chills were the most common symptoms, and upper abdominal tenderness was the most common physical finding. An elevated serum alkaline phosphatase was seen in 73.8% of all patients and was the most common biochemical abnormality. Biliary tract disease was the most frequent underlying disorder. In the bacteriological study, we obtained positive cultures in 89.3% of the cases:65.0% were Gram-negative organism, 17.5% were Gram-positive organism, and 6.8% were anaerobes. E. coli was the most frequently cultured organism (31.5%). Ultrasonography and/or CT scanning was employed in the diagnosis and the follow up of all patients. Surgical open drainage was performed in 52 cases (50.5%) and percutaneous closed drainage in 51 cases (49.5%). The outcome of surgical open drainage was similar to that of percutaneous closed drainage, except for the mortality rate. Post-treatment complications occurred in 26 cases (25.2%), and the most frequent complication was a pulmonary problem (8.7%). The mortality rate due to pyogenic liver abscess was 7.8%, and the most common cause of death was sepsis.