Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess

El absceso hepático es un reto diagnóstico y terapéutico. Es una patología poco frecuente en la niñez que predomina en países en desarrollo y se asocia a malnutrición y parasitosis. El absceso hepático piógeno es el más frecuente, es una causa de hospitalización prolongada por el requerimiento de antimicrobianos endovenosos; usualmente con baja mortalidad.A continuación, presentamos una serie de cuatro casos clínicos de pacientes con abscesos hepáticos piógenos que fueron manejados entre el 2016 y 2018 en el Hospital de Especialidades Pediátricas.Tres pacientes fueron del sexo femenino y uno masculino. En dos de los pacientes se identi có factor predisponente: diabetes mellitus e infección avanzada por VIH. Los síntomas más frecuentes fueron ebre (100%), dolor abdominal (100%) y hepatomegalia (50%). En ninguno de los casos se sospechó absceso hepático a su ingreso. Los casos fueron diagnosticados por sonograma hepático y corroborados con tomografía abdominal. El tamaño promedio de las lesiones fue de 6.88 x 6.18 x 6.12 cm. Tres fueron de localización derecha y uno de localización izquierda. Todos los pacientes recibieron antibioticoterapia de amplio espectro y drenaje percutáneo. Se identi có agente etiológico en uno de los pacientes: Staphylococcus aureus.Los pacientes recibieron una media de 33 + 3.5 días de tratamiento. Con evolución favorable en todos los casos y mejoría en seguimiento con ultrasonidos. Ningún paciente requirió intervención quirúrgica. Abstract The liver abscess involves an authentic diagnostic and therapeutic challenge. It is not frecuent in childhood. Occurs mainly in developing countries and is associated to malnutrition and parasitic infection, that are described as risk factors. Pyogenic liver abscess represents, in most of the cases, a cause of long-time hospitalizations because of the requirement of endovenous treatment, but usually with low mortality.We describe a four-case series of patients with pyogenic liver abscess between 2016 and 2018 in Hospital de Especialidades Pediatricas in Panamá City.Three patients were female and one was a male. In two of the cases, there were risk factors such as diabetes mellitus and advanced HIV infection.The most frequent symptoms were: fever (100%), abdominal pain (100%) and hepatomegaly (50%).In neither one of the cases, liver abscess was suspected as diagnosis. All cases were diagnosed by hepatic sonogram and con rmed by abdominal CT- scan. The mean size of lesions was 6.88 x 6.18 x 6.12 cm. Three of the cases were located in right lobe and one in the left lobe of the liver. They were managed with broad-spectrum antibiotics and percutaneous drainage.Staphylococcus aureus was isolated in one case.The patients received a mean of 33 + 3.5 days of treatment. All cases evolved well with improvement of lesion in ultrasonography. None of the patients required surgical intervention.

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Evaluation of clinical risk factors for developing pleural empyema secondary to liver abscess

BMC Gastroenterology ◽

10.1186/s12876-019-1128-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Eunjue Yi ◽

Tae Hyung Kim ◽

Jun Hee Lee ◽

Jae Ho Chung ◽

Sungho Lee

Keyword(s):

Risk Factors ◽

Pleural Effusion ◽

Liver Abscess ◽

Biliary Tract ◽

Clinical Manifestation ◽

Pyogenic Liver Abscess ◽

Pleural Empyema ◽

Patient Characteristics ◽

Group 2 ◽

The Right

Abstract Background The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess. Methods Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed. Results A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6 ± 6.35 days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR = 2.30, p = 0.048), and larger diameter of the liver abscess (OR = 1.02, p = 0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR = 10.62, p = 0.044), bilateral pleural effusion (OR = 46.72, p = 0.012) and combined biliary tract inflammation (OR = 21.05, p = 0.040) were significantly associated with the need for invasive intervention including surgery on effusion. Conclusion The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.

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Spontaneous Rupture of Primary Pyogenic Liver Abscess

Journal of the Royal Society of Medicine ◽

10.1177/014107688607900919 ◽

1986 ◽

Vol 79 (9) ◽

pp. 547-548 ◽

Cited By ~ 2

Author(s):

C M El Khatib

Keyword(s):

Liver Abscess ◽

Spontaneous Rupture ◽

Pyogenic Liver Abscess

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Clinical Outcomes and Prognostic Factors of Cancer Patients with Pyogenic Liver Abscess

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-011-1650-3 ◽

2011 ◽

Vol 15 (11) ◽

pp. 2036-2043 ◽

Cited By ~ 8

Author(s):

Shiuan-Chih Chen ◽

Yuan-Ti Lee ◽

Shih-Jei Tsai ◽

Kuang-Chi Lai ◽

Chi-Chou Huang ◽

...

Keyword(s):

Prognostic Factors ◽

Cancer Patients ◽

Clinical Outcomes ◽

Liver Abscess ◽

Pyogenic Liver Abscess

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Spontaneous rupture of liver abscess with biliary communication presenting as a lumbar mass

International Surgery Journal ◽

10.18203/2349-2902.isj20214400 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3484

Author(s):

Ajay Bhandarwar ◽

Amarjeet Tandur ◽

Geoffrey Kharmutee ◽

Akshay Rathod ◽

Kaustubh Dodke ◽

...

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Spontaneous Rupture ◽

Pyogenic Liver Abscess ◽

Primary Treatment ◽

Minimal Invasive ◽

Endoscopic Management ◽

Primary Treatment Modality ◽

Biliary Communication ◽

Minimal Invasive Techniques

Pyogenic liver abscess was first reported in the writings of Hippocrates, which was based on the type of fluid recovered from the abscess related to a high mortality rate ranging between 15% and 19% at that time. However in 1938, Ochsner and De Bakey described the recommended surgical treatment as the primary treatment modality. Surgery remained the therapy of choice until the mid-1980s, when percutaneous drainage was shown to be a safer alternative in many cases. Spontaneous rupture of liver abscess may occur free in the peritoneal cavity or in neighbouring organs, an event which is generally considered as a surgical emergency, while localized rupture can be managed with drainage, either percutaneous or surgical/minimal invasive techniques and addition of appropriate antibiotic treatment. In cases where there is uneventful rupture of abscess and localized to the neighbouring organs and tissues can be successfully treated by a combination of broad-spectrum antibiotics and percutaneous drainage and endoscopic management.

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