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biliary tract diseases causes of pyogenic liver abscess. Values are given as number and percentages.
Source publication
Pyogenic liver abscess (PLA) are space-occupying lesions in the liver associated with high morbidity and mortality. The aim of this study is to review an Italian hospital experience in epidemiological, clinical patterns, and management of PLA.
We performed a retrospective, descriptive case series at a single center assessing demographic characteris...
Context in source publication
Context 1
... shown in Figure 3, of all PLA, in 28 cases (25.7%) the cause was not clear: cryptogenic abscess. Biliary tract diseases, including cholelithiasis, cholecystitis, and malignancies, were identified in 55% of cases (Table 2). In 12% of cases the cause of PLA was assigned to be hematogenous. ...Citations
... This study also confirms some well-known PLA characteristics from the literature: the preponderance of males, "typical" symptoms (e.g. abdominal pain, fever) and the predominant involvement of the right liver lobe (Table 1) 19,[35][36][37][38]40,41,45,46 . Biliary malignancies, cholelithiasis, and ischemic bile duct disease were the most frequent causes for PLA in our study. ...
... A possible explanation for this observation is the interdisciplinary liver center at our hospital with a large liver transplant program; a center effect is therefore likely. On the other hand, there are indications of a general shift in etiology: whereas decades ago appendicitis, trauma, post-surgical complications or hematogenous spread were common causes, in recent years diseases of the hepatic-pancreatic-biliary system have increasingly become the cause of PLA 14,17,[34][35][36]38,41,42,44 . This is certainly due to a changed patient clientele with older and more multi-morbid patients with underlying malignant diseases or immunosuppression, paired with an increasing willingness for medical intervention. ...
... The frequent use of US as initial imaging method is in line with other studies 18,36,37,39 and reflects the wide availability, time and cost-effectiveness as well as high sensitivity for identifying liver lesions 47,48 . In a retrospective study of 268 patients, Lin et al. calculated a diagnostic sensitivity for US of 86% 49 . ...
Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.
... Most studies used a regimen of 2 weeks of parenteral, followed by more prolong course (4-6 weeks) of antimicrobial therapy and switching to oral antibiotics when clinical and inflammatory responses allowed 18 . According to the present study mean (± SD) duration of antimicrobial therapy to accomplish clinical cure was 16.2 ± 4.3 days which was lower contrast to the previously published studies [17][18][19] , where the duration of antibiotic therapy was 4-6 weeks. This could be due to, study included only pyogenic liver abscess and lesser number of patients underwent drainage procedure which could explain the longer course of antibiotics. ...
... During the follow up no participants required surgical intervention due to complications like rupture into pericardium/ peritoneum/pleural cavity and there was no mortality. However in retrospective analysis morality from pyogenic liver abscess was reported around 10% and amoebic liver abscess was 2-15% 3,19 . The need for surgical intervention due to complication was reported around 7% in pyogenic liver abscess and 2-7% in amoebic liver abscess 3,19 . ...
... However in retrospective analysis morality from pyogenic liver abscess was reported around 10% and amoebic liver abscess was 2-15% 3,19 . The need for surgical intervention due to complication was reported around 7% in pyogenic liver abscess and 2-7% in amoebic liver abscess 3,19 . This could be explained by the fact that the present study included only uncomplicated liver abscess cases and majority of the participants (95%) underwent prompt percutaneous aspiration/drainage. ...
Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2–3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.
Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.
... To diagnose pyogenic hepatic abscesses, radiological investigations are crucial [4,6,8]. These include contrast-enhanced CT scans and ultrasonography with a sensitivity level of 98% [4,6]. ...
... The percutaneous image-guided drainage of the abscess is an effective safe alternative to surgical technique. This procedure involves percutaneous evacuation with or without catheter insertion [4,8,9]. Typically, the main treatment approach for a liver abscess is percutaneous drainage in conjunction with antimicrobial therapy [1, 4,8]. ...
... This procedure involves percutaneous evacuation with or without catheter insertion [4,8,9]. Typically, the main treatment approach for a liver abscess is percutaneous drainage in conjunction with antimicrobial therapy [1, 4,8]. The minimally invasive procedure in the current case was the ultrasound and fluoroscopic-guided percutaneous transhepatic liver abscess drainage through pigtail placement. ...
... Otro estudio en realizado en Europa encontró que 53,5% de los casos tuvieron un aislamiento microbiológico, siendo el aislado más frecuente E. coli (26,5%), seguido por Streptococcus spp. (13,2%) 22 . Estudios realizados, tanto en Chile como en Colombia, han observado que los microorganismos prevalentes son K. pneumoniae, E. coli y estreptococos 6,13,14 , con una tendencia cada vez mayor de aislamientos de Pseudomonas spp. ...
... La mortalidad asociada a esta patología viene en descenso en las últimas décadas, posiblemente relacionado con el mejoramiento de los estudios imagenológicos, la terapia antimicrobiana, el monitero en cuidado intensivo y las técnicas de drenaje 25 . En este estudio la mortalidad fue de 7,1%, menor a lo reportado en la mayoría de los estudios donde superó el 10% 9,22,26,27 . En relación a la duración en días de la hospitalización, los hallazgos encontrados por nuestro grupo son similares a los reportado en Corea del Sur, con una media de 19,0 ± 12,1 días 20 , mientras que en otro estudio realizado en Qatar la media de hospitalización fue 13,6 ± 8,1 días 28 . ...
Introducción:
El absceso hepático (AH) es el tipo mas común de abscesos viscerales. Se estima que el perfil epidemiológico de esta enfermedad ha cambiado con el aumento de la resistencia de los microorganismos y el uso de nuevos medicamentos.
Objetivo:
Describir las características demográficas y clínicas de los pacientes hospitalizados con diagnóstico de AH en un hospital universitario del suroccidente colombiano.
Métodos:
Se realizó un estudio obser- vacional retrospectivo, en la Fundación Valle del Lili, Cali, Colombia. Se incluyeron pacientes mayores de 18 años con diagnóstico de AH hospitalizados entre 2011-2020.
Resultados:
Se incluyeron 182 pacientes. La mediana de edad fUe 56 años (rango intercuartílico, 45-67) y 62,1% fueron hombres. El microrganismo mas común fue Klebsiella pneumoniae (17,6%). La mayoría requirió drenaje percutáneo (58,2%). El 58,8% tuvo un absceso único y 54,4% fue manejado en cuidados intensivos. El 7,1% de los pacientes falleció. Al comparar los casos que fueron manejados en cuidados intensivos vs. aquellos que no lo fueron, hubo más hepatomegalia (28,3 vs. 11,0%, p = 0,004), derrame pleural derecho (48,5 vs. 28,1%, p = 0,010), cirugía (42,4 vs. 13,4%, p < 0,001), falla terapéutica (22,2 vs. 7,3%, p = 0,007) y muerte (12,1 vs. 1,2%, p = 0,005) en los atendidos en UCI.
Conclusión:
Las Enterobacterales son la principal causa de AH en nuestra población. La mortalidad ha disminuido, pero la hospitalización en cuidados intensivos sigue siendo alta.
... A liver abscess (LA) is a rare condition characterized by the formation of a purulent cavity by microorganisms in the liver [1][2][3][4][5]. LA is classified as bacterial, protozoan (amoebic), or fungal [1][2][3][4][5]. ...
... A liver abscess (LA) is a rare condition characterized by the formation of a purulent cavity by microorganisms in the liver [1][2][3][4][5]. LA is classified as bacterial, protozoan (amoebic), or fungal [1][2][3][4][5]. The most common causes of bacterial (pyogenic) liver abscesses (BLA) are Escherichia coli, Klebsiella spp, Streptococcus anginosus group, Staphylococcus aureus, and anaerobes. ...
... Amebic liver abscesses (ALA) are the most common manifestation of extraintestinal amebiasis caused by Entamoeba histolytica. Fungal pathogens, however, are comparitively rare cause of LA [1][2][3][4][5]. ...
Background
Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients’ demographics, clinical manifestations, diagnosis, management, and outcome.
Methods
We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp.
Results
Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%.
Conclusion
Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
... The etiology of pyogenic liver abscess (PLA) exhibits geographical variation, with Escherichia coli being the predominant organism in North America, Staphylococcus and Streptococcus species in Europe, and Klebsiella spp. in Asia [1]. PLA represents 13% of all intra-abdominal abscesses, with a propensity to occur in the right liver lobe due to its larger size and rich blood supply as compared to other liver segments [2][3][4]. The pathogenesis of PLA is postulated to stem from the introduction of bacteria to the liver during intra-abdominal infection, namely, those involving the biliary tract [3][4][5]. ...
Introduction
Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis.
Case Presentation
We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established.
Conclusion
Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.
... Bệnh lý kèm theo hay gặp là đái tháo đường (28,1%), tăng huyết áp (14,3%), lạm dụng rượu bia (6,6%), sỏi mật (8,7%). Một số nghiên cứu trước đây cũng ghi nhận nam giới là đối tượng hay bị mắc bệnh hơn so với nữ giới, đồng thời bệnh thường gặp ở nhóm bệnh nhân lớn tuổi, đi kèm đó là các bệnh lý như tăng huyết áp, đái tháo đường, sỏi mật… [2], [5], [6]. Điều này phù hợp với đặc điểm của bệnh, áp xe gan thường xuất hiện sau một nhiễm trùng nguyên phát ở ổ bụng hoặc sau khi các tác nhân vi sinh vật xâm nhập vào cơ thể qua đường tiêu hóa; hệ thống miễn dịch suy giảm là một trong những điều kiện thuận lợi giúp bệnh bùng phát và diễn biến nặng nề hơn. ...
... Đặc điểm một số xét nghiệm cận lâm sàng (Bảng 1): Kết quả xét nghiệm công thức máu ghi nhận giảm Hemoglobin xảy ra ở 57,1% bệnh nhân, kết quả này tương đương với nghiên của là Serraino C và cộng sự (2018) là 61,5% [5]; có sự khác biệt so với nghiên cứu của Đào Đức Tiến là 35,4% [7], trong khi tới 70% ở nghiên cứu của Hà Khắc Trung [9]. Một số cơ chế gây thiếu máu có thể giải thích như: Tổn thương tế bào gan gây suy giảm chức năng tạo máu; độc tố của vi khuẩn gây tan huyết; nguyên nhân gây bệnh là Entamoeba histolytica với thể ăn hồng cầu. ...
... Các xét nghiệm đánh giá nhiễm trùng trong nghiên cứu của chúng tôi cho thấy đa số bệnh nhân có bạch cầu tăng 70,9%, tỷ lệ bạch cầu đa nhân trung tính tăng 73%, số lượng bạch cầu ưa acid tăng 26%, trong 57 bệnh nhân được làm xét nghiệm PCT (procalcitonin) thì có tới 98,2% tăng PCT; những kết quả trên phù hợp với bệnh cảnh nhiễm trùng của áp xe gan do các tác nhân gây bệnh như vi khuẩn, kí sinh trùng (sán lá gan, amip…). Nghiên cứu của Serraino C và cộng sự (2018) trên 109 bệnh nhân áp xe gan do vi khuẩn cũng ghi nhận 77% có bạch cầu tăng, 100% có PCT tăng [5]; báo cáo của Đào Đức Tiến (2022): 75% có bạch cầu tăng, tỷ lệ bạch cầu đa nhân trung tính tăng gặp ở 85,4% bệnh nhân, 26/26 (100%) bệnh nhân có xét nghiệm PCT tăng trên ngưỡng bình thường [7]. Trong nghiên cứu của chúng tôi, một số chỉ số xét nghiệm sinh hóa máu như enzym AST tăng chiếm 50,5%; ALT tăng chiếm 54,1%, bilirubin toàn phần tăng chiếm 38,3% bệnh nhân; enzym gan tăng là hậu quả của tổn thương hoại tử tế bào gan, kèm theo đó có thể dẫn tới tình trạng suy giảm chức năng gan. ...
Mục tiêu: Mô tả đặc điểm lâm sàng, cận lâm sàng và vi sinh vật học ở bệnh nhân áp xe gan tại bệnh viện Trung ương Quân đội 108. Đối tượng và phương pháp: Nghiên cứu hồi cứu, mô tả cắt ngang trên 196 bệnh nhân áp xe gan được điều trị tại Bệnh viện Trung ương Quân đội 108 trong thời gian từ tháng 01/2018 đến tháng 8/2023. Kết quả: Tuổi trung bình trong nghiên cứu là 57,8 ± 16,0; tỉ lệ nam/nữ là 3,1/1. Bệnh kèm theo thường gặp là đái tháo đường (28,1%), tăng huyết áp (14,3%), sỏi mật (7,8%). Yếu tố nguy cơ dịch tễ trong quần thể nghiên cứu: Không tẩy giun định kỳ (99%), ăn rau sống (49%), ăn gỏi sống (44,9%). Tam chứng Fontan điển hình gặp ở 26% số bệnh nhân. Bên cạnh đó, trong 196 bệnh nhân, 57,15% có thiếu máu, 70,9% có tăng số lượng bạch cầu (trong đó tăng tỷ lệ bạch cầu đa nhân trung tính 73% và số lượng bạch cầu ưa acid tăng 26,0%); 56/57 bệnh nhân (98,2%) có tăng procalcitonin. Ổ áp xe được phát hiện bằng chẩn đoán hình ảnh: Chủ yếu gan phải (74,0%), một ổ đơn độc (82,6%), kích thước trung bình là 63,3 ± 29,1, ổ lớn nhất có kích thước 172mm. Có 63 bệnh nhân phân lập mọc vi khuẩn, trong đó Klebsiella chiếm tỉ lệ cao nhất (80,9%), E. coli (7,9%). Kết luận: Áp xe gan là bệnh lý nhiễm khuẩn cấp tính, thường gặp ở đối tượng cao tuổi, có bệnh nền, nam giới, có liên quan trực tiếp tới thói quen sinh hoạt không hợp vệ sinh. Nguyên nhân chủ yếu do vi khuẩn Gram âm; Và chẩn đoán hình ảnh là phương tiện chẩn đoán hữu hiệu.
... A pyogenic liver abscess (PLA) is an infrequent but potentially lifethreatening condition characterized by the formation of spaceoccupying lesions within the liver parenchyma [1]. It carries a significant morbidity and a mortality rate of 6.13 % of all the affected cases [1]. ...
... A pyogenic liver abscess (PLA) is an infrequent but potentially lifethreatening condition characterized by the formation of spaceoccupying lesions within the liver parenchyma [1]. It carries a significant morbidity and a mortality rate of 6.13 % of all the affected cases [1]. The prevalence of liver abscesses is estimated to be approximately 2.3 cases per 100,000 people annually, with higher rates observed in men than women (3.3 versus 1.3 per 100,000) [2]. ...
... The prevalence of liver abscesses is estimated to be approximately 2.3 cases per 100,000 people annually, with higher rates observed in men than women (3.3 versus 1.3 per 100,000) [2]. With the emergence of antibiotics, biliary tract diseases have become the most common predisposing factor, accounting for approximately 40 % of cases [1]. ...
Introduction and importance
Pyogenic liver abscess (PLA) is a potentially life-threatening condition characterized by the formation of space-occupying lesions within the liver parenchyma. Despite advancements in diagnostic imaging and antibiotic therapies, complications such as biliary fistula formation can arise, posing challenges in management.
Case presentation
This case study presents a 23-year-old male patient with PLA complicated by a biliary fistula. Diagnostic imaging via CT scan and MRI confirmed a liver abscess and biliary dilation. The patient underwent a second drainage for ascitic fluid following the initial percutaneous liver catheter drainage.
Clinical discussion
The patient responded positively to the treatment, with reduced abscess size and fistula resolution. While endoscopic interventions offer promising results, their limited availability necessitates alternative treatment strategies, such as percutaneous drainage and appropriate antibiotics.
Conclusion
This case emphasises the importance of individualized management approaches for PLA complicated by biliary fistulas. Despite the challenges, successful outcomes can be achieved through careful management and appropriate treatment strategies.
... The clinical findings are often associated with the elevation of the inflammatory indexes -such as WBC count and WBCs type percentage alteration, CRP, ESR, fibrinogen and PCT -and the elevation of hepatic indexes such as bilirubin and transaminases. Moreover, the diagnostic hypothesis is often supported by the presence of predisposing conditions of abscess formation, such as biliopancreatic pathologies present in 35.2% of the cases, despite the increasing number of cryptogenic lesions that in our study rises the 22.3% of the cases similarly to the case series presented by Serraino et al. [19]. ...
Background: Pyogenic hepatic abscess (PHA) is an uncommon infectious disease of the liver that should represents a life-threatening condition if not correctly diagnosed and managed. Nowadays there are not precise indications and clear evidences on the best therapeutic approach and on the superiority of a treatment. Methods: Patients with diagnosis of PHA admitted at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and December 2022 were identified in a prospective database. Among the demographic, epidemiological and clinical data collected we included the therapeutic choices – antibiotic treatment, image guided percutaneous drainage and surgical operation – and their effect in terms of healing time, treatment failure and time of hospitalization. Results: Patients with single abscesses treated with antibiotics have significant high healing time (p=0.0001) and in-hospital time (p=0.0001) and no differences in treatment failure than patients treated with invasive techniques. Patients that underwent surgical operation have significant higher healing time than percutaneous group (p=0.002) such as higher mean hospital stay (p=0.03 for abscesses <5 cm and p=0.02 for abscesses larger than 5 cm). The last, the percutaneous approach shows a failure rate significantly higher than the surgical procedure (p=0.009 for abscesses <5 cm and p=0.001 for abscesses larger than 5 cm). Conclusions: The study proposed showed the antibiotic therapy is the first line treatment and should first empirically and then directly modified on specimen culture results. Image guided percutaneous drainage should be considered when the antibiotic therapy alone is not sufficient or as bridge to surgery if surgical indications are proven.
... After percutaneous drainage fails or in patients with primary illnesses, including biliary PLA, abscess rupture, and so forth [26], an open surgical drainage of a liver abscess is recommended. A few benefits of surgical drainage include placement precision and concomitant abscess and primary illness treatment [28,29]. According to current guidelines, liver abscesses smaller than 3 cm can be managed conservatively [30]. ...
Background: Treatment for liver abscess, a major source of intra-abdominal infection, depends on how it presents. Over time, the method of treating PLA has changed, moving from open surgical drainage to percutaneous drainage assisted by imaging. Objectives: This systematic review aims to investigate the efficacy of surgical approaches to manage liver abscesses. Methods: PubMed, SCOPUS, Web of Science, and Science Direct, were systematically searched to include the relevant literature. Rayyan QRCI was used throughout this systematic approach. Results & interpretation: included nine studies with a total of 632 patients. Antibiotics and/ or US or CT-guided PNA are the first line of treatment to manage liver abscesses. However, the relatively few individuals in whom aspiration was impossible because of thick pus, a septated or loculated abscess, or an abscess that had ruptured in any body cavity were indications for open or laparoscopic surgery. Additionally, we demonstrated that successful surgical procedures were linked to a significant decrease in mortality and a shorter hospital stay in patients with ruptured ALA. Only generalized peritonitis or further infections refractory to non-surgical treatment necessitate surgery. Additional randomized controlled studies involving a suitable patient population should be conducted to raise the level of evidence.
