THERAPEUTIC APPROACH TO HEPATIC-ABSCESSES

Thirty-five patients with hepatic abscesses were treated at our instit ution during an 8-year period. Twenty-nine patients had bacterial absc esses, and six patients had amoebic abscesses. The patients were admit ted with fever (95%), right upper quadrant pain (63%), and nausea and vomiting (40%) as the most common symptoms. Eleven patients had some i nciting cause for the abscess formation; the remaining 18 bacterial ab scesses were cryptogenic. The primary abnormal test results were leuko cytosis (91%) and liver enzyme elevations (80%). All patients with amo ebic abscesses were serologically positive for amoebic infection. Comp uted tomography (CT) was the most effective imaging modality for diagn osis. Twenty patients were treated with open surgical drainage, 11 wit h percutaneous drainage, and 4 with antibiotics alone. Three of the fo ur latter patients had amoebic abscesses. Abscesses in two patients in itially treated with percutaneous drainage did not resolve, and the pa tients ultimately required surgery. The remaining indications for surg ery were concomitant conditions requiring surgical intervention or ina ccessibility of the abscess to percutaneous drainage. Antibiotics were given to all patients, with treatment duration from 10 to 60 days. Th e hospital mortality was 6% due to sepsis and a postoperative myocardi al infarction in one patient, and perioperative myocardial infarction in another; overall morbidity was 20%. At a mean follow-up of 13 month s, all surviving patients had resolution of the abscesses shown by eit her CT (11 patients) or clinical examination (22 patients). We conclud e that effective drainage, whether it be surgical or percutaneous, and appropriate antibiotic coverage are the mainstays of therapy for hepa tic abscesses.