PYOGENIC HEPATIC-ABSCESS IN A COMMUNITY-HOSPITAL

Pyogenic hepatic abscesses are rare lesions and are most commonly the result of biliary tract disease. During a 3-year period at our institu tion, 15 patients were diagnosed with pyogenic hepatic abscess. Ten ca ses were related to biliary disease. Of these, five were associated wi th previous biliary tract operations. The remaining five were due to m etastases, infection at another site, or cryptogenic causes. Most absc esses were multiple. Treatment consisted of antibiotics alone for thre e patients, percutaneous drainage and intravenous antibiotics for seve n patients, open drainage with intravenous antibiotics for three patie nts, and papillotomy with intravenous antibiotics for one patient. The single untreated patient died. The other death occurred among those p atients treated with intravenous antibiotics alone. Four patients init ially treated by percutaneous drainage required subsequent open draina ge. All of these patients had multiple abscesses. The mean length of s tay in the hospital was least among the group treated by operative dra inage. Our review suggests that pyogenic hepatic abscesses may be trea ted by several different modalities, the choice of management should b e individualized, and the length of stay may be decreased by operative drainage.