[Therapeutic options in the treatment of pyogenic liver abscess]

Pyogenic liver abscess is a rare and life-threatening disease. Our aim is to discuss the aetiology and problems of diagnosis and treatment of this disease, based on our own clinical experience. We present and compare different therapeutic options, i. e. ultrasound-guided percutaneous abscess drainage, CT-guided drainage and open surgical drainage.

In a time period of 8 years, 62 patients with pyogenic liver abscesses were treated. The therapeutic procedure used most frequently was ultrasound-guided percutaneous abscess drainage in 41 patients, followed by CT-guided drainage in 13 cases. 8 patients were primarily treated with surgical drainage or liver resection, respectively.

With an overall mortality of 9.6 % we achieved an encouraging result. The comparison of mortality between groups treated with ultrasound-guided percutaneous abscess drainage (7.3 %) and CT-guided drainage (7.7 %) revealed no significant prognostic difference. The comparison of local complications and drainage failure between ultrasound-guided percutaneous abscess drainage (2.4 %) and CT-guided drainage (15.4 %), however, showed better results for the ultrasound-guided interventions (1/41 vs. 2/13 patients). Two patients undergoing open surgical drainage died due to an advanced septic shock syndrome.

Our study suggests that ultrasound duplex imaging with percutaneous abscess drainage is a reliable and effective approach for the treatment of pyogenic liver abscess. Based on other studies in the literature and our own results we developed a diagnostic and therapeutic algorithm for the treatment of liver abscesses.