A Clinical Study of Pyogenic Liver Abscess

Kim, Tae Hun

Abstract

BACKGROUND/AIMS
Pyogenic liver abscess is a potentially life-threatening disease with substantial mortality rate. With the recent advances in diagnostic modalities and new treatment strategies, the overall mortality of pyogenic liver abscess has been decreased significantly but stillhigh mortality rates are recorded in patients with old age, multiple abscesses, malignant biliary obstruction and inadequate drainage. Therefore pyogenic liver abscess remains a major clinical challenge. We are going to investigate the current clinical features of pyogenic liver abscess.
METHODS
Medical records of those who admitted to the Ewha Womans University Mokdong Hospital since 1993 and diagnosed as having Pyogenic liver abscess were reviewed. A total of 88 pyogenic liver abscess patients was detected and their clinical presentation, bacteriologic etiologies, comorbidities and treatment results were investigated.
RESULTS
Fifty male and 38 female (1.3 :1) patients were enrolled and the mean age was 59years. The most common presenting symptom was fever/chill (77%) followed by abdominal pain(64%), nausea/vomiting (42%) and general weakness (41%). Diabetes mellitus was combined in 17% of the patients and most of pyogenic liver abscesses were induced by ascending biliary infection (43%) or unknown cause (52%). Leukocytosis was evident in 74% of the patients and elevated akaline phosphatase in 52%. Sixty five percent of the abscess cavities were located inright lobe of the liver and most of them were solitary (73%). Pus culture was more efficient than blood culture for the detection of causative microorganis and Klebsiella pnemoniae was most commonly isolated. Percutaneous aspiration or drainge procedures were applicated in 65% of the patients and three mortalities (3%) were recorded while most of the patients were improved.
CONCLUSION
Rapid diagnosis of pyogenic liver abscess can be done through a complete history taking, physical examination and a prompt imaging studies and aggressive application of percutaneous aspiration or drainage of the abscess cavity with the empirical antibiotic administration targetting gram-negative aerobe may contribute to the improvement of the mangement of pyogenic liver abscess.