Abstract • 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, aspiration, or catheter drainage was an effective alternative to open drainage. 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 percutaneously placed catheters. Nineteen (83%) recovered; four required open surgical drainage. Of seven patients who required open surgical 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. These results confirm 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. (Arch Surg. 1991;126:991-996) References 1. Ochsner A, Debakey M, Murray S. Pyogenic liver abscess, II: an analysis of 47 cases with review of the literature . Am J Surg . 1938;40:292-319.Crossref 2. Bertel CK, Van Heerden JA, Sheedy PF. Treatment of pyogenic hepatic abscesses: surgical vs percutaneous drainage . Arch Surg . 1986;121:554-558.Crossref 3. Klatchko BA, Schwartz SI. Diagnostic and therapeutic approaches to pyogenic abscess of the liver . Surg Gynecol Obstet . 1989;168:332-336. 4. Gyorffey EJ, Frey CF, Silva J, McGahan J. Pyogenic liver abscess: diagnostic and therapeutic strategies . Ann Surg . 1987;206:699-705.Crossref 5. Bergamini TM, Larson GM, Malangoni MA, Richardson JD. Liver abscess: review of a 12-year experience . Am Surg . 1987;53:596-599. 6. Barnes PF, DeCock KM, Reynolds TN, Ralls PW. A comparison of amebic and pyogenic abscesses of the liver . Medicine . 1987;66:472-483.Crossref 7. Cohen JL, Martin FM, Rossi RL, Schoetz DJ. Liver abscess: the need for complete gastrointestinal evaluation . Arch Surg . 1989;124:561-564.Crossref 8. Juniper K Jr, Worrell CL, Minshew MC, Roth LS, Cypert H, Lloyd RE. Serologic diagnosis of amebiasis . Am J Trop Med Hyg . 1972;21:157-168. 9. Ralls PW, Barnes PF, Radin DR, Colletti PM, Halls J. Sonographic features of amebic and pyogenic liver abscesses: a blinded comparison . Am J Rad . 1987;149:499-501. 10. Ochsner A, Debakey M. Amebic hepatitis and hepatic abscess . Surgery . 1943;13:460-612. 11. McFadzean AJS, Chang KPS, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics: a report of 14 consecutive cases of recovery . Br J Surg . 1953;41:141-152.Crossref 12. England RA, England MJ. Hong Kong an elective . Boston Med Q . 1964; 15:64-69. 13. Pitt. HA. Surgical management of hepatic abscesses . World J Surg . 1990;14:498-504.Crossref 14. Gerzof SG, Johnson WC, Robbins AH, Nasbeth DC. Intrahepatic pyogenic abscess treatment by percutaneous drainage . Am J Surg . 1985;149:487-494.Crossref 15. Wong KP. Percutaneous drainage of pyogenic liver abscesses . World J Surg . 1990;14:492-497.Crossref 16. Donovan AJ, Yellin AE, Ralls PW. Hepatic abscess . World J Surg . 1991;15:162-169.Crossref 17. Maher JA, Reynolds TB, Yellin AE. Successful medical treatment of pyogenic liver abscess . Gastroenterology . 1979;77:618-622.
Archives of Surgery – American Medical Association
Published: Aug 1, 1991