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The Comparison of Clinical Course and Results of Treatment Between Gas-Forming and Non–Gas-Forming Pyogenic Liver Abscess

The Comparison of Clinical Course and Results of Treatment Between Gas-Forming and... Abstract Objectives: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. Design: Case series. Setting: Both primary and referral hospital care. Patients: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non–gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. Main Outcome Measures: A χ2 test for qualitative data and Student's t test for quantitative data. Results: Duration of symptoms were shorter (mean±SD, 5.2±5.3 vs 7.6±10 days) (P<.005) and the incidence of septic shock was higher in the gas-forming than in the non—gas-forming group (32.5% vs 11.7%) (P<.01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (>5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non–gas-forming group (27.7% vs 14.4%) (P<.01). Conclusions: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.(Arch Surg. 1995;130:401-405) References 1. Pitt HA. Surgical management of hepatic abscess . World J Surg . 1990;14: 498-504.Crossref 2. Halvorsen RA Jr, Foster WL Jr, Wilkinson RH Jr, Silverman PM, Thomposon WH. Hepatic abscess . Gastrointest Radiol . 1988;13:135-141.Crossref 3. Rubinson HA, Isikoff MB, Hill MC. Diagnostic imaging of hepatic abscess: a retrospective analysis . AJR Am J Roentgenol . 1980;135:735-740.Crossref 4. Elson MW. Antemortem radiographic demonstration of gas gangrence of the liver . Radiology . 1960;74:57-60.Crossref 5. Foster SC, Schenider B, Seaman WB. Gas-containing pyogenic liver abscess . Radiology . 1970;94:613-618.Crossref 6. Kahn SP, Lindenauer M, Wojtalik RS, Hildreth D. Clostridia hepatic abscess . Arch Surg . 1972;104:209-212.Crossref 7. Beetlestone CA, Bohrer SP. Right upper quadrant gas shadow . JAMA . 1976; 236:1397-1398.Crossref 8. Kanner R, Weinfeld A, Tedesco FJ. The radiology corner . Am J Gastroenterol . 1979;71:432-437. 9. Salky BA, Kaynon A, Baner JJ, Gelernt IM, Kreel I. Ruptured hepatic abscess . Am J Gastroenterol . 1987;77:880-881. 10. Hayashi Y, Uchiyama M, Inokuma T, Torisu M. Gas-containing pyogenic liver abscess: a case report and review of the literature . Jpn J Surg . 1989;19:74-77.Crossref 11. Yang CC, Chen CY, Lin XZ, Chang TT, Shin JS, Lin CY. Pyogenic liver abscess in Taiwan . Am J Gastroenterol . 1993;88:1911-1915. 12. Lee TY, Wan YL, Tsai CC. Gas-forming liver abscess: radiological fingings and clinical significance . Abdom Imaging . 1994;19;47-52. 13. Smith RS. Pyogenic liver abscess in the aged . Am J Surg . 1944;63:206-213.Crossref 14. McDonald Ml, Corey GR, Gallis HA, Durack DT. Single and multiple pyogenic liver abscess . Medicine . 1984;63:291-302.Crossref 15. Chiu CT, Lin DY, Wu CS, Chang-Chien CS, Sheen IS, Liaw YF. A clinical study on pyogenic liver abscess . J Formos Med Assoc . 1987;86:405-412. 16. Huang JJ, Chen KW, Ruaan MK. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection . J Urol . 1991;146:148-151. 17. Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesion of pyogenic liver abscess . Arch Intern Med . 1991;151:1557-1559.Crossref 18. Lee KT, Sheen PC, Chen JS, Ker CG. Pyogenic liver abscess: mutivariate analysis of risk factors . World J Surg . 1991;15:372-377.Crossref 19. Cheng DL, Liu YC, Yen MY, Liu CY, Shi FW, Wang LS. Pyogenic liver abscess . J Formos Med Assoc . 1990;89:571-576. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Comparison of Clinical Course and Results of Treatment Between Gas-Forming and Non–Gas-Forming Pyogenic Liver Abscess

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430040063012
Publisher site
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Abstract

Abstract Objectives: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. Design: Case series. Setting: Both primary and referral hospital care. Patients: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non–gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. Main Outcome Measures: A χ2 test for qualitative data and Student's t test for quantitative data. Results: Duration of symptoms were shorter (mean±SD, 5.2±5.3 vs 7.6±10 days) (P<.005) and the incidence of septic shock was higher in the gas-forming than in the non—gas-forming group (32.5% vs 11.7%) (P<.01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (>5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non–gas-forming group (27.7% vs 14.4%) (P<.01). Conclusions: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.(Arch Surg. 1995;130:401-405) References 1. Pitt HA. Surgical management of hepatic abscess . World J Surg . 1990;14: 498-504.Crossref 2. Halvorsen RA Jr, Foster WL Jr, Wilkinson RH Jr, Silverman PM, Thomposon WH. Hepatic abscess . Gastrointest Radiol . 1988;13:135-141.Crossref 3. Rubinson HA, Isikoff MB, Hill MC. Diagnostic imaging of hepatic abscess: a retrospective analysis . AJR Am J Roentgenol . 1980;135:735-740.Crossref 4. Elson MW. Antemortem radiographic demonstration of gas gangrence of the liver . Radiology . 1960;74:57-60.Crossref 5. Foster SC, Schenider B, Seaman WB. Gas-containing pyogenic liver abscess . Radiology . 1970;94:613-618.Crossref 6. Kahn SP, Lindenauer M, Wojtalik RS, Hildreth D. Clostridia hepatic abscess . Arch Surg . 1972;104:209-212.Crossref 7. Beetlestone CA, Bohrer SP. Right upper quadrant gas shadow . JAMA . 1976; 236:1397-1398.Crossref 8. Kanner R, Weinfeld A, Tedesco FJ. The radiology corner . Am J Gastroenterol . 1979;71:432-437. 9. Salky BA, Kaynon A, Baner JJ, Gelernt IM, Kreel I. Ruptured hepatic abscess . Am J Gastroenterol . 1987;77:880-881. 10. Hayashi Y, Uchiyama M, Inokuma T, Torisu M. Gas-containing pyogenic liver abscess: a case report and review of the literature . Jpn J Surg . 1989;19:74-77.Crossref 11. Yang CC, Chen CY, Lin XZ, Chang TT, Shin JS, Lin CY. Pyogenic liver abscess in Taiwan . Am J Gastroenterol . 1993;88:1911-1915. 12. Lee TY, Wan YL, Tsai CC. Gas-forming liver abscess: radiological fingings and clinical significance . Abdom Imaging . 1994;19;47-52. 13. Smith RS. Pyogenic liver abscess in the aged . Am J Surg . 1944;63:206-213.Crossref 14. McDonald Ml, Corey GR, Gallis HA, Durack DT. Single and multiple pyogenic liver abscess . Medicine . 1984;63:291-302.Crossref 15. Chiu CT, Lin DY, Wu CS, Chang-Chien CS, Sheen IS, Liaw YF. A clinical study on pyogenic liver abscess . J Formos Med Assoc . 1987;86:405-412. 16. Huang JJ, Chen KW, Ruaan MK. Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection . J Urol . 1991;146:148-151. 17. Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesion of pyogenic liver abscess . Arch Intern Med . 1991;151:1557-1559.Crossref 18. Lee KT, Sheen PC, Chen JS, Ker CG. Pyogenic liver abscess: mutivariate analysis of risk factors . World J Surg . 1991;15:372-377.Crossref 19. Cheng DL, Liu YC, Yen MY, Liu CY, Shi FW, Wang LS. Pyogenic liver abscess . J Formos Med Assoc . 1990;89:571-576.

Journal

Archives of Surgery – American Medical Association

Published: Apr 1, 1995

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