Liver abscess: a changing entity

Over the past 12 years, 25 patients with liver abscess have been treated at the Medical University of South Carolina. Their clinical course was compared with a previous series of 22 patients from this institution reported in 1968. Our findings were discussed in the light of clinical aspects of liver abscess reported in the surgical literature over the past four decades. These comparisons show a diminishing role of amebic infection and appendicitis as etiologic factors in the development of liver abscess. Immunologic deficiencies are emerging as an important etiologic category. Over the past decade, anaerobic organisms have demonstrated a more obvious role in this infection. The clinical presentation of these patients in recent years has been characterized by an increasingly chronic pattern rather than the frequent septic presentation of the preantibiotic era. Over the past two decades, the mortality of liver abscess has diminished markedly in spite of few changes in operative approach. This is partly due to earlier, accurate diagnosis with the use of liver scanning. Hopefully, this trend will continue with the more frequent use of new diagnostic techniques, such as computerized axial tomography, and with improvement of pre- and postoperative care.