REVIEW OF PYOGENIC LIVER-ABSCESS AT THE ROYAL-ADELAIDE-HOSPITAL 1980-1987

Pyogenic liver abscess is an uncommon condition which carries substantial morbidity and mortality if untreated. A review was undertaken of 31 patients who were admitted to the Royal Adelaide Hospital (RAH) between January 1980 and December 1987 and who were diagnosed as having pyogenic liver abscess. The aims of the study were to review the aetiology, current methods of investigation and treatment of the disease, and to formulate a management plan based on the findings. Hypoalbuminaemia, leukocytosis and elevated alkaline phosphatase were the most common findings. Hyperbilirubinaemia was not a usual feature. Computerised tomography (CT) scanning and ultrasound were the most useful imaging modalities in identification of the abscess. The sensitivity of CT scanning in evaluating the size of abscesses was lower than anticipated and this may lead to a higher than necessary rate of surgical drainage. A case is presented to illustrate this. Most abscesses were secondary and frequently due to extension of infection from biliary structures. Diseases causing diminished resistance to bacterial infection had a significant role in the pathogenesis. The overall mortality rate was 25%. Risk factors increasing mortality included advanced age, multiplicity of abscesses, depressed immune status and the presence of complications due to the abscess. Of patients who survived, four were treated with antibiotics alone. eleven with percutaneous drainage and antibiotics, and eight with surgery and antibiotics. We conclude that patients with hepatic abscesses should be managed initially by CT or ultrasound‐guided aspiration. If pus is obtained a percutaneous drain should be inserted into the cavity and systemic antibiotics administered. If serosanguineous fluid only is obtained this may indicate oedema around a small abscess (or inflammatory focus) and may be treated with systemic antibiotics only. Surgical drainage should be reserved for cases in which improvement does not occur with aspiration or percutaneous drainage and appropriate systemic antibiotics. Copyright © 1990, Wiley Blackwell. All rights reserved