The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess
F. F. Chou, S. M. Sheen-Chen, Y. S. Chen and T. Y. Lee
Department of Surgery, Chang Gung Medical School, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
OBJECTIVES: To study and review the clinical manifestations, courses, and
results of treatment in 83 cases of verified gas-forming pyogenic liver
abscess. DESIGN: Case series. SETTING: Both primary and referral hospital
care. PATIENTS: Four hundred twenty-four patients with clinical diagnosis
of pyogenic liver abscess were enrolled in the study. Eighty-three patients
had gas-forming abscesses and 341 had non-gas-forming abscesses. The
clinical manifestations, duration of symptoms, incidence of septic shock,
laboratory findings, concurrent diabetes mellitus, cause of abscess, size
of abscess, and results of treatment were recorded. MAIN OUTCOME MEASURES:
A chi 2 test for qualitative data and Student's test for quantitative data.
RESULTS: Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6
+/- 10 days) (P < .005) and the incidence of septic shock was higher in
the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P <
.01). Laboratory findings revealed high levels of blood glucose, aspartate
aminotransferase, alkaline phosphatase, and serum urea nitrogen in the
gas-forming group. The size of abscess was usually bigger (> 5 cm) in
this group. In the gas-forming group, 71 patients (85.5%) had diabetes
mellitus and 65 patients (78.3%) had conditions of cryptogenic origin.
Klebsiella pneumoniae was the main bacteria, in blood culture and liver
aspirates, especially in gas-forming liver abscess. Medical treatment
and/or aspiration carried a high mortality rate (44.4%) in the gas-forming
group; also, the overall mortality rate was higher in this group than in
the non-gas-forming group (27.7% vs 14.4%) (P < .01). CONCLUSIONS: The
gas-forming liver abscess may be a disease of wide spectrum of severity and
may run a fulminating course. Strong antibiotics with early adequate
drainage are mandatory. Surgery should not be delayed if necessary.
