Liver Abscess

 

• Pyogenic abscess, accounts for 80% of abscess.
• Amebic abscess due to Entamoeba histolytica, accounts for 10%.
• Fungal abscess, accounts for < 10%.
• 50% of solitary liver abscesses occur in the right Liver lobe.
• Right hepatic lobe (~75%), less commonly left (20%) or caudate (5%) lobes.
• Pyogenic abscesses are usually polymicrobial.
• 50% of the bacterial cases develop by cholangitis. 
• Pyogenic Abscess- initial manifestation of an occult intra‐abdominal malignancy (up to 15%).
• Positive blood cultures in up to 50%.
• Most common organisms: E. coli, Klebsiella, Streptococcus, Staphylococcus, & anaerobes.
• K pneumoniae thought to be associated with colorectal cancer.
• Fever in 90% & abdominal pain in about 50-75%.
• In-hospital mortality estimated at 2.5% -19%

       Drainage of the abscess & antibiotic treatment are the cornerstones of treatment.

• Antibiotic Therapy: 

        If the size of the abscess < 3-5 cm
        Oral antibiotics are given after intravenous antibiotics are first administered. 

• Percutaneous Drainage: 

         Abscess > 5 cm
         Continuous fever despite 48-72 hours of ABX therapy
         Indications that the abscess may rupture
         U/S or CT-guided aspiration & drainage- first-line treatment. 

• Surgery:

          Where percutaneous drainage is impractical.
          When there are complications like rupture or numerous abscesses. 
          Open surgery or laparoscopic surgery.