Pyogenic liver abscesses: another look at medical management

14 patients with 17 pyogenic liver abscesses were treated initially by non-surgical means. 3 patients received intravenous antibiotics alone, and 11 had intravenous antibiotics plus percutaneous aspiration. Non-surgical management alone was successful in only 1 patient. Among the 13 others 2 are well after percutaneous catheter insertion and 5 are well after surgical drainage. 6 patients died despite medical and surgical therapy. After large-needle aspiration 2 patients died and 3 had serious complications. Non-surgical management of infected space-occupying hepatic lesions or abscesses in immune-suppressed patients is unlikely to be successful. This report shows that medical management, with or without percutaneous aspiration, is not consistently successful even in patients with normal immune systems and no predisposing causes for their hepatic abscesses.