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Open Access Highly Accessed Research article

Modern management of pyogenic hepatic abscess: a case series and review of the literature

Helen M Heneghan12*, Nuala A Healy12, Sean T Martin1, Ronan S Ryan3, Niamh Nolan4, Oscar Traynor5 and Ronan Waldron1

Author Affiliations

1 Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland

2 Department of Surgery, National University of Ireland, Galway, Ireland

3 Department of Radiology, Mayo General Hospital, Castlebar, Mayo, Ireland

4 Department of Histopathology, St.Vincent's University Hospital, Dublin, Ireland

5 Liver Unit, St. Vincent's University Hospital, Dublin, Ireland

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BMC Research Notes 2011, 4:80  doi:10.1186/1756-0500-4-80

Published: 24 March 2011

Abstract

Background

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 literature in this field, and propose guidelines to aid in the current management of this complex disease.

Methods

Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.

Results

Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.

Conclusions

Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.