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Pyogenic liver abscess

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Abstract

Experience with 34 patients with pyogenic liver abscess is reviewed to evaluate the impact of percutaneous drainage and duration of antibiotic therapy on results of treatment. Patients with shock, adult respiratory distress syndrome, disseminated intravascular coagulation, jaundice, severe hypoalbuminemia, and diabetes had a poor prognosis. Percutaneous drainage was used successfully in 4 of 6 patients, but its use did not affect mortality rate or length of hospital stay. Percutaneous drainage may be the procedure of choice for selected patients. Half of our patients received antibiotics for 2 weeks or less with no abscess recurrences in this group. Long-term antibiotics may not be necessary after adequate surgical or percutaneous abscess drainage.

Résumé

Nous avons analysé notre expérience des abcès hépatiques pyogènes pour déterminer l'influence du drainage percutané et de la durée de l'antibiothérapie sur les résultats du traitement. On observait un mauvais pronostic chez les patients ayant eu un choc, un syndrome de détresse respiratoire de l'adulte, une coagulopathie vasculaire disséminée, un ictère, une hypoalbuminémie et/ou un diabète. Le drainage percutané a été utilisé avec succès chez 4 des 6 patients mais n'a influencé ni la mortalité ni la durée d'hospitalisation. Le drainage percutané a été le procédé de choix chez un groupe de patients sélectionnés. La moitié des patients avaient reçu des antibiotiques 2 semaines ou moins sans récidive. Une utilisation prolongée des antibiotiques n'est pas nécessaire si l'abcès a été correctement drainé chirurgicalement ou par voie percutanée.

Resumen

Se revisó la experiencia con treinta y cuatro pacientes con absceso piogénico del hígado con el fin de evaluar el impacto del drenaje percutáneo y la duración de la terapia antibiótica sobre los resultados del tratamiento. Los pacientes con shock, síndrome de dificultad respiratoria del adulto, coagulación diseminada intravascular, ictericia, hipoalbuminemia severa, y diabetes exhibieron un mal pronóstico. El drenaje percutáneo fue utilizado exitosamente en 4 de 6 pacientes pero su uso no modificó la tasa de mortalidad ni la duración de la hospitalización. El drenaje percutáneo puede ser el procedimiento de elecctión en casos seleccionados. La mitad de nuestros pacientes recibió antibióticos por 2 semanas o menos, sin que se presentara recurrencia del absceso. La antibioticoterapia a largo plazo puede ser innecesaria una vez realizado un adecuado drenaje, quirúrgico o percutáneo, del absceso.

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Authors and Affiliations

  1. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

    E. Diane Bowers M.D., Dennis J. Robison M.D. & Raymond C. Doberneck M.D., Ph.D.

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  1. E. Diane Bowers M.D.
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  2. Dennis J. Robison M.D.
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  3. Raymond C. Doberneck M.D., Ph.D.
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Bowers, E.D., Robison, D.J. & Doberneck, R.C. Pyogenic liver abscess. World J. Surg. 14, 128–132 (1990). https://doi.org/10.1007/BF01670563

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