Pyogenic liver abscess. Modern treatment
S. C. Stain, A. E. Yellin, A. J. Donovan and H. W. Brien
Department of Surgery, Los Angeles County-University of Southern California Medical Center 90033.
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.
