Current treatment of liver abscess – Experience of Surgical Clinic of University Hospital Pilsen

Overview

Introduction:
Liver abscesses are a special nosological unit which can be found particularly in immunocompromised patients and elderly people being over eighty. This also causes high morbidity of patients and it caused mortality in the past, as well. These are mostly pyogenic abscesses, i.e. abscesses of bacterial origin (cCa 80%), remaining 20% are uniformly represented by abscesses made up of modus and parasites. The originators of pyogenic abscess are most frequently Streptococcus miller and S. faecalis, Escherichia coli and Klebsiella pneumoniae.

Objective:
The retrospective analysis of a group of patients treated for liver abscess in the Department of Surgery and the Department of Internal Medicine of University Hospital in Pilsen.

Methodology:
From 2007 to 2012, 54 patients with the diagnosis of liver abscess were hospitalized in the Department of Surgery of University Hospital and Faculty of Medicine of Charles University in Pilsen. There were more men (35 patients – 64.8%) than women (19 patients – 35.2%), the average age was 64 in the range of 28–87. There was a research of primary procedure at treatment as well as patients’ age, aetiology of abscess, morbidity, mortality and the duration of hospitalization.

Results:
From the etiological point of view, it was most of ten an access with no provable cause, e.i.primary one (26 cases – 48.1%). Infectious agents were identified by cultivation tests in 45 cases (83.3%). The cause of bacterial abscesses was mostly Escherichia coli (16 cases – 29.6%). The drainage by means of CT navigation was a sufficient surgery for 31 patients (57.4%). In 14 patients (25.9%), open drainage was a primary surgery. One half of patients had some complications, mortality of this disease reached 3.7%. The average duration of hospitalization was 18.5 days.

Conclusion:
Liver abscess has to be taken into account within differential diagnostics of septic temperatures with pain under right rib. The basis of diagnosis are clinical and laboratory examinations, ultrasonography and computer tomography. Regarding treatment, the method of choice is drainage navigated by CT and use of broad-spectrum antibiotics. Open surgical drainage is performed in case of focuses being inaccessible for radiology frequency and in patients who react to their previous therapy in an insufficient way. In consideration with its seriousness and small incidence, the treatment of liver abscesses belongs to specialized centres of liver surgery.

Keywords:
liver abscess – CT drainage – antibiotics