Critical review of the treatment of pyogenic hepatic abscess

A retrospective review of 29 consecutive patients with pyogenic hepatic abscesses was undertaken to ascertain the efficacy of various treatments. Percutaneous routes were used 25 times (aspiration alone in 16 and with concomitant drainage in nine), as a primary step 22 times and for recurrent abscesses, three times. An operation was required in nine patients; initially in five and after percutaneous treatment in four. Antibiotics alone were used twice. There were seven deaths, two after antibiotics alone and five after initial percutaneous aspirations. There were six recurrent abscesses, all but one after percutaneous aspiration. Our results suggest that antibiotics alone and percutaneous aspiration alone are inadequate in the treatment of pyogenic hepatic abscesses; percutaneous management is valid provided concomitant drainage is used, and that once the abscess has been successfully handled percutaneously, surgical treatment is a safe alternative as a first step, for abscesses recurring after percutaneous management, or for removal of the primary cause of the disease.