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Liver abscess. The need for complete gastrointestinal evaluation
J L Cohen1, F M Martin, R L Rossi
1Department of General Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
Abstract:
The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation.
Insights
Pyogenic liver abscesses often present with unclear origins, commonly diagnosed as fever of unknown origin. Further evaluation is crucial for effective treatment, especially when initial interventions fail.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Pyogenic liver abscess (PLA) diagnosis is often delayed.
- Initial presentation frequently misdiagnosed as fever of unknown origin (FUO).
Purpose of the Study:
- To analyze the diagnostic challenges and treatment outcomes of pyogenic liver abscesses.
- To identify the origins and evaluate management strategies for liver abscesses.
Main Methods:
- Retrospective review of 20 patients diagnosed with pyogenic liver abscess between 1981 and 1987.
- Analysis of initial diagnoses, abscess origins, and treatment modalities (percutaneous transhepatic drainage vs. open surgery).
Main Results:
- Liver abscess suspected on admission in only 3 of 20 patients; FUO was the most common initial diagnosis.
- Intestinal origin in 7 patients, pancreatobiliary in 11, and cryptogenic in 2.
- Percutaneous transhepatic drainage (PTD) success rate was 36% (4/11), while open surgery was performed in 9 patients.
- PTD success was lower compared to open surgery, especially without clear biliary pathology.
Conclusions:
- Delayed diagnosis is common in pyogenic liver abscess cases.
- Percutaneous transhepatic drainage may have limited success without identified biliary tract pathology.
- Comprehensive gastrointestinal evaluation is recommended for all liver abscess patients, particularly when biliary causes are not evident.
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