Single and multiple pyogenic liver abscesses: Etiology, clinical course, and outcome

Background. Pyogenic liver abscesses are uncommon but they still carry a hi gh mortality rate when encountered. This study was undertaken to evaluate t he differences in the clinical behaviour of patients with single and multip le abscesses. Methods: From January 1985 to December 1997, 133 patients wit h this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, m ethods of treatment, and outcome were assessed and compared in both types o f abscesses. Results: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration o f symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High l evels of alkaline phosphatase were more frequently seen in multiple abscess es than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in mu ltiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in mult iple lesions as well but the statistical difference was not significant. Co nclusions: These results suggest that multiple liver abscesses comprise a d isease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess. Copyright (C) 2001 S. Karger AG, Basel.