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[Pyogenic liver abscess. A descriptive study of 35 cases]
A Ramos1, T Gazapo, J Murillas
1Servicios de Medicina Interna III, Clinica Puerta de Hierro. Madrid.
Abstract:
Thirty-five patients with pyogenic hepatic abscess (PHA) attended over 13 years in a general hospital were studied. The aim of the study was to know the usefulness of the performance of opaque enema in patients with cryptogenic PHA and the prognosis of the patients treated with only antibiotics. The most frequent clinical and analytical manifestations were fever and leukocytosis. Other less frequent findings were abdominal pain, hepatomegaly and elevated alkaline phosphatase and aspartate aminotransferase levels. One third of the patients presented radiologic alterations at the base of the right hemithorax. Colon studies in the patients with cryptogenic PHA performed to discard another origin of the abscess demonstrated very low profitability. Abdominal echography showed adequate sensitivity (0.85) in the diagnosis of PHA and allowed percutaneous drainage to be performed in most of the cases. The patients who were treated with only antibiotics presented a significantly worse prognosis than those treated with antibiotics and drainage (p = 0.03). Drainage of the PHA also allowed a decrease in the length of fever duration.
Insights
Pyogenic hepatic abscess (PHA) diagnosis is best achieved with abdominal echography. Antibiotic treatment alone leads to a worse prognosis for PHA patients compared to those receiving antibiotics and drainage.
Area of Science:
- Hepatology
- Infectious Diseases
- Radiology
Background:
- Pyogenic hepatic abscess (PHA) is a serious infection requiring effective diagnostic and treatment strategies.
- Clinical manifestations often include fever and leukocytosis, with less frequent findings like abdominal pain and elevated liver enzymes.
Purpose of the Study:
- To evaluate the utility of opaque enemas in diagnosing cryptogenic PHA.
- To assess the prognosis of patients with PHA treated solely with antibiotics versus those receiving antibiotics and drainage.
Main Methods:
- Retrospective study of 35 patients with PHA over 13 years.
- Analysis of clinical, analytical, and radiological findings.
- Evaluation of diagnostic yield of colon studies and abdominal echography.
- Comparison of treatment outcomes based on antibiotic therapy alone versus combined antibiotic and drainage therapy.
Main Results:
- Colon studies for cryptogenic PHA showed low diagnostic profitability.
- Abdominal echography demonstrated high sensitivity (0.85) for PHA diagnosis and facilitated percutaneous drainage.
- Patients treated with antibiotics and drainage had a significantly better prognosis (p = 0.03) and shorter fever duration than those treated with antibiotics alone.
Conclusions:
- Abdominal echography is a sensitive and effective tool for diagnosing PHA and guiding percutaneous drainage.
- Percutaneous drainage in conjunction with antibiotics significantly improves patient prognosis and reduces fever duration in PHA cases.