Liver abscess. The need for complete gastrointestinal evaluation
J. L. Cohen, F. M. Martin, R. L. Rossi and D. J. Schoetz Jr
Department of General Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
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.
