Cause Of Liver Abscess Research Articles

Intrahepatic abscess due to gallbladder perforation.

Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. We report four cases of this condition and describe the imaging procedures related to its diagnosis and treatment. The medical and x-ray files of 39 patients with percutaneous drainage of liver abscesses were retrospectively reviewed. Four patients with hepatic abscess due to gallbladder perforation were identified. The patients presented with clinical features suggestive of cholecystitis. Sonography in four patients showed a hypoechoic lesion in the liver adjacent to the gallbladder. CT in three patients showed a hypodense area in the liver, corresponding to the sonographic findings. Percutaneous abscess drainage, followed by an abscessogram, was performed in all patients. Contrast material injected through the drainage catheter filled the gallbladder directly from the abscess cavity. Two patients subsequently underwent cholecystectomy, confirming perforation of the gallbladder fundus. In both cases the gallbladder was noted to be embedded in the liver and covered by adhesions. Perforation of the gallbladder is a rare cause of pyogenic liver abscess. We suggest, however, based on our two patients who underwent surgery, and several cases reported in the literature, that this condition may be more common when the gallbladder is partially or totally intrahepatic.

Hepatic abscess caused bySalmonella typhi

Salmonella typhi is a rare cause of liver abscess. We describe a 47-year-old African male with multiple liver abscesses due to S. typhi in an area where hepatic amebiasis is endemic. The patient did not respond appropriately to amebicidal therapy and culture of the liver aspirate on two occasions yielded S. typhi. The Widal test, initially negative, became positive on repeat testing 10 days later. Percutaneous aspiration combined with appropriate antibiotic therapy resulted in a complete recovery. No predisposing cause could be found. We report the clinical, radiological, and microbiological features of this case and review the literature on this rare but easily treatable condition.

The changing clinical spectrum of liver abscess: the Jerusalem experience

A retrospective study was conducted of all 31 patients with liver abscess admitted to Shaare Zedek Medical Center between 1979, the year computed tomographic scan and ultrasound were introduced, and 1992. Fever and abdominal pain were the most common symptoms. Duration of symptoms was short: 81% of patients had symptoms for < or = 5 days and none had symptoms for more than 3 weeks. Amoebic abscess was found in one patient only, the remainder were pyogenic. Biliary tract pathology remains the most common cause of liver abscess (39%). The diagnosis was made by ultrasound in 22/31 (71%) and by computed tomographic scan in 9/31 (29%) of patients. Treatment consisted of intravenous antibiotics and percutaneous drainage under ultrasound guidance in 24/31 patients (77%). Four patients died (13%), three of whom had underlying malignancies. Clinical features were compared with those from a similar series of 36 cases with liver abscess reported from Jerusalem predating ultrasound and computed tomographic scan (1967-1977). Several major changes have occurred. First, the relative incidence of amoebic abscess has dramatically decreased. Second, ultrasound and computed tomographic scan have facilitated earlier diagnosis and percutaneous drainage, contributing to improved survival and lower morbidity.

Liver abscess. The need for complete gastrointestinal evaluation.

The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation.

Liver abscess in Crohn's disease: Report of four cases and review of the literature

Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed. The incidence of liver abscess in patients with Crohn's disease (114–297 per 100,000) appears to be higher than that of liver abscess in the general population (8–16 per 100,000). Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed. In comparison to patients with liver abscess in the general population, patients with Crohn's disease and liver abscess are considerably younger, are more likely to have multiple rather than solitary abscesses, and usually have a predisposing intraabdominal focus of infection, rather than a biliary one. Streptococci, especially Streptococcus milleri, are the most frequent cause of liver abscess in patients with Crohn's disease. Liver scanning should be performed routinely in patients with Crohn's disease in whom a febrile illness cannot be completely explained by bowel disease, or in whom fever does not respond to drainage of intraabdominal abscesses.

Hepatic Abscesses Due to Yersinia enterocolitica

Infection withYersinia enterocoliticais being reported with increasing frequency from many parts of the world. To our knowledge,Y enterocoliticahas not been described as a cause of liver abscesses in children in the English literature. Adults withY enterocoliticaabscesses have been symptomatic, had underlying liver diseases, and have died.1We describe here an infant with multiple liver abscesses caused byY enterocolitica. Report of a Case.—A 3-month-old male infant was referred to us for evaluation of an enlarged liver. Physical examination had shown normal results 2½ weeks prior to admission. He had diarrhea one week prior to admission and had been febrile with a temperature of 38.3 °C. There had been no vomiting, bleeding, jaundice, or feeding problems. His mother noted an increase in his abdominal size for one week. Physical examination showed a pale, 5.5-kg, afebrile infant. The liver was 5 cm below the

Yersinia enterocolitica and Yersinia pseudotuberculosis from wildlife in Ontario.

Four isolates of Yersina enterocolitica and six of Y. pseudotuberculosis were made from carcasses collected in Ontario in 1973. Y. enterocolitica was isolated from the following species: Canada goose, Branta canadensis (serotype 4,33), Pekin robin, Leiothrix lutea (serotype 6,30), beaver, Castor canadensis (serotype as yet unknown), and raccoon, Procyon lotor (serotype 5,27). Yersiniosis was apparently the cause of death of the beaver and the cause of liver abscesses in the raccoon; the significance of the isolates from the birds was not determined. Y. pseudotuberculosis isolations were from a crow, Corvus brachyrhynchos (serotype 1A), two purple martins, Progne subis (serotype 1B), and three beavers (serotype 1B). Yersiniosis was apparently the cause of abscesses in one of the beavers and the cause of death of the other cases. During the period from 1962 to 1972, Y. pseudotuberculosis had been isolated in this laboratory from four beavers and one snowshoe hare, Lepus americanus. There was no record of pr...

Human Infection with B. Necrophorum

Human infection with necrophorum is comparatively rare, although it is recognized as the cause of a variety of destructive lesions in many species of mammals and birds. Loeffler in 1884 isolated from diphtheria-like lesions in the throats of calves an anaerobic, pleomorphic, Gram-negative bacterium to which he applied the name Bacillus diphtheriae vitulorum. In animals this agent is responsible for necrotic infection in the oral cavity, skin, hoofs, genitalia, and intestinal tract. Embolic spread to practically all of the internal organs is frequent, especially to the liver and the lungs. It is a common cause of liver abscess in cattle and birds. necrophorum is representative of a group of similar or identical anaerobic bacteria described under different names. Consideration of the morphology, growth, and staining characteristics of these various organisms reveals an almost complete identity in essential points. Furthermore, the disease pictures produced by different members of this group both in man and lower animals bear a striking resemblance. Dach, Dragstedt and Heinz cultured this organism from an isolated loop of colon in three human cases of ulcerative colitis and from the bowels of two monkeys. In 1936 these same workers were able to recover necrophorum from the colons of thirteen out of twenty cases of ulcerative colitis, while cultures from six normal cases were negative. Complement-fixing antibodies for necrophorum were found in fourteen of sixteen cases of chronic ulcerative colitis. In a third contribution they state: Bacterium necrophorum has been found con-