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Liver Abscess: The Need for Complete Gastrointestinal Evaluation

Liver Abscess: The Need for Complete Gastrointestinal Evaluation Abstract • The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation. (Arch Surg. 1989;124:561-564) References 1. Gyorffy EJ, Frey CF, Silva J Jr, McGahan J. Pyogenic liver abscess: diagnostic and therapeutic strategies . Ann Surg . 1987;206:699-705.Crossref 2. Bertel CK, van Heerden JA, Sheedy PF II. Treatment of pyogenic hepatic abscesses: surgical vs percutaneous drainage . Arch Surg . 1986;121:554-558.Crossref 3. Falk KA, Angerås UJ, Friman VZ, Gamklov GR, Lukes PJ. Pyogenic liver abscesses: have changes in management improved the outcome? Acta Chir Scand . 1987;153:661-664. 4. Miedema BW, Dineen P. The diagnosis and treatment of pyogenic liver abscesses . Ann Surg . 1984;200:328-335.Crossref 5. McDonald MI, Corey GR, Gallis HA, Durack DT. Single and multiple pyogenic liver abscesses: natural history, diagnosis and treatment, with emphasis on percutaneous drainage . Medicine . 1984;63:291-302.Crossref 6. Pitt HA, Zuidema GD. Factors influencing mortality in the treatment of pyogenic hepatic abscess . Surg Gynecol Obstet . 1975;140:228-234. 7. Kandel G, Marcon NE. Pyogenic liver abscess: new concepts of an old disease . Am J Gastroenterol . 1984;79:65-71. 8. Ochsner A, DeBakey M, Murray S. Pyogenic abscess of the liver: analysis of 47 cases with review of literature . Am J Surg . 1938;40:292-319.Crossref 9. Crass JR. Liver abscess as a complication of regional enteritis: interventional considerations . Am J Gastroenterol . 1983;78:747-749. 10. Herbert DA, Fogel DA, Rothman J, Wilson S, Simmons F, Ruskin J. Pyogenic liver abscesses: successful non-surgical therapy . Lancet . 1982;16:134-136.Crossref 11. Maher JA Jr, Reynolds TB, Yellin AE. Successful medical treatment of pyogenic liver abscess . Gastroenterology . 1979;77:618-622. 12. Bergamini TM, Larson GM, Malangoni MA, Richardson JD. Liver abscess: review of a 12-year experience . Am Surg . 1987;53:596-599. 13. Cheung NK, Malfitan RC, Najem AZ, Rush BF Jr. Pyogenic liver abscess . Am Surg . 1978;44:272-278. 14. McFadzean AJS, Chang KPS, Wong CC. Solitary pyogenic abscess of liver treated by closed aspiration and antibiotics: a report of 14 consecutive cases with recovery . Br J Surg . 1953;41:141-152.Crossref 15. Karlson KB, Martin EC, Fankuchen EI, Schultz RW, Casarella WJ. Percutaneous abscess drainage . Surg Gynecol Obstet . 1982;154:44-48. 16. Johnson RD, Mueller PR, Ferrucci JT Jr, et al. Percutaneous drainage of pyogenic liver abscesses . AJR . 1985;144:463-467.Crossref 17. Gerzof SG, Johnson WC, Robbins AH, Nasbeth DC. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage . Am J Surg . 1985;149:487-494.Crossref 18. Gray R, Leekam R, Mackenzie R, St Lovis EL, Grosman H. Percutaneous abscess drainage . Gastrointest Radiol . 1985;10:79-84.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Liver Abscess: The Need for Complete Gastrointestinal Evaluation

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410050051009
Publisher site
See Article on Publisher Site

Abstract

Abstract • The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation. (Arch Surg. 1989;124:561-564) References 1. Gyorffy EJ, Frey CF, Silva J Jr, McGahan J. Pyogenic liver abscess: diagnostic and therapeutic strategies . Ann Surg . 1987;206:699-705.Crossref 2. Bertel CK, van Heerden JA, Sheedy PF II. Treatment of pyogenic hepatic abscesses: surgical vs percutaneous drainage . Arch Surg . 1986;121:554-558.Crossref 3. Falk KA, Angerås UJ, Friman VZ, Gamklov GR, Lukes PJ. Pyogenic liver abscesses: have changes in management improved the outcome? Acta Chir Scand . 1987;153:661-664. 4. Miedema BW, Dineen P. The diagnosis and treatment of pyogenic liver abscesses . Ann Surg . 1984;200:328-335.Crossref 5. McDonald MI, Corey GR, Gallis HA, Durack DT. Single and multiple pyogenic liver abscesses: natural history, diagnosis and treatment, with emphasis on percutaneous drainage . Medicine . 1984;63:291-302.Crossref 6. Pitt HA, Zuidema GD. Factors influencing mortality in the treatment of pyogenic hepatic abscess . Surg Gynecol Obstet . 1975;140:228-234. 7. Kandel G, Marcon NE. Pyogenic liver abscess: new concepts of an old disease . Am J Gastroenterol . 1984;79:65-71. 8. Ochsner A, DeBakey M, Murray S. Pyogenic abscess of the liver: analysis of 47 cases with review of literature . Am J Surg . 1938;40:292-319.Crossref 9. Crass JR. Liver abscess as a complication of regional enteritis: interventional considerations . Am J Gastroenterol . 1983;78:747-749. 10. Herbert DA, Fogel DA, Rothman J, Wilson S, Simmons F, Ruskin J. Pyogenic liver abscesses: successful non-surgical therapy . Lancet . 1982;16:134-136.Crossref 11. Maher JA Jr, Reynolds TB, Yellin AE. Successful medical treatment of pyogenic liver abscess . Gastroenterology . 1979;77:618-622. 12. Bergamini TM, Larson GM, Malangoni MA, Richardson JD. Liver abscess: review of a 12-year experience . Am Surg . 1987;53:596-599. 13. Cheung NK, Malfitan RC, Najem AZ, Rush BF Jr. Pyogenic liver abscess . Am Surg . 1978;44:272-278. 14. McFadzean AJS, Chang KPS, Wong CC. Solitary pyogenic abscess of liver treated by closed aspiration and antibiotics: a report of 14 consecutive cases with recovery . Br J Surg . 1953;41:141-152.Crossref 15. Karlson KB, Martin EC, Fankuchen EI, Schultz RW, Casarella WJ. Percutaneous abscess drainage . Surg Gynecol Obstet . 1982;154:44-48. 16. Johnson RD, Mueller PR, Ferrucci JT Jr, et al. Percutaneous drainage of pyogenic liver abscesses . AJR . 1985;144:463-467.Crossref 17. Gerzof SG, Johnson WC, Robbins AH, Nasbeth DC. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage . Am J Surg . 1985;149:487-494.Crossref 18. Gray R, Leekam R, Mackenzie R, St Lovis EL, Grosman H. Percutaneous abscess drainage . Gastrointest Radiol . 1985;10:79-84.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1989

References