Early Surgical Drainage for Pyogenic Liver Abscess in the Western World – A New Paradigm

Abstract

Introduction: Pyogenic liver abscess (PLA) is not common in the Western world. Most patients are treated with image guided drainage (IGD). However, it is not successful in multiloculated abscess needing a later surgical drainage. We pursued a policy of best drainage as the first treatment even if it included liver resection and report our results. Methods: All patients treated for liver abscess at the University Hospital of Wales, Cardiff, UK, were identified from the Radiology and liver unit database from December 2010 to December 2020. We excluded patients who had gallbladder perforation into liver causing abscess. We collected data on demographics, mode of presentation, comorbidities, cause if known, organism, treatment, hospital stay and deaths. Results: There were 82 patients with a median age 68 (16-91) and male:female ratio of 2:1. The main presenting symptom was abdominal pain and fever in 62%. E.Coli and K.Pneumonia were the most common organisms. Treatment was surgical, IGD and antibiotics in 49%,21% and 30% respectively. Hospital stay was 13 days with no difference between the different treatment groups. Overall mortality was 5/82 (6%). Mortality in operative, IGD and antibiotic groups were 5%, 12% and 4% respectively. Two patients who died following surgery were elderly and had severe sepsis at presentation. Conclusion: Our results show that offering the best treatment including surgical drainage/resection as the first treatment leads to lower mortality and avoids prolonged hospital stay. Early referral to a liver unit for opinion or transfer is essential to achieve these results.