[Pathology, diagnosis and therapy of liver abscess]

Bacterial hepatic abscesses are a rare but serious disease. They develop either secondary to injuries or ischemia of the liver, infections in the drainage area of the portal vein, systemic sepsis or biliary infections. An abscess secondary to injuries or ischemia of the liver or infections in the drainage area of the portal vein, is usually caused by a mixed flora consisting of gramnegative aerobes and anaerobic bacteria. Hepatic abscesses secondary to systemic sepsis contain Staphylococci or Streptococci, while in abscesses on the basis of biliary infections gramnegative organisms are found. Clinically, one can find signs of systemic sepsis, pain in the right upper quadrant and a tender enlarged liver. Jaundice is absent unless a biliary obstruction is present simultaneously. The diagnosis is confirmed by ultrasonography or computerized tomography. An uncertain diagnosis can be confirmed by aspiration under ultrasonographic or computertomographic guidance. The therapy consists of administration of antibiotics and surgical or percutaneous drainage. Surgical drainage via laparotomy is always mandatory if one suspects a primary infectious focus within the abdomen. The mortality of multiple liver abscesses is 20 per cent, that of single abscesses 10 per cent. Amebic abscesses have been observed in nonendemic regions sporadically after travel or spontaneously. Clinical and radiological manifestations are the same as for bacterial abscesses. They are differentiated from bacterial abscesses by positive serology for amebiasis or aspiration which yields the typical anchovy paste. Most important complications are hepato-bronchial fistulae, empyema and amebic pericarditis. The therapy consists of a nitroimidazole and a luminal amebicide. Except for diagnostic reasons aspiration is only indicated for large abscesses of the left lobe of the liver. Mortality of an uncomplicated amebic liver abscess should be under one per cent.