Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.
Humans ; Liver/radiography/ultrasonography ; Liver Abscess, Pyogenic/*diagnosis/microbiology ; Male ; Middle Aged ; Salmonella Infections/*diagnosis

Many advances, including the development of antibiotics, the advent of diagnostic techniques and the use of nonsurgical drainage have decreased the mortality rate of pyogenic liver abscess. But, early prompt diagnosis and proper treatment is mandatory in gas-forming pyogenic liver abscess because it may run a fulminating course to death. Gas-forming pyogenic liver abscess mostly occurred to old diabetics. Symptoms of duration are shorter and the prognosis is poorer in the gas-forming than in the non-gas-forming liver abscess. We report three cases of gas-forming pyogenic liver abscess which occurred in old diabetic patients. They were successfully managed by parenteral antibiotics and early percutaneous drainage under sonographic guidance. Early and adequate drainage of pus by pigtail catheter may play a crucial role on the treatment of gas-forming liver abscess.
Anti-Bacterial Agents ; Catheters* ; Diabetes Mellitus ; Diagnosis ; Drainage* ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Mortality ; Prognosis ; Suppuration ; Ultrasonography

BACKGROUND/AIMS: The clinical features of pyogenic liver abscess have changed after the introduction of antimicrobial agents and intervention. This study was conducted to clarify the changes in the clinical features of pyogenic liver abscess during the recent 12 years. METHODS: We reviewed the medical records of 157 cases with pyogenic liver abscesses that were treated at our hospital between January 1995 and July 2006. The period was divided to 1 (1995-2000; 72 cases) and 2 (2001-July 2006; 85 cases). RESULTS: Prevalence of patients with an age over 70 increased significantly in period 2 compared to period 1 (p=0.019). The biliary tract was the most common portal of entry during the 12 years, and biliary procedures were the important causative factors. Compared to the non-biliary group, the biliary group was older and it had a higher frequency of recurrent abscess, Escherichia coli infection, and air-biliary gram (p<0.05). Klebsiella pneumoniae was the most common pathogen, and the frequency of E. coli was increased in period 2 compared to period 1 (p=0.045). Only 6.9% and 1.2% of the patients during period 1 and 2, respectively, were treated surgically. The overall mortality was 0.6% (0% vs. 1.2%, respectively). The interval from onset to admission, the size of the abscess cavity, the time to defervescence and the hospital stay were shorter in period 2 than in period 1 (p=0.044, p=0.013, p=0.02 and p=0.0002, respectively). CONCLUSIONS: Recently, pyogenic liver abscess affects the elderly, and biliary procedures are its important causative factor. E. coli is still a common pathogen in relation to the biliary portal of entry. The elderly patients with biliary problems need better medical attention to avoid the development of pyogenic liver abscess, and for making an early diagnosis and achieving a better outcome.
Abscess ; Aged ; Anti-Infective Agents ; Biliary Tract ; Early Diagnosis ; Escherichia coli ; Escherichia coli Infections ; Humans ; Klebsiella pneumoniae ; Length of Stay ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Medical Records ; Prevalence

BACKGROUND/AIMS: This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. METHODS: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69 :1, and the peak incidence was in the sixth decade. RESULTS: The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. CONCLUSIONS: The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess.
Abscess ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde* ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Humans ; Incidence ; Liver Abscess ; Liver Abscess, Pyogenic* ; Liver Cirrhosis ; Male

Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to double-check tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC.
alpha-Fetoproteins ; Biomarkers, Tumor ; Carcinoma, Hepatocellular ; Diagnosis ; Hepatitis B, Chronic ; Humans ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Liver Neoplasms ; Lymphatic Diseases ; Male ; Needles ; Pathology

Pyogenic liver abscess is a rare but highly lethal disease. The diagnosis and treatment of pyogenic liver abscess has been evolving owing to specific antibiotic therapy, ultrasonography, abdominal computed tomography with improved percutaneous and operative techniques. However, pyogenic liver abscess may present as a rapidly fatal outcome. These unfavorable results are mainly attributed to the increasing numbers of patients with malignant disease and biliary tract disease. Carcinoma of the gallbladder has remained an uniformly fatal neoplasm characterized by early metastasis and rapid fatal course. In early stage, the symptom is nonspecific and often mimics benign biliary tract disease. We experienced a case of the gallbladder carcinoma presenting with pyogenic liver abscess in a 78-year-old female patient. Surgical drainage and cholecystectomy were done. The microscopic finding of resected gallbladder revealed large cell neuroendocrine carcinoma of gallbladder.
Aged ; Biliary Tract Diseases ; Carcinoma, Neuroendocrine* ; Cholecystectomy ; Diagnosis ; Drainage ; Fatal Outcome ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic* ; Neoplasm Metastasis ; Ultrasonography

Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.
Cecal Diseases/complications/*diagnosis/surgery ; Colonoscopy ; Female ; Humans ; Laparoscopy ; Liver/pathology ; Liver Abscess, Pyogenic/*diagnosis/etiology ; Middle Aged ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis/surgery

BACKGROUND: The mortality of liver abscess markedly decreased because of the improvement of diagnosis and treatment modalities, however, the incidence is still high and various complications have been developed. Our study was to clarify the clinical features, complications, changing patterns of causative organisms and predicting parameters for development of complications in liver abscess. METHODS: We reviewed 197 cases of pyogenic and amebic liver abscesses treated at Chonnam University Hospital from January 1989 to March 2003. These cases were divided into subgroups by time of occurrence, and the data was reviewed comparatively. Predicting parameters for development of complications in recent 5 years were also analyzed. RESULTS: The male to female ratio was 1.59 : 1 and the peak incidence age of liver abscess was in the 7th decade. There were no significant interval changes in incidence of pyogenic liver abscess (96.4%) and amebic liver abscess (3.6%) from January 1989 to March 2003. The most common infection route in pyogenic liver abscess was biliary tract (45.8%), followed by cryptogenic cause (44.2%), pulmonary disease (2.6%), hematogenous (2.1%) and abdominal trauma (1.5%). The pus culture came out positive in 50.4% of pyogenic liver abscess. Klebsiella pneumoniae was the most commonly isolated organism in pyogenic liver abscess (32.9%). The significant predicting parameters for development of complications were age (>or=60), systemic inflammatory response syndrome (SIRS, >or=2 factors), C-reactive protein (CRP, >or=8 mg/dL), bilirubin (>or=2 mg/dL), albumin (<3 g/dL) and AST (>or=200 IU/L, p<0.05). CONCLUSION: There were no significant interval changes in etiologies and predisposing conditions of liver abscess in Gwangju-Chonnam Province from January 1989 to March 2003. Age, SIRS, CRP, bilirubin, albumin and AST were considered as significant predicting parameters for development of complications in liver abscess.
Biliary Tract ; Bilirubin ; C-Reactive Protein ; Diagnosis ; Female ; Humans ; Incidence ; Jeollanam-do ; Klebsiella pneumoniae ; Liver Abscess* ; Liver Abscess, Amebic ; Liver Abscess, Pyogenic ; Liver* ; Lung Diseases ; Male ; Mortality ; Suppuration ; Systemic Inflammatory Response Syndrome

Pneumoperitoneum is usually the result of a perforated gastrointestinal (GI) tract associated with peritonitis. However, on rare occasions, spontaneous pneumoperitoneum not associated with a perforated GI tract has been described in the literature. A ruptured liver abscess is one of these occasions, and herein a case that resulted in pneumoperitoneum is reported. A 61-year-old woman was referred to the ER with acute onset of abdominal pain. The patient had been diagnosed as having diabetes mellitus and hypertension. The abdominal examination was not remarkable for tenderness, but her vital signs were unstable. Laboratory investigations revealed a WBC count of 4, 000/mm3, Na+ of 129 mEq/L, and K+ of 3.2 mEq/L. A plain radiography disclosed a minute amount of free air in the left subphrenic space, and a computed tomography (CT) scan visualized a low-density cystic mass suspected to be a gas forming pyogenic liver abscess. A laparoscopic exploration was performed for diagnosis and peritoneal drainage. Under the laparoscopy, a ruptured liver abscess and large amount purulent plaque were observed scattered in the entire peritoneal cavity. Evacuation of the abscess, cholecystectomy, liver biopsies, and peritoneal lavage were carried out after conversion to an open laparotomy. An abscess culture was obtained from the liver, with Klebsiella pneumoniae revealed as the pathogen. The administration of appropriate antibiotics followed the surgery, and she recovered without complications. A ruptured pyogenic liver abscess is an extremely rare and threatening condition despite the advances in diagnostic technology and new strategies for their treatment. However, the appropriate surgical management, followed by effective antibiotic therapy, will recover the patient without serious complications.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Biopsy ; Cholecystectomy ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Gastrointestinal Tract ; Humans ; Hypertension ; Klebsiella pneumoniae ; Laparoscopy ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Middle Aged ; Peritoneal Cavity ; Peritoneal Lavage ; Peritonitis ; Pneumoperitoneum ; Radiography ; Rupture, Spontaneous* ; Vital Signs

BACKGROUND/AIMS: The mortality rate of pyogenic liver abscess (PLA) has decreased dramatically, but it remains a potentially life threatening disease. Most cases are cryptogenic or occur in elderly men with underlying biliary tract disease. Although several studies have addressed the characteristics and etiology of PLA, research on factors affecting PLA-associated mortality is lacking. This study intended to identify the clinical and radiological features, pathogens, complications, and predictors of mortality in Korean PLA patients. METHODS: The medical records of 231 PLA patients diagnosed at Yeungnam University Medical Center between January 2010 and January 2014 were analyzed. A diagnosis of PLA was made based on imaging studies and blood and abscess cultures. The clinical, radiological, and laboratory findings of patients were analyzed. RESULTS: The mean patient age was 64.0±12.9 years and the male to female ratio was 1.5:1. Klebsiella pneumoniae was the predominant organism isolated from hepatic abscesses (69.9%) and blood (74.2%). The most common complication was pleural effusion (35.8%) and most common co-infection was cholangitis (8.2%). The overall mortality rate of PLA was 6.9% (16/231), and was significantly higher in patients with a history of liver abscess (OR 5.970, 95% CI 1.207-29.529; p=0.028), bilirubinemia (>2 mg/dL) (OR 9.541, 95% CI 2.382-38.216; p=0.001), thrombocytopenia (<140×10(3)/µL) (OR 4.396, 95% CI 1.130-17.106; p=0.033), or anemia (<12 g/dL) (OR 13.277, 95% CI 1.476-119.423; p=0.021). CONCLUSIONS: The prognosis of PLA appears to be dependent on underlying pathologies and severity of condition. More aggressive treatment should be considered if a poor prognosis is expected.
Abscess ; Academic Medical Centers ; Aged ; Anemia ; Biliary Tract Diseases ; Cholangitis ; Coinfection ; Diagnosis ; Female ; Humans ; Hyperbilirubinemia ; Klebsiella pneumoniae ; Liver Abscess ; Liver Abscess, Pyogenic* ; Male ; Medical Records ; Mortality* ; Pathology ; Pleural Effusion ; Prognosis ; Retrospective Studies* ; Risk Factors ; Thrombocytopenia