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Modern Treatment

Steven C. Stain, MD; Albert E. Yellin, MD; Arthur J. Donovan, MD; Heather W. Brien, MD

Arch Surg. 1991;126(8):991-996.

Abstract
• Historically, open surgical drainage has been the treatment of choice for pyogenic liver abscess. The records of 54 patients with pyogenic liver abscess were reviewed to determine whether earlier diagnosis with current imaging tests and definitive treatment with antibiotics, aspiration, or catheter drainage was an effective alternative to open drainage. Twenty-nine patients were treated with broad-spectrum antibiotics and diagnostic aspiration. Twenty-three (79%) recovered uneventfully, and six required catheter or operative drainage. Twenty-three patients (including five who failed aspiration) underwent drainage with percutaneously placed catheters. Nineteen (83%) recovered; four required open surgical drainage. Of seven patients who required open surgical drainage, six recovered. One (2%) of the 54 patients died following failed aspiration and catheter and surgical drainage. Four patients were successfully treated with antibiotics alone without aspiration. These results confirm that pyogenic liver abscess can be successfully treated with broad-spectrum antibiotics and aspiration or percutaneous catheter drainage. Open surgical drainage is reserved for patients in whom treatment fails or who require celiotomy for concurrent disease.

(Arch Surg. 1991;126:991-996)

Author Affiliations
From the Department of Surgery, Los Angeles County–University of Southern California Medical Center and the University of Southern California School of Medicine, Los Angeles.

Footnotes
Accepted for publication May 19, 1991.

Read before the 98th Annual Meeting of the Western Surgical Association, Scottsdale, Ariz, November 13, 1990.

Reprint requests to Department of Surgery, Room 9442, Los Angeles County–University of Southern California Medical Center, 1200 N State St, Los Angeles, CA 90033 (Dr Yellin).

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