Pyogenic hepatic abscesses

A review of pyogenic liver abscess at the University of Alabama in Birmingham revealed 29 cases, of which 22 were single and seven were multiple. Etiology was cryptogenic in 11, secondary to biliary tract disease in seven, trauma in six, and pyelophlebitis in four, and secondary infection in a primary neoplasm in one. No single set of specific diagnostic criteria could be elucidated, but fever occurred in every patient. Leukocytosis, hypoalbuminemia, and elevated alkaline phosphatase were present in more than 80 per cent of patients. Other clinical findings and routine laboratory abnormalities were less consistently present. In suspect patients, a technetium-99 scan was positive in 18 of 19. Ten patients died, including six of seven with multiple abscesses, seven of seven with positive abscess and blood cultures, and seven of 11 in whom liver abscess was not suspected prior to operation or autopsy. Diagnosis demands a high index of suspicion, in patients in whom suggestive factors are present, and liberal use of the technetium-99 scan. Successful treatment requires exploratory laparotomy, with care of discern any underlying septic focus or the presence of multiple abscesses, and wide drainage of the abscesses, as well as vigorous supportive care and appropriate antibiotics.