Hepatic abscess: Diagnosis and management.

Area of Science:

• Hepatology
• Infectious Diseases
• Radiology

Background:

• Hepatic abscess (HA) is a serious liver infection with high mortality, often caused by bacterial or amebic pathogens.
• Etiologies are diverse, including biliary disease, intra-abdominal infections, trauma, and iatrogenic causes, with increasing incidence of Klebsiella pneumoniae HA.
• Diagnosis relies on imaging (ultrasound, CT) and needle aspiration for bacteriology, while treatment involves antibiotics and drainage.

Purpose of the Study:

• To provide a comprehensive overview of hepatic abscess (HA) etiology, diagnosis, and management.
• To highlight the importance of multidisciplinary collaboration in treating HA.
• To emphasize preventive measures against iatrogenic HA.

Main Methods:

• Literature review of hepatic abscess (HA) pathogenesis, clinical presentation, and treatment modalities.
• Analysis of diagnostic imaging techniques and microbiological investigations.
• Discussion of therapeutic strategies including antibiotics, drainage, and source control.

Main Results:

• Bacterial pyogenic HA is most common in Western countries, while amebic HA prevails in Southeast Asia and Africa.
• Klebsiella pneumoniae is an emerging cause of HA, associated with distant septic metastases.
• Effective management requires a combination of antibiotics, drainage, and addressing the underlying cause.

Conclusions:

• Hepatic abscess (HA) necessitates prompt diagnosis and a multi-specialty approach for optimal outcomes.
• Identifying the source and mechanism of HA is critical for tailoring treatment.
• Pre-procedural assessment for biliary contamination and vascular stenosis can prevent iatrogenic HA.