Recent Clinical Aspect of Hepatic Abscess: Development of Diagnosis and Treatment

During the last 5 years, 18 cases of pyogenic hepatic abscess were reviewed for changes in the cause, imaging and therapeutic method, and the prognosis. The causes of the heptic abscesses were portal seeding in one case, arterial seeding in two cases, cryptogenic in four cases, biliary tract disease in seven cases, ischemia due to transcatheter arterial embolization (TAE) in three cases and local infection due to partial hepatectomy in one case. The patients with first three former causes had a solitary lesion, a cystic type lesion in the echogram. A species of Klebsiella was found in the abscess culture, and they recovered completely after percutaneous hepatic abscess drainage under echography. The patients whose abscesses were caused by biliary infection or TAE showed multiple lesions, cystic and tumor type lesions in the echogram, and irregular internal density by computerized tomography. Several species of bacteria (Klebsiella, Escherichia coli, Pseudomonas and anaerobic bacilli) were found in the abscess cultures. The frequency of occurrence of several species of bacteria in a single patient's abscess culture was 70%. Although percutaneous biliary drainage and percutaneous abscess drainage were performed, four patients whose primary disease was a malignancy died of disseminated intravascular coagulation with organ failure. These methods of diagnosis for hepatic abscesses have been developed and the therapeutic results for a solitary hepatic abscess improved but those for multiple hepatic abscesses were still not good.