Modern management of pyogenic hepatic abscess: a case series and review of the literature

Abstract

BackgroundPyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease.MethodsDemographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.ResultsOver a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.ConclusionsPyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.

Clinical, laboratory and management profile in patients of liver abscess in central India

“…Heneghan et al presented study on 11 patients with a mean age of 60.27 years 6 males and 5 females, present study showed and majority of patients were in their fourth decade with male dominancy being 81.90% (131) female 18.10% (29) cases. 3,4 Clinical presentation of Pyogenic liver abscess is non-specific and similar to that of other hepatobiliary inflammatory or infectious process. A combination of nonspecific systemic symptoms is the most common presentation, including fever and rigors, nausea and vomiting, right upper quadrant pain, Tender hepatomegaly, anorexia, weight loss, weakness and malaise.…”

“…Study presented by Malik AA et al showed Hemoglobin level of the less than 10 zgm% was found in 59% of patients, total leucocyte count more than 10 000/ cumm in 68% of patients, serum transaminases and alkaline phosphatase levels were elevated in 84% of patients, present study shows about 45.63% patients had Hb<10gms/dl, polymorph nuclear leukocytosis in 139 patients, raised SGPT in 136 patients and SGOT in 133 patients and enzymes (raised alkaline phosphatase in 17 patients), In Heneghan et al study 7(64%) patients were anaemic ↑ White cell count in 91% (10) cases and deranged liver function test in 10 cases(91%). 3,4 Newer radiological techniques such as ultrasound and CT scanning have greatly enhanced our ability to establish the diagnosis of hepatic abscess and have increased our understanding of the natural history of this process. Ultrasonography is the preferred initial tool for the diagnosis of liver abscess with a sensitivity of 85% to 95%.…”

“…5,[16][17][18] This is also evident from our series where 97 patients (60.63%) had USG guided aspiration and 31 patients (19.38%) had pigtail catheter drainage and were subjected to this mode of treatment, In Malik AA et al case study open surgical drainage was done in 127 cases, percutaneous drainage 26 cases and 16 cases were managed on iv antibiotics only with mortality in 19 patients, In Heneghan et al initially all patients were started with antibiotic therapy followed by USG guided percutaneous drainage in all patients out of which and only 2 patients required surgical intervention with no mortality. 3,4 Patients among them subsequently needed open surgical drainage because of inadequate response to percutaneous drainage. It is recommended that several factors be considered in choosing between surgical and percutaneous drainage.…”

“…Heneghan et al presented a case series on 11 patients over a period of 5 years to study the Modern management of pyogenic hepatic abscess. 4 Initially all patients were started with antibiotic therapy followed by USG guided percutaneous drainage in all patients out of which and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.…”

Clinical and biochemical profile of liver abscess patients

“…However, studies from west where PLA are more common, average age is above 60years. [12][13][14] As far as sex predisposition was concerned, after recruiting 50 consecutive patients, only 9 patients were female. Indian data show predominant male involvement; Sharma et al, Mukhopadhyay et al and Ghosh et al, reported male to female ratio to be 14.4:1, 7:1 and 11:1, respectively.…”