Pyogenic liver abscess: A review of 10 years' experience in management

Background: Over the past 15 years, diagnostic and interventional radiology techniques have allowed accurate localization of liver abscesses and image -guided percutaneous drainage. This review examines whether these technical advances improve clinical results and discusses the selection of treatment for patients with liver abscesses. Methods: Ninety-eight patients were treated for pyogenic liver abscess (PLA ) at the Royal Prince Alfred Hospital, Sydney, between January 1987 and Jun e 1997. The hospital records were examined and clinical presentation, labor atory, radiological and microbiological findings were recorded. Association s between these findings and failure of initial non-operative management we re determined using odds ratios with 95% confidence intervals. Independent predictors were then determined by logistic regression. This analysis was r epeated to determine factors associated with mortality. Results: Cholelithiasis and previous hepatobiliary surgery were the most fr equently identifiable causes of PLA, each responsible in 15 patients. All 9 8 patients were treated with intravenous antibiotics and in 13 patients thi s was the only therapy. Of the remaining 85 patients, six proceeded straigh t to laparotomy and 79 had percutaneous drainage, of whom 15 required subse quent laparotomy. Factors predicting failure of initial non-operative manag ement were unresolving jaundice, renal impairment secondary to clinical det erioration, multiloculation of the abscess, rupture on presentation and bil iary communication. The overall hospital mortality rate was 8%. Conclusion: Pyogenic liver abscess remains a disease with significant morta lity. Image-guided percutaneous drainage is appropriate treatment for singl e unilocular PLA. Surgical drainage is more likely to be required in patien ts who have abscess rupture, incomplete percutaneous drainage or who have u ncorrected primary pathology.