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Pyogenic Liver Abscesses Caused by Acute Appendicitis: Frequency and Diagnostic and Therapeutic Recommendations
Doerte Wichmann1, Alfred Königsrainer1, Ulrich Schweizer1
1Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Tuebingen, Germany.
Abstract:
Pyogenic liver abscesses (PLA) are caused by biliary diseases or hematogenous spreading of mostly intra-abdominal infections. Liver abscesses resulted in hematogenous spreading of infections via the portal vein, such as abscesses caused by acute appendicitis. Pyogenic liver abscesses associated with appendicitis have rarely been described in the literature, especially in adults. The standard therapeutic procedures for liver abscesses are broad-spectrum antibiotic therapy and percutaneous drainage. Surgery for liver abscesses is required in cases of unsuccessful processes. A retrospective analysis of patients with liver abscesses between January 2005 and June 2013 was performed. Parameters investigated included demographics, etiologies of abscesses, treatment modalities, and germ spectrum including antibiotic profile. Five cases of PLA caused by appendicitis were reviewed in detail. During the study period, 49 patients with PLA and 1,986 patients with acute appendicitis were treated in our hospital. Twenty-one patients with PLA were treated with antibiotic agents and computed tomography (CT)-guided drainage. Liver resections were necessary in 29 of the patients with PLA. In five patients with PLA, abscesses were caused by an acute appendicitis (9.4% of all PLA, 0.25% of all appendicitis operations). Diagnosis of appendicitis as cause of PLA was made during surgery for liver resections in three patients. Previous imaging was not clear in all cases of PLA caused by appendicitis. The most common pre-operative symptoms in patients with PLA caused by appendicitis were fever and right upper quadrant tenderness. Pyogenic liver abscesses caused by acute appendicitis are rare. In the study period of eight and one-half years nearly 2,000 cases of acute appendicitis were treated and five of these patients developed liver abscesses (0.25%). Pyogenic liver abscesses should be considered in patients with unusual high infectious parameters, septic symptoms, and detection of unknown liver lesions.
Insights
Pyogenic liver abscesses (PLA) from appendicitis are rare, occurring in 0.25% of appendicitis cases. Consider PLA in patients with severe infection symptoms and unexplained liver lesions.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Pyogenic liver abscesses (PLA) are serious infections often linked to biliary or intra-abdominal sources.
- Appendicitis is an uncommon cause of PLA, particularly in adults, with limited literature documenting this association.
- Standard treatment involves antibiotics and drainage, with surgery reserved for refractory cases.
Purpose of the Study:
- To investigate the incidence and characteristics of pyogenic liver abscesses secondary to acute appendicitis.
- To highlight the diagnostic challenges and clinical presentation of PLA caused by appendicitis.
- To evaluate treatment outcomes for PLA originating from appendicitis.
Main Methods:
- Retrospective analysis of patients with PLA between January 2005 and June 2013.
- Detailed review of five cases where appendicitis was the etiology of PLA.
- Comparison of PLA incidence with acute appendicitis cases treated during the study period.
Main Results:
- Five cases (0.25%) of PLA were attributed to acute appendicitis out of 1,986 appendicitis cases.
- Diagnosis was challenging, with appendicitis identified during surgery in three patients.
- Common symptoms included fever and right upper quadrant tenderness; imaging was not always conclusive.
Conclusions:
- Pyogenic liver abscesses stemming from acute appendicitis are infrequent but should be considered in patients presenting with severe infectious symptoms and liver lesions of unknown origin.
- Early recognition and appropriate management are crucial for favorable outcomes.
- This rare presentation underscores the importance of considering intra-abdominal sources for PLA, even atypical ones like appendicitis.
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