PYOGENIC LIVER ABSCESS: REVIEW OF 54 CASES

Historically open surgical drainage has been the treatment of choice for pyogenic liver abscess. The records of 54 patients with pyogenic liver abscess were reviewed to determine whether earlier diagnosis with current imaging tests and definitive treatment with antibiotics and aspiration drainage was an effective alternative to surgery. The clinical features, laboratory tests, imaging, and microbiologic findings, management strategy and final outcome were studied. Twenty-nine patients were treated with broad-spectrum antibiotics and diagnostic aspiration. Twenty-three (79%) recovered uneventfully, and six required catheter or operative drainage. Twenty-three patients (including five who failed aspiration) underwent drainage with percutaneusly placed catheters. Nineteen (83%) recovered, four required open drainage, and of seven patients who required open drainage, six recovered. One (2%) of the 54 patients died following failed aspiration and catheter and surgical drainage. Four patients were successfully treated with antibiotics alone without aspiration. This study confirms that pyogenic liver abscess can be successfully treated with broad spectrum antibiotics and aspiration or percutaneous catheter drainage. Open surgical drainage is reserved for patients in whom treatment fails or who require celiotomy for concurrent disease.