Liver Abscess Follow-up

  • Author: Ruben Peralta, MD, FACS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 30, 2011
 

Further Inpatient Care

  • Aggressively seek an underlying source of the abdominal pathology.
  • Perform weekly serial CT scans or ultrasound examinations to document adequate drainage of abscess cavity.
  • Maintain drains until the output is less than 10 cc/d.
  • Monitor fever curves. Persistent fever after 2 weeks of therapy may indicate the need for more aggressive drainage.
  • For patients with an underlying malignancy, definitive treatment, such as surgical removal of the mass, should be pursued if at all possible.
Next

Further Outpatient Care

  • Patients will require prolonged parenteral antimicrobial therapy that may continue after discharge. Monitoring of medication levels, renal function, and blood counts may be needed. Enteral nutrition is the preferred route unless it is clinically contraindicated.
  • Drain care may be required.
  • Continue radiologic evaluation to document progress of therapy after discharge.
Previous
Next

Complications

  • Sepsis
  • Empyema resulting from contiguous spread or intrapleural rupture of abscess
  • Rupture of abscess with resulting peritonitis
  • Endophthalmitis when an abscess is associated with K pneumoniae bacteremia
Previous
Next

Prognosis

  • If a liver abscess is left untreated, the prognosis is uniformly fatal.
  • Indicators of a poor prognosis have been described since 1938 and include multiplicity of abscesses, underlying malignancy, severity of underlying medical conditions, presence of complications, and delay in diagnosis.[2]
  • Indicators of a poor prognosis in amebic abscess include a bilirubin level of greater than 3.5 mg/dL, encephalopathy, hypoalbuminemia (ie, serum albumin level of < 2 g/dL), and multiple abscesses; all are independent factors that predict poor outcome.
  • An underlying malignant etiology and an Acute Physiology and Chronic Health Evaluation (APACHE II) score greater than 9 increases the relative mortality by 6.3-fold and 6.8-fold, respectively.
  • Chen et al examined prognostic factors for elderly patients with pyogenic liver abscess.[6] Results from the study, which included 118 patients aged 65 years or older and 221 patients below age 65 years, indicated that age and an APACHE II score of 15 or greater at hospital admission were risk factors for mortality. The evidence ultimately suggested that outcomes for older patients with pyogenic liver abscess are on a par with those for younger patients. The investigators also found that in the younger patient group, there was greater frequency of males suffering from alcoholism, a cryptogenic abscess, and K pneumoniae infection.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Ruben Peralta, MD, FACS  Professor of Surgery, Anesthesia and Emergency Medicine, Senior Medical Advisor, Board of Directors, Program Chief of Trauma, Emergency and Critical Care, Consulting Staff, Professor Juan Bosch Trauma Hospital, Dominican Republic

Ruben Peralta, MD, FACS is a member of the following medical societies: American Association of Blood Banks, American College of Healthcare Executives, American College of Surgeons, American Medical Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Massachusetts Medical Society, Society of Critical Care Medicine, and Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Michelle V Lisgaris  MD, Assistant Professor, School of Medicine, Case Western Reserve University

Michelle V Lisgaris is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Robert A Salata, MD  Chief and Clinical Program Director of Division of Infectious Diseases, Vice Chair for International Affairs, Professor, Department of Medicine, Case Western Reserve University School of Medicine

Robert A Salata, MD is a member of the following medical societies: American Association of Immunologists, American Federation for Medical Research, American Medical Association, Central Society for Clinical Research, Infectious Diseases Society of America, Ohio State Medical Association, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Marco G Patti, MD  Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

  1. Ochsner A, DeBakey M, Murray S. Pyogenic Abscess of the Liver II. An Analysis of Forty-Seven Cases with Review of the Literature. Am J Surg. 1938;XL:292-319.

  2. Chen SC, Huang CC, Tsai SJ, et al. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg. Aug 2009;198(2):164-72. [Medline].

  3. Brisse S, Fevre C, Passet V, et al. Virulent clones of Klebsiella pneumoniae: identification and evolutionary scenario based on genomic and phenotypic characterization. PLoS One. 2009;4(3):e4982. [Medline].

  4. Lin YT, Liu CJ, Chen TJ, Chen TL, Yeh YC, Wu HS, et al. Pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Am J Med. Dec 2011;124(12):1158-64. [Medline].

  5. Alsaif HS, Venkatesh SK, Chan DS, Archuleta S. CT Appearance of Pyogenic Liver Abscesses Caused by Klebsiella pneumoniae. Radiology. Jul 2011;260(1):129-38. [Medline].

  6. Chen SC, Lee YT, Yen CH, et al. Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors. Age Ageing. May 2009;38(3):271-6; discussion. [Medline].

  7. Bahloul M, Chaari A, Bouaziz-Khlaf N, et al. Multiple pyogenic liver abscess. World J Gastroenterol. May 14 2006;12(18):2962-3. [Medline].

  8. Branum GD, Tyson GS, Branum MA, et al. Hepatic abscess. Changes in etiology, diagnosis, and management. Ann Surg. Dec 1990;212(6):655-62. [Medline].

  9. Burris GW, Gordon BM. Cold defect on indium leukocyte scanning of a hepatic abscess. Clin Nucl Med. Jan 1998;23(1):26-8. [Medline].

  10. Cameron JL. Hepatic abscess. In: Current Surgical Treatment. 8th ed. 2004:298-303.

  11. Casado JL, Pintado V, Gomez-Mampaso E, et al. Mycobacterial liver abscess in a patient with AIDS. Postgrad Med J. Mar 1998;74(869):181-3. [Medline].

  12. Casanova C, Lorente JA, Carrillo F, et al. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. Jun 1989;149(6):1467. [Medline].

  13. Cerwenka H, Bacher H, Werkgartner G. Treatment of patients with pyogenic liver abscess. Chemotherapy. 2005;51:366-369.

  14. Ch Yu S, Hg Lo R, Kan PS, et al. Pyogenic liver abscess: treatment with needle aspiration. Clin Radiol. Dec 1997;52(12):912-6. [Medline].

  15. Chan KS, Yu WL, Tsai CL, et al. Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients. Chin Med J (Engl). Jan 20 2007;120(2):136-9. [Medline].

  16. Chen C, Chen PJ, Yang PM, et al. Clinical and microbiological features of liver abscess after transarterial embolization for hepatocellular carcinoma. Am J Gastroenterol. Dec 1997;92(12):2257-9. [Medline].

  17. Chou FF, Sheen-Chen SM, Chen YS, et al. Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment. World J Surg. May 1997;21(4):384-8; discussion 388-9. [Medline].

  18. Chou FF, Sheen-Chen SM, Lee TY. Rupture of pyogenic liver abscess. Am J Gastroenterol. May 1995;90(5):767-70. [Medline].

  19. Chu KM, Fan ST, Lai EC, et al. Pyogenic liver abscess. An audit of experience over the past decade. Arch Surg. Feb 1996;131(2):148-52. [Medline].

  20. Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses - percutaneous or open drainage?. Singapore Med J. Dec 2007;48(12):1158-65; quiz 1165. [Medline].

  21. Corredoira J, Casariego E, Moreno C, et al. Prospective study of Streptococcus milleri hepatic abscess. Eur J Clin Microbiol Infect Dis. Aug 1998;17(8):556-60. [Medline].

  22. De la Maza LM, Naceim F, Berman LD. The changing etiology of liver abscess. Further observations. JAMA. Jan 14 1974;227(2):161-3. [Medline].

  23. Doctor N, Dafnios N, Jones A, et al. Primary squamous carcinoma of liver: presentation as liver abscess. Indian J Gastroenterol. Jan 1998;17(1):28-9. [Medline].

  24. Drnovsek V, Fontanez-Garcia D, Wakabayashi MN, et al. Gastrointestinal case of the day. Pyogenic liver abscess caused by perforation by a swallowed wooden toothpick. Radiographics. May-Jun 1999;19(3):820-2. [Medline].

  25. Farges O, Leese T, Bismuth H. Pyogenic liver abscess: an improvement in prognosis. Br J Surg. Sep 1988;75(9):862-5. [Medline].

  26. Giorgio A, Tarantino L, De Stefano G. Hepatic abscess caused by Salmonella typhi: diagnosis and management by percutaneous echo-guided needle aspiration. Ital J Gastroenterol. Jan 1996;28(1):31-3. [Medline].

  27. Giorgio A, Tarantino L, Mariniello N, et al. Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance. Radiology. Apr 1995;195(1):122-4. [Medline].

  28. Gloor B, Ly Q, Candinas D. Role of laparoscopy in hepatic cyst surgery. Dig Surg. 2002;19(6):494-9. [Medline].

  29. Greenwood LH, Collins TL, Yrizarry JM. Percutaneous management of multiple liver abscesses. AJR Am J Roentgenol. Aug 1982;139(2):390-2. [Medline].

  30. Haaga JR, Weinstein AJ. CT-guided percutaneous aspiration and drainage of abscesses. AJR Am J Roentgenol. Dec 1980;135(6):1187-94. [Medline].

  31. Haron E, Feld R, Tuffnell P, et al. Hepatic candidiasis: an increasing problem in immunocompromised patients. Am J Med. Jul 1987;83(1):17-26. [Medline].

  32. Herbert DA, Fogel DA, Rothman J, et al. Pyogenic liver abscesses: successful non-surgical therapy. Lancet. Jan 16 1982;1(8264):134-6. [Medline].

  33. Horii K, Yamazaki O, Matsuyama M, et al. Successful treatment of a hepatic abscess that formed secondary to fish bone penetration by percutaneous transhepatic removal of the foreign body: report of a case. Surg Today. 1999;29(9):922-6. [Medline].

  34. Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg. May 1996;223(5):600-7; discussion 607-9. [Medline].

  35. Hughes MA, Petri WA Jr. Amebic liver abscess. Infect Dis Clin North Am. Sep 2000;14(3):565-82, viii. [Medline].

  36. Jan YY, Yeh TS, Chen MF. Cholangiocarcinoma presenting as pyogenic liver abscess: is its outcome influenced by concomitant hepatolithiasis?. Am J Gastroenterol. Feb 1998;93(2):253-5. [Medline].

  37. Johannsen EC, Sifri CD, Madoff LC. Pyogenic liver abscesses. Infect Dis Clin North Am. Sep 2000;14(3):547-63, vii. [Medline].

  38. Kar P, Kapoor S, Jain A. Pyogenic liver abscess: aetiology, clinical manifestations and management. Trop Gastroenterol. Oct-Dec 1998;19(4):136-40. [Medline].

  39. Katkhouda N, Mavor E. Laparoscopic management of benign liver disease. Surg Clin North Am. Aug 2000;80(4):1203-11. [Medline].

  40. Khanna R, Levendoglu H. Liver abscess due to Yersinia enterocolitica: case report and review of the literature. Dig Dis Sci. Apr 1989;34(4):636-9. [Medline].

  41. Lamps LW, Pinson CW, Raiford DS, et al. The significance of microabscesses in liver transplant biopsies: a clinicopathological study. Hepatology. Dec 1998;28(6):1532-7. [Medline].

  42. Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. Feb 2005;100(2):322-31.

  43. Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. Oct 1986;146(10):1913-6. [Medline].

  44. MacDonald GA, Greenson JK, DelBuono EA, et al. Mini-microabscess syndrome in liver transplant recipients. Hepatology. Jul 1997;26(1):192-7. [Medline].

  45. Mandel SR, Boyd D, Jaques PF, et al. Drainage of hepatic, intraabdominal, and mediastinal abscesses guided by computerized axial tomography. Successful alternative to open drainage. Am J Surg. Jan 1983;145(1):120-5. [Medline].

  46. Mathieu D, Vasile N, Fagniez PL, et al. Dynamic CT features of hepatic abscesses. Radiology. Mar 1985;154(3):749-52. [Medline].

  47. Mazza D, Gugenheim J, Toouli J, et al. Survival of a liver graft recipient treated for an aspergillar liver abscess. Clin Infect Dis. Oct 1996;23(4):831-2. [Medline].

  48. McDonald AP, Howard RJ. Pyogenic liver abscess. World J Surg. Jul 1980;4(4):369-80. [Medline].

  49. McDonald KL, Davani M. The rim sign in hepatic abscess: case report and review of the literature. J Nucl Med. Aug 1997;38(8):1282-3. [Medline].

  50. Mir-Madjlessi SH, McHenry MC, Farmer RG. Liver abscess in Crohn's disease. Report of four cases and review of the literature. Gastroenterology. Oct 1986;91(4):987-93. [Medline].

  51. Mischinger HJ, Hauser H, Rabl H, et al. Pyogenic liver abscess: studies of therapy and analysis of risk factors. World J Surg. Nov-Dec 1994;18(6):852-7; discussion 858. [Medline].

  52. Moore-Gillon JC, Eykyn SJ, Phillips I. Microbiology of pyogenic liver abscess. Br Med J (Clin Res Ed). Sep 26 1981;283(6295):819-21. [Medline].

  53. Mulholland MW, Lillemoe KD, Doherty GM. Hepatic infection and acute hepatic failure. In: Greenfield's Surgery Scientific Principles and Practice. 4th ed. 2006:909-925.

  54. Perez-Cruet MJ, Grable E, Drapkin MS, et al. Pylephlebitis associated with diverticulitis. South Med J. May 1993;86(5):578-80. [Medline].

  55. Philips RL. Computed tomography and ultrasound in the diagnosis and treatment of liver abscesses. Australas Radiol. Aug 1994;38(3):165-9. [Medline].

  56. Pope IM, Poston CJ. Pyogenic liver abscess. Surgery of the Liver and Biliary Tract. 2000;1135-1145.

  57. Quinlivan D, Davis TM, Daly FJ, et al. Hepatic abscess due to Eikenella corrodens and Streptococcus milleri: implications for antibiotic therapy. J Infect. Jul 1996;33(1):47-8. [Medline].

  58. Rabkin JM, Orloff SL, Corless CL, et al. Hepatic allograft abscess with hepatic arterial thrombosis. Am J Surg. May 1998;175(5):354-9. [Medline].

  59. Rahimian J, Wilson T, Oram V. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. Dec 1 2004;39(11):1654-9.

  60. Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. Apr 1998;170(4):1035-9. [Medline].

  61. Rintoul R, O'Riordain MG, Laurenson IF, et al. Changing management of pyogenic liver abscess. Br J Surg. Sep 1996;83(9):1215-8. [Medline].

  62. Rubin RH, Swartz MN, Malt R. Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Am J Med. Oct 1974;57(4):601-10. [Medline].

  63. Sabbaj J. Anaerobes in liver abscess. Rev Infect Dis. Mar-Apr 1984;6 Suppl 1:S152-6. [Medline].

  64. Sabbaj J, Sutter VL, Finegold SM. Anaerobic pyogenic liver abscess. Ann Intern Med. Oct 1972;77(4):627-38. [Medline].

  65. Seeto RK, Rockey DC. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine (Baltimore). Mar 1996;75(2):99-113. [Medline].

  66. Serste T, Bourgeois N, Vanden Eynden F, et al. Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin. Am J Gastroenterol. Jun 2007;102(6):1209-15. [Medline].

  67. Sheinfeld AM, Steiner AE, Rivkin LB, et al. Transcutaneous drainage of abscesses of the liver guided by computed tomography scan. Surg Gynecol Obstet. Nov 1982;155(5):662-6. [Medline].

  68. Soni PN, Hoosen AA, Pillay DG. Hepatic abscess caused by Salmonella typhi. A case report and review of the literature. Dig Dis Sci. Aug 1994;39(8):1694-6. [Medline].

  69. Sparberg M, Gottschalk A, Kirsner JB. Liver abscess complication regional enteritis: report of two cases. Gastroenterology. Nov 1965;49(5):548-51. [Medline].

  70. Strungs I, Farrell DJ, Matar LD, et al. Multiple hepatic abscesses due to Yersinia enterocolitica. Pathology. Oct 1995;27(4):374-7. [Medline].

  71. Sugano S, Matuda T, Suzuki T, et al. Hepatic actinomycosis: case report and review of the literature in Japan. J Gastroenterol. Oct 1997;32(5):672-6. [Medline].

  72. Tachopoulou OA, Vogt DP, Henderson JM, et al. Hepatic abscess after liver transplantation: 1990-2000. Transplantation. Jan 15 2003;75(1):79-83. [Medline].

  73. Tan Y, Chung AY, Chow PK et al. An Appraisal of Surgical and Percutaneous Drainage for Pyogenic Liver Abscesses Larger than 5 cm. Annals of Surgery. 2005;241:485-490.

  74. Tazawa J, Sakai Y, Maekawa S, et al. Solitary and multiple pyogenic liver abscesses: characteristics of the patients and efficacy of percutaneous drainage. Am J Gastroenterol. Feb 1997;92(2):271-4. [Medline].

  75. Thaler M, Pastakia B, Shawker TH, et al. Hepatic candidiasis in cancer patients: the evolving picture of the syndrome. Ann Intern Med. Jan 1988;108(1):88-100. [Medline].

  76. Thomas PG, Ravindra KV. Amebiasis and biliary infection. Surgery of the Liver and Biliary Tract. 2000;1147-1166.

  77. Townsend CM, Beuchamp RD, Evers BM. The liver. In: Sabiston Textbook of Surgery. 17th ed. 2004:1513-1567.

  78. Trump DL, Fahnestock R, Cloutier CT, et al. Anaerobic liver abscess and intrahepatic metastases: a case report and review of the literature. Cancer. Feb 1978;41(2):682-6. [Medline].

  79. Tsui BC, Mossey J. Occult liver abscess following clinically unsuspected ingestion of foreign bodies. Can J Gastroenterol. Jul-Aug 1997;11(5):445-8. [Medline].

  80. Vakil N, Hayne G, Sharma A, et al. Liver abscess in Crohn's disease. Am J Gastroenterol. Jul 1994;89(7):1090-5. [Medline].

  81. Vallejo JG, Stevens AM, Dutton RV, et al. Hepatosplenic abscesses due to Brucella melitensis: report of a case involving a child and review of the literature. Clin Infect Dis. Mar 1996;22(3):485-9. [Medline].

  82. Vukmir RB. Pyogenic hepatic abscess. Am Fam Physician. May 1 1993;47(6):1435-41. [Medline].

  83. Wells CD, Arguedas M. Amebic liver abscess. South Med J. Jul 2004;97(7):673-82.

  84. Wong E, Khardori N, Carrasco CH, et al. Infectious complications of hepatic artery catheterization procedures in patients with cancer. Rev Infect Dis. Jul-Aug 1991;13(4):583-6. [Medline].

  85. Yang DM, Kim HN, Kang JH. Complications of pyogenic hepatic abscess: computed tomography and clinical features. J Comput Assist Tomogr. May-Jun 2004;28(3):311-7.

  86. Yeh TS, Ho YP, Jan YY, et al. Efficacy of color sonography and harmonic scalpel in laparoscopic management of multiple/lobulated liver cysts and abscesses. Hepatogastroenterology. Mar 2007;54(74):485-8. [Medline].

  87. Yeh TS, Jan YY, Jeng LB, et al. Pyogenic liver abscesses in patients with malignant disease: a report of 52 cases treated at a single institution. Arch Surg. Mar 1998;133(3):242-5. [Medline].

  88. Yoshida M, Mitsuo M, Kutsumi H, et al. A successfully treated case of multiple liver abscesses accompanied by portal venous gas. Am J Gastroenterol. Nov 1996;91(11):2423-5. [Medline].

 
Previous
Next
 
Table 1: Presenting symptoms and signs in 715 patients diagnosed with liver abscess.
Table 2: Microbiologic results from 312 cases of liver abscess compiled from the literature.
Table 3: Comparison of the radiologic procedures used in the diagnosis of liver abscess.
Table 4: Underlying etiology of 1086 cases of liver abscess compiled from the literature.
Computed tomography (CT) scan findings of liver abscess are shown. A large, septated abscess of the right hepatic lobe is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
Computed tomography (CT) scan findings of liver abscess are shown. A large anterior abscess involving the left hepatic lobe is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.