Presentation and Management of Pyogenic Liver Abscess in Surgery Department: About 34 Cases

Abstract

AIM: To describe the clinical features, imaging findings, bacteriologic profile, etiology, treatment and outcome in patients presenting pyogenic liver abscess in a Tunisian hospital. METHODES: We report, in a retrospective study, 34 cases of pyogenic liver abscess that were hospitalized between January, 1st 2004 and December, 31st 2013. RESULTS: Thirty-four cases (19 males, 15 females) were found. The mean age was 64 years. The most significant clinical features of pyogenic liver abscess were upper abdominal pain with high grade fever and hepatomegaly. Thirty-one patients were investigated by CT scan, which showed a positive diagnosis in 100% of cases, 82.4% of liver abscesses were found in the right lobe of liver and were solitary in 79.4% of cases. The most causative germs, were isolated in pus culture, were Escherichia coli and Klebsiella. The most common etiologies were biliary and cryptogenic origin; portal pyemia and hematogenous origin were also found. All of patient had received intravenous antibiotic therapy (cephalosporin or fluoroquinolones combination with metronidazole and aminoglycoside) but only two patients were healed by this regime. The mean duration of intravenous antibiotic therapy was 15.5 days. The percutaneous drainage was performed in 50% (n=17) of cases and was successfully in about 70% of cases. Surgery was performed in 58.82% (n=20) of cases. Six patients had only surgical drainage of abscess and the other 14 patients had cholecystectomy with drainage of abscess.The mean length of hospital stay was 19.7 days. The outcome was generally favorable with the exception of one death from septic shock. CONCLUSION: PLA is a rare condition but has undergone a huge change. It affects the subjects increasingly older. Bacteriologically, there is an emergence of Klebsiella in favor of Escherichia coli. Its treatment became less chirurgical thanks to the development of percutaneous drainage. Its outcome is generally favorable.