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Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the liter...
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Context 1
... series reflected this changing trend in aetiology; with a biliary source in 45%, diverticular aetiology in 27.5%, and likely haematogenous dissemination in the remain- ing 27.5% of patients. The organisms isolated from a liver abscess are varied, usually polymicrobial, and reflective of the infectious source (Table 3). Whilst this study and review focused primarily on bacterial causes of liver abscess, it should be noted that parasitic organ- isms are also common etiological factors, particularly in tropical and subtropical climates. ...
Similar publications
Klebsiella pneumoniae liver abscess (KPLA) is an emerging syndrome with the initial cases described in Taiwan in the 1980s. There is high mortality with this condition, and immediate aggressive treatment is necessary. Diabetes mellitus (D.M.) is the single most important risk factor for developing KPLA. Here, we describe a rare case of recurrent cr...
Citations
... Risk factors for PLA include diabetes mellitus (DM), underlying hepatobiliary or pancreatic diseases, and gastrointestinal cancers involving the biliary tract. [6][7][8] In recent years, biliary tract diseases, such as choledocholithiasis, hepatobiliary malignancy, strictures, and congenital biliary anomalies, have emerged as the predominant causes of PLA. 9 Regarding long-term complications associated with ERCP, our previous study showed a significantly increased risk of pyogenic liver abscess (PLA) in patients who underwent ES compared to those without ES. 5 The underlying mechanism involves the disruption of the barrier between the hepatobiliary system and the duodenum following ES, which promotes duodenal-biliary reflux. ...
Background
Endoscopic Retrograde Cholangiopancreatography (ERCP), used for choledocholithiasis treatment, carries a risk of pyogenic liver abscess (PLA) due to communication between the biliary system and bowel contents. However, limited data exists on this issue. This study aims to identify the risk factors pertaining to liver abscesses following ERCP lithotomy.
Methods
We conducted a retrospective case series across multiple centers to evaluate patients who developed PLA after ERCP for choledocholithiasis. Data was obtained from the Chung Gung Research Database (January 2001 to December 2018). Out of 220 enrolled patients, 195 were categorized in the endoscopic sphincterotomy (ES) group, while 25 were in the non-ES group for further analysis.
Results
The non-ES group had significantly higher total bilirubin levels compared to the ES group (4.3 ± 5.8 vs 1.9 ± 2.0, p<0.001). Abscess size, location, and distribution (single or multiple) were similar between the two groups. The most common pathogens were Klebsiella pneumoniae and Escherichia coli. Pseudomonas infection was significantly less prevalent in the ES group compared to the non-ES group (3.6% vs 16.7%, p=0.007). Patients with concurrent malignancies (HR: 9.529, 95% CI: 2.667–34.048, p=0.001), elevated total bilirubin levels (HR: 1.246, 95% CI: 1.062–1.461, p=0.007), multiple abscess lesions (HR: 5.146, 95% CI: 1.777–14.903, p=0.003), and growth of enterococcus pathogens (HR: 4.518, 95% CI: 1.290–15.823, p=0.001) faced a significantly higher risk of in-hospital mortality.
Conclusion
PLA incidence was higher in the ES group compared to the non-ES group following ERCP for choledocholithiasis. Attention should be given to significant risk factors, including concurrent malignancies, elevated total bilirubin levels, multiple abscess lesions, and growth of enterococcus pathogens, to reduce in-hospital mortality.
... Without prompt diagnosis and appropriate therapy, PLA is ultimately fatal, and complications are relatively common [7,18]. Possible complications include pyothorax, peritonitis, hemobilia, and cerebral abscess. ...
... Possible complications include pyothorax, peritonitis, hemobilia, and cerebral abscess. Broad-spectrum parenteral antibiotics, initially based on suspected etiology and later adjusted based on results of cultures, is the mainstay of treatment [18]. The optimal duration of antibiotic therapy is usually 4-6 weeks depending on the patient's clinical response. ...
... The optimal duration of antibiotic therapy is usually 4-6 weeks depending on the patient's clinical response. Parenteral therapy is given for about 2-4 weeks, followed by appropriate oral antibiotics for the remaining duration of therapy [1,7,18]. This was the regimen used for our patient with excellent clinical response. ...
Background
Pyogenic liver abscess is a rare condition in children especially in early infancy. The diagnosis requires a high index of suspicion and treatment has to be aggressive to avoid fatality. There is a rarity of reports of the condition in infancy in the African population. Thus, we report a case of the hepatic abscess with documented hypergammaglobulinemia in a young infant seen at the Lagos University Teaching hospital.
Case presentation
We describe the case of a 38-day-old female infant who presented with 4 weeks history of fever and 2 weeks history of progressive abdominal distension. At the onset of illness abdominal ultrasound suggested hepatic abscess and abdominal CT scan confirmed multiple loculated collections in 3 segments of the liver. Patient had drainage of the abscess and additional investigations revealed hypergammaglobulinemia (IgM, IgG, and IgE) in the patient. She completed 6 weeks of antibiotics and made significant clinical improvement.
Conclusions
Pyogenic liver abscess should be considered in the differential diagnosis of an infant with pyrexia with abdominal swelling, even in the absence of well-established risk factors. A high index of suspicion for underlying primary immunodeficiency is important when the condition is diagnosed in early infancy.
... Surgical options include surgical drainage or partial liver resection [13]. Surgical resection was considered in certain clinical circumstances: 1) Liver abscess not amenable to percutaneous drainages, such as huge, multiseptated, or multifocal abscesses [14]; 2) Ruptured liver abscess or fistula formation in which surgery is highly likely required [11]; 3) Failed treatment with an optimal antibiotic therapy and percutaneous drainage [15]; and 4) concomitant pathologies requiring surgical intervention, such as malignancy or biliary abnormality [15]. Depending on the surgeon's experience and the location of the liver abscess, liver resection can be performed by (mini)laparotomy or a less inva- sive laparoscopic approach [15]. ...
... Surgical options include surgical drainage or partial liver resection [13]. Surgical resection was considered in certain clinical circumstances: 1) Liver abscess not amenable to percutaneous drainages, such as huge, multiseptated, or multifocal abscesses [14]; 2) Ruptured liver abscess or fistula formation in which surgery is highly likely required [11]; 3) Failed treatment with an optimal antibiotic therapy and percutaneous drainage [15]; and 4) concomitant pathologies requiring surgical intervention, such as malignancy or biliary abnormality [15]. Depending on the surgeon's experience and the location of the liver abscess, liver resection can be performed by (mini)laparotomy or a less inva- sive laparoscopic approach [15]. ...
... Surgical resection was considered in certain clinical circumstances: 1) Liver abscess not amenable to percutaneous drainages, such as huge, multiseptated, or multifocal abscesses [14]; 2) Ruptured liver abscess or fistula formation in which surgery is highly likely required [11]; 3) Failed treatment with an optimal antibiotic therapy and percutaneous drainage [15]; and 4) concomitant pathologies requiring surgical intervention, such as malignancy or biliary abnormality [15]. Depending on the surgeon's experience and the location of the liver abscess, liver resection can be performed by (mini)laparotomy or a less inva- sive laparoscopic approach [15]. In the first case, open surgical abscess drainage with partial liver resection (segment VII resection) was necessary due to the failure of antibiotics and percutaneous aspiration. ...
Pyogenic liver abscesses (PLAs) are relatively rare but often fatal if left untreated. Antibiotic therapy combined with percutaneous procedures has replaced surgery as the cornerstone of treatment. However, open surgical drainage or liver resection may be a last resort. This study aimed to review our experience in treating PLA, with a focus on the conditions requiring partial liver resection as the last viable curative option. Medical records of patients with PLA admitted to Jordan Hospital between October 2014 through October 2020 were retrospectively reviewed. Medical and demographic data of all 43 patients admitted to our facility with a diagnosis of PLA were extracted. We reviewed these patients and extracted the cases that required surgical intervention. Four (three males and one female) of the 43 patients with PLA required surgical intervention. The underlying causes of liver abscesses were as follows: one traumatic due to shrapnel injury from an explosion, one following chemoembolization for hepatocellular carcinoma, and two patients with no apparent etiology. All patients were diagnosed with a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Two patients had negative cultures. All patients received broad-spectrum antibiotics, and all underwent CT- or ultrasound-guided percutaneous drainage or aspiration. All four patients required partial hepatic resection due to treatment failure or inaccessible percutaneous procedures with clinical improvement. Although antimicrobial and interventional therapy remains the primary treatment option in PLA, the surgical option with open surgical drainage or partial liver resection remains viable and curative in selected patients.
... This demonstrated the need for drainage in the treatment of PLAs. 10 With the advent of antibiotics in the 1900's, followed by the development of computed tomographic (CT) imaging and minimally invasive drainage techniques later in the century, there were significant decreases in PLA-associated morbidity and mortality. 5,12 In the modern era, the first-line treatment is antibiotics combined with percutaneous drainage techniques. Despite this, mortality still ranges from 6 to 10% throughout the world and has not significantly improved over the last two decades. ...
Antibiotics and drainage have largely replaced hepatic resection for the treatment of liver abscesses in the modern era; however, in cases caused by a rare strain of Klebsiella pneumoniae with a hypermucoviscous phenotype, more aggressive hepatic resection may be required. The patient is a 34-year-old male who presented to Landstuhl Regional Medical Center with a week of epigastric pain. His workup revealed a 6 cm liver abscess with growth to 10 cm in 48 hours. He underwent multiple drainage procedures at Landstuhl and then was transferred to Walter Reed where further surgical drainage was performed. Initial cultures demonstrated K. pneumoniae. He clinically improved and was able to discharge after a 2 week hospitalization. His final remaining surgical drain was removed as an outpatient, but 48 hours after removal, he was admitted to the intensive care unit in septic shock. Imaging revealed a 12 cm liver abscess, and cultures verified hypermucoviscous Klebsiella. After multidisciplinary discussion and counseling, he underwent an open right partial hepatectomy. Postoperatively he gradually recovered from his sepsis and major operation and then returned to his home in Landstuhl. This is a case of a rare hypermucoviscous variant of K. pneumoniae causing a liver abscess resistant to multiple drainage procedures, ultimately requiring open hepatic surgical resection for source control. This remains a last-resort option in the treatment of liver abscesses and should be considered early when caused by this rare strain of Klebsiella.
... A retrospective study showed that in patients with colonic diverticular disease (diverticulosis/diverticulitis), the incidence of PLA is 2.44 times higher than patients without diverticular disease [11]. This is also consistent with the findings of another study which concluded that colonic diverticulitis was associated with 27.5% of cases of PLA [12]. A review of the literature revealed other risk factors include biliary tree malignancies, particularly cholangiocarcinoma and hepatobiliary infections which may also lead to SAG-related liver abscess [13]. ...
Pyogenic liver abscess (PLA) is known as a pus-filled lesion found in the liver which can quickly become fatal if not found and treated in a timely manner. The most common group of bacteria found in PLA is the Streptococcus Anginosus Group (SAG). Patients with PLA usually present with fever and right upper quadrant abdominal pain which can at times be referred to the right shoulder owing to dermatomal involvement. We present a case where a patient with a past medical history significant for recent diverticulosis presenting with a left lower quadrant abdominal pain, fever, and hypotension and on further workup was found to have a PLA. Blood cultures and cultures from the abscess grew Streptococcus constellatus. This bacteria is part of the SAG group however, it is rarely found in PLA and bloodstream.
... Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed. 7 The surgical option also has the added advantage of accurate positioning of drainage catheter and simultaneous treatment of the abscess and underlying abdominal pathology. 8,9 Our objective was to study the Postoperative hospital stay, day of intracavitary drain removal, adequacy of drainage, duration of surgery, complications and secondary intervention required will be evaluated. ...
Background: In the era of minimal invasive surgical techniques, laparoscopic drainage provides faster recovery, shorter hospital stay, less surgical site infection and better cosmesis than open surgical drainage does with added advantage of accurate positioning of drainage catheter and simultaneous treatment of the abscess and underlying abdominal pathology. Methods: A total of 33 patients of age group 18-65 years were enrolled. Diagnosis was made using ultrasonography and CECT abdomen and laparoscopic drainage done and drain placed. Adequacy of drainage of abscess was analyzed using ultrasonography on POD- 5, 20 and 30 and were followed upto 3 months. Day of intra-cavitary drain removal, duration of post operative hospital stay, complications after surgery, requirement of readmission and intervention after readmission were recorded and analyzed. Results: Out of 33 patients, 1 patient developed sinus tract formation at intracavitary drain site. 3 patients had inadequate drainage for which drain change was required. 33% (N=11) patients showed complete resolution of abscess at post operative day 20 where as 72.7% patients (N=24) showed complete resolution of abscess on post operative day 30. All 33 patients showed complete resolution of abscess after 3 months of surgery. Conclusions: Laparoscopic procedure provides every advantages of open surgical drainage of liver abscess while avoiding complications of open surgeries. It allows breakdown of loculations, drainage of viscid pus, necrotic tissues, adequate irrigation of abscess cavity and should be considered for patients with large, complex, septated or multiple abscesses and failed percutaneous drainage.
... Double catheter drainage probably facilitates rapid emptying of the abscess cavity particularly in patients with large multiloculated lesions where a second drainage tube can be positioned in another part of the abscess. Rapid unobstructed emptying of the pus probably reduces the high bacterial load and inflammation, thereby decreasing the duration of hospitalization (32). In our study we observed a decrease in the time to removal of catheter and the duration of hospitalization in patients who had DP drainage compared with those treated with SP drainage. ...
Background:
This study aims to investigate the efficacy and safety of double pigtail tube drainage compared with single pigtail tube drainage for the treatment of multiloculated pyogenic liver abscesses greater than 5 cm.
Patients and methods:
This study retrospectively analyzed patients with pyogenic liver abscess admitted in the Affiliated Hospital of Chengde Medical College between May 2013 and May 2021. Patients with pyogenic liver abscess more than 5 cm in size, who underwent drainage of the abscess with either double pigtail or single pigtail tube, were included.
Results:
A total of 97 patients with pyogenic liver abscesses larger than 5 cm were studied. These included 34 patients with double pigtail tube drainage and 63 patients with single pigtail tube drainage. The postoperative hospital stay (13.39 ± 4.21 days vs. 15.67 ± 7.50 days; P = 0.045), and time for removal of the catheter (17.23 ± 3.70 days vs. 24.11 ± 5.83 days; P = 0.038) were lower in the double pigtail tube group compared with the single pigtail tube group. The rate of reduction, in three days, of c-reactive protein levels was 26.61 ± 14.11 mg/L/day in the double pigtail tube group vs. 20.06 ± 11.74 mg/L/day in the single pigtail tube group (P = 0.025). The diameter of the abscess cavity at discharge was 3.1 ± 0.07 cm in the double pigtail tube group as compared with 3.7 ± 0.6 cm in the single pigtail tube group (P = 0.047). There was no bleeding in any of the patients despite abnormal coagulation profiles. There was no recurrence of abscess within six months of discharge and no death in the double pigtail tube group. Conclusion: Double pigtail tube drainage treatment in multiloculated pyogenic liver abscesses greater than 5 cm in size, is safe and effective.
... With advances in diagnostic imaging and less invasive interventions, the mortality attributed to PLA has steadily declined. A recent nationwide study reported an inpatient mortality rate of 6% in the US [1], with international studies reporting patient fatality rates of 11-31% [7,8]. Multiple studies have noted a gradual epidemiologic change with regard to age, clinical presentation, etiology, microbiology, and treatment strategies. ...
... Multiple studies have noted a gradual epidemiologic change with regard to age, clinical presentation, etiology, microbiology, and treatment strategies. Tese transitions have been attributed to better access to care, improved imaging techniques, increased frequency of biliary tract pathology, and early diagnosis and management of the classic disorders previously associated with PLA formation (e.g., appendicitis, diverticulitis) [8][9][10]. Indeed, the most common etiology of PLA reported in recent years has shifted from gastrointestinal sepsis to biliary disease [6][7][8][9][10][11]. ...
... Tese transitions have been attributed to better access to care, improved imaging techniques, increased frequency of biliary tract pathology, and early diagnosis and management of the classic disorders previously associated with PLA formation (e.g., appendicitis, diverticulitis) [8][9][10]. Indeed, the most common etiology of PLA reported in recent years has shifted from gastrointestinal sepsis to biliary disease [6][7][8][9][10][11]. ...
Background:
Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. In recent years, advances in diagnostics and management have led to early diagnosis and treatment and decreased mortality. We present recent data from a large series of patients with PLA and examine the trends in the management of PLA over a period of 50 years.
Methods:
The medical records of all patients admitted to the Shaare Zedek Medical Center, Israel, between January 2011 and December 2021 with a primary or secondary diagnosis of PLA were reviewed retrospectively.
Results:
: Ninety-five patients with PLA were identified. Thirty-eight (40%) were female. The median patient age was 66 years (range 18-93). The diagnosis of PLA in all patients was confirmed with abdominal computed tomography (CT). In twenty patients (21.1%), PLA was not diagnosed by the initial abdominal US. Most abscesses were right-sided. Biliary tract origin was the most common underlying cause of PLA (n = 57, 60%), followed by cryptogenic etiology (n = 28, 30%). Escherichia coli, Klebsiella pneumoniae, and Streptococcus species were most commonly identified. The most common primary treatment modality was percutaneous drainage (PD), which was performed in 81 patients (85.3%). Fourteen patients (14.7%) were treated medically without intervention, and two patients (2.1%) were treated surgically following a failure of PD. Four patients died as a direct result of PLA.
Conclusions:
Patients diagnosed with PLA are older, the male predominance is less pronounced, and the offending pathogens are likely to originate from the biliary tract. This study questions the utility of abdominal US as the initial diagnostic imaging in patients with suspected PLA (versus CT) and demonstrates improved outcomes for patients with PLA over the years.
... These microorganisms can reach the liver through the blood or the biliary system. [1][2][3] The abscess is a cystic lesion walled off by necrotic liver tissues filled with supportive material. 4 This supportive material consists of the liquefied liver tissue, the invading microorganism, and white blood cells. ...
Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD).
Methods
A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software.
Results
Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR = 1.23; 95% CI [1.12, 1.36], P < 0.00001), time for achieving 50% reduction of cavity size (MD = −2.32; 95% CI [−3.07, −1.57], P < 0.00001), and time for clinical improvement (MD = −1.92; 95% CI [−2.55, −1.28], P < 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P = 0.36, P = 0.06 and P = 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P = 0.39).
Conclusion
PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.
... These microorganisms can reach the liver through the blood or the biliary system. [1][2][3] The abscess is a cystic lesion walled off by necrotic liver tissues filled with supportive material. 4 This supportive material consists of the liquefied liver tissue, the invading microorganism, and white blood cells. ...
Background: Liver abscesses differ in their aetiology, location, and number. Image-guided percutaneous drainage techniques are the currently used management for liver abscesses. We conducted our study to compare the clinical safety and efficacy of percutaneous needle aspiration (PNA) to percutaneous catheter drainage (PCD). Methods: A systematic review of major reference databases was undertaken in February 2022 for randomized controlled trials (RCTs) that compare PNA to PCD in treating liver abscess patients. The quality of the included trials was assessed using the Cochrane tool. Statistical meta-analysis was conducted using RevMan and open meta-analyst software. Results: Fifteen RCTs were included in this review, with 1676 patients enrolled. The overall quality of the included trials was moderate, with most domains of unclear risk. PCD was superior to PNA in the success rate (RR = 1.23; 95% CI [1.12, 1.36], P < 0.00001), time for achieving 50% reduction of cavity size (MD = À2.32; 95% CI [À3.07, À1.57], P < 0.00001), and time for clinical improvement (MD = À1.92; 95% CI [À2.55, À1.28], P < 0.00001). The two modalities did not differ in the days of hospital stay, duration of IV antibiotics, and time needed for total or subtotal reduction of cavity size (P = 0.36, P = 0.06 and P = 0.40, respectively). High heterogeneity levels were detected. Regarding major complications, the two modalities were equally safe (P = 0.39). Conclusion: PCD has a higher success rate and results in a faster 50% reduction in the abscess cavity size and clinical improvement. The two modalities are equally safe.
