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Pyogenic liver abscess: Studies of therapy and analysis of risk factors

  • Société International de Chirurgie-Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993
  • Published:
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Abstract

Experience with 46 patients diagnosed with liver abscesses over a 13-year period was reviewed to ascertain the impact of percutaneous versus surgical drainage. In most of the cases the abscesses were liagnosed by sonography or computed tomography. The most common pathogenetic mechanism was ascending biliary tract infection. Of the 46 total patients, 27 were primarily treated surgically, whereas 19 underwent percutaneous drainage. In the surgical group five (18.5%) patients required reoperation. Percutaneous drainage failed in four patients (21.1%). Multivariate stepwise logistic regression analysis revealed that a high APACHE II score, low hemoglobin level, and high serum bilirubin level were significant predictors of a complicated clinical course. Death was related more closely to the overall condition of the patient, as expressed by a high APACHE II score, and the underlying disease (malignancy) than to the mode of therapy.

Résumé

Pendant une période d'observation de 13 ans, nous avons comparé nos résultats après drainage percutané ou après drainage chirurgical chez 46 patients ayant eu un abcès du foie. Dans la majorité des cas, les abcès ont été diagnostiqués par l'échographie et/ou la tomodensitométrie. La cause la plus fréquente a été l'infection biliaire ascendante. Parmi les 46 patients, au total, 27 ont été traités chirurgicalement alors que 19 ont eu un drainage

Resumen

Se revisó la experiencia en 46 pacientes con el diagnóstico de absceso hepático manejados en el curso de 13 años, con el objeto de definir el impacto del drenaje percutáneo versus el drenaje quirúrgico. En la mayoría de los casos los abscesos fueron diagnosticados por sonografia y/o escanografia computadorizada. El mecanismo patogénico más común fue la infección biliar ascendente. Del total de 46 pacientes, 27 fueron tratados primordialmente por drenaje quirúrgico, en tanto que 19 fueron sometidos a drenaje percutáneo. En el Grupo quirúrgico hubo 5 pacientes (18.5%) que requirieron reoperación, en tanto que el drenaje percutáneo falló en 4 pacientes (21%). El análisis multivariable reveló que un alto indice APACHE II y un bajo nivel de hemoglobina, junto con un alto nivel de bilirrubina, fueron factores significativos de pronóstico en relación a una evolución clínica complicada. La mortalidad apareció más íntimamente relacionada con la condición general del paciente expresada según un alto índice APACHE II y una enfermedad subyacente (neoplasia maligna), que con la modalidad terapéutica.

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Authors and Affiliations

  1. Department of Surgery, Karl-Franzens University, School of Medicine, Auenbruggerplatz 29, A 8036, Graz, Austria

    Haus-Jörg Mischinger M.D., Hubert Hauser M.D., Hans Rabl M.D., Georg Werkgartner M.D. & Randy Rubin Ph.D.

  2. Institute for Medical Informatics and Statistics, Karl-Franzens University, School of Medicine, Auenbruggerplatz 29, A 8036, Graz, Austria

    Franz Quehenberger Ph.D.

  3. Department of Radiology, Karl-Franzens University, School of Medicine, Auenbruggerplatz 29, A 8036, Graz, Austria

    Ernst Due M.D.

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  1. Haus-Jörg Mischinger M.D.
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Mischinger, HJ., Hauser, H., Rabl, H. et al. Pyogenic liver abscess: Studies of therapy and analysis of risk factors. World J. Surg. 18, 852–857 (1994). https://doi.org/10.1007/BF00299085

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