CHANGING MANAGEMENT OF PYOGENIC LIVER-ABSCESS

The case records of 23 patients who presented over a 5-year period wit h a diagnosis of pyogenic liver abscess were reviewed. Ascending chola ngitis was implicated in nine cases, seven of which were associated wi th underlying malignancy. Haematogenous spread via the portal route ac counted for five cases. Primary treatment included percutaneous absces s drainage in 15 patients. Whereas nine of the 11 patients with benign underlying pathology were managed successfully, the four with maligna nt biliary obstruction did not survive. Only one of the 23 patients wh o presented with hepatic abscess required surgical intervention. Percu taneous abscess drainage combined with appropriate antibiotic therapy is an effective means of managing hepatic abscess, but there remains a substantial overall mortality rate resulting from the increasing inci dence of malignant biliary obstruction as a cause of this condition.