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The Need for Complete Gastrointestinal Evaluation

Jeffrey L. Cohen, MD; F. Maureen Martin, MD; Ricardo L. Rossi, MD; David J. Schoetz, Jr, MD

Arch Surg. 1989;124(5):561-564.

Abstract
• The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation.

(Arch Surg. 1989;124:561-564)

Author Affiliations
From the Departments of General Surgery (Dr Rossi) and Colon and Rectal Surgery (Dr Schoetz), Lahey Clinic Medical Center, Burlington, Mass. Dr Cohen is now in private practice in Hartford, Conn. Dr Martin is now with the Department of Surgery, New England Deaconess Hospital, Boston, Mass.

Footnotes
Accepted for publication February 11, 1989.

Winner of the Resident's Prize at the 69th Annual Meeting of the New England Surgical Society, Montreal, Canada, September 16, 1988.

Reprint requests to Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA 01805 (Dr Shoetz).

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