Heptaobiliary infections

Although cholangitis is the most prevalent hepatobiliary infectious process, liver abscess represents the most serious and conspicuous hepatobiliary infection. Amebic liver abscess typically occurs in individuals from endemic areas or those traveling to endemic areas. It is associated with an excellent prognosis when managed expediently with antiamebic antibiotics. Recent reports emphasize a possible association between amebic liver abscess and HIV infection. Drainage or surgery for amebic liver abscess is rarely necessary. In contrast, pyogenic liver abscess is associated with significant morbidity and mortality, although the prognosis of patients with this hepatobiliary infection has improved in recent years. Pyogenic liver abscess occurs most often in patients without identifiable predisposing factors, but when identified, they are most often biliary tract-related. Management of pyogenic liver abscess has historically been surgical, but in recent years, there has been a dramatic shift toward noninvasive management, particularly involving strategies based on percutaneous drainage techniques.