Pyogenic liver abscess

Klatchko, B.A., Schwartz, SJ. Diagnostic and therapeutic approaches to pyogenic abscess of the liver. Surg. Gynec. Obstetr. 1989 168 332-336... 

Acute intraabdominal contamination, such as after a traumatic injury, may be treated with a very short course (24 hours) of antimicrobials.25 For established infections (i.e., peritonitis or intraabdominal abscess), an antimicrobial course limited to 5 to 7 days is justified. Under certain conditions, therapy for longer than 7 days would be justified, e.g., if the patient remains febrile or is in poor general condition, when relatively resistant bacteria are isolated, or when a focus of infection in the abdomen still may be present. For some abscesses, such as pyogenic liver abscess, antimicrobials may be required for a month or longer. 

Fig. 27.1 CT scan shows multiple pyogenic liver abscesses in segment 4 (a and b) following perforation in diverticulitis (E. coli). Full recovery...

Cheng, D.-L., Liu, Y.-C., Yen, M.-Y., Liu, C.-Y., Wang, R.-S. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch. Intern. Med. 1991 151 1557-1559... 

Chou, F.-F., Sheen-Chen, S.-M., Chen, Y.-S., Lee, T.-Y. The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess. Arch. Surg. 1995 130 401-405... 

Gyorffy, E.J., Frey, C.F., Silva, J., McGahan, J. Pyogenic liver abscess. Diagnostic and therapeutic strategies. Ann. Surg. 1987 206 699-705... 

McDonald, M.I., Corey, G.R., Gallis, H.A., Durack, D.T. Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore) 1984 63 291-302... 

Miyamoto, ML, Fang. F.C. Pyogenic liver abscess involving Actinomyces case report and review. Clin. Infect. Dis. 1993 16 303—309... 

Peer, A., Strauss, S., Pik, A. Percutaneous catheter drainage of multiple pyogenic liver abscess a case report. Europ. X Radiol. 1990 ... 

Reddy, K.R., Jeffers, L., Livingstone, A.S., Gluck, C.A., ScUff, E.R. Pyogenic liver abscess complicating common bile duct stenosis secondary to chronic calcific pancreatitis. A rare presentation. Gastroenterology 1984 86 953-957... 

Seeto, R.K., Rockey, D.C. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine 1996 75 99-113... 

Stain, St.C., Yellin, A.E., Donoran, A.J., Brien, H.W. Pyogenic liver abscess. Modern treatment. Arch. Surg. 1991 126 991-996... 

Teitz, S., Guidetti-Sharon, A., Manor, H. Pyogenic liver abscess warning indicator of silent colonic cancer. Dis. Colon Rectum 1995 38 1220-1223... 

Wong, K.-R Percutaneous drainage of pyogenic liver abscesses. World J. Surg. 1990 14 492- 497... 

Pyogenic liver abscess is a rare disease in the pediatric patients with an incidence of 25 per 100,000 hospital admissions however, it has a high mortality rate, especially in immunocompromised patients, patients with multiple (or ruptured) abscesses, and patients with chronic granulomatous disease. 

Hashimoto et al. (1995) reported 56 cases of pyogenic liver abscesses 39 and 10 patients underwent CT-guided drainage or simple aspiration without drainage, respectively. Six patients were treated with open operative drainage, while one patient with advanced cancer only received antibiotics. Five of 39 patients had to undergo operation after primary percutaneous drainage (87% success rate). Overall mortality rate was 12.5% (7/56). 

These lesions include simple (bile duct) cyst, autosomal dominant polycystic liver disease, biliary hamartoma, Caroli s disease, pyogenic and amoebic abscesses, intrahepatic hydatid cyst, biliary cystadenoma and cystadenocarcinoma, cystic subtypes of primary liver neoplasms, cystic metastases, and intrahepatic hematoma and biioma. 

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