Pyogenic liver abscess: Changing patterns in approach

Abstract

Sixty-one cases of pyogenic liver abscess seen at the UCLA Hospital and the Wadsworth Veterans Administration Hospital are reviewed. Hepatic abscess should be suspected in those patients with continued sepsis who, in addition, have an increase in size and tenderness of the liver. Since the introduction of antibiotic therapy, as well as of newer diagnostic technics, there has been an increased awareness of this clinical situation. Recently there have also been changes in the etiologic, bacteriologic, and operative approach to this lesion. Previously, liver abscess has been due primarily to portal infection from intraperitoneal disease. In this series 60 per cent of the cases were due to either intraperitoneal disease or generalized septicemia. Biliary obstructive disease in older patients has also begun to increase. The predominant organisms cultured were streptococcus and staphylococcus. Gram-negative organisms, which previously accounted for the majority of abscesses, were found in only twelve cases. In the past, drainage through an “extraperitoneal” approach has been emphasized. With vigorous antibiotic therapy, however, the transabdominal approach may be employed with minimal danger. Solitary pyogenic abscess is best treated by open surgical drainage as soon as it is diagnosed. When there are multiple small abscesses in the liver, effective surgical drainage seldom can be accomplished and one must depend upon intensive chemotherapy, which at times can provide an effective recovery. An understanding of these concepts will allow early and more vigorous therapy to be instituted.