Therapeutic approach to hepatic abscesses

Thirty-five patients with hepatic abscesses were treated at our institution during an 8-year period. Twenty-nine patients had bacterial abscesses, and six patients had amoebic abscesses. The patients were admitted with fever (95%), right upper quadrant pain (63%), and nausea and vomiting (40%) as the most common symptoms. Eleven patients had some inciting cause for the abscess formation; the remaining 18 bacterial abscesses were cryptogenic. The primary abnormal test results were leukocytosis (91%) and liver enzyme elevations (80%). All patients with amoebic abscesses were serologically positive for amoebic infection. Computed tomography (CT) was the most effective imaging modality for diagnosis. Twenty patients were treated with open surgical drainage, 11 with percutaneous drainage, and 4 with antibiotics alone. Three of the four latter patients had amoebic abscesses. Abscesses in two patients initially treated with percutaneous drainage did not resolve, and the patients ultimately required surgery. The remaining indications for surgery were concomitant conditions requiring surgical intervention or inaccessibility of the abscess to percutaneous drainage. Antibiotics were given to all patients, with treatment duration from 10 to 60 days. The hospital mortality was 6% due to sepsis and a postoperative myocardial infarction in one patient, and perioperative myocardial infarction in another; overall morbidity was 20%. At a mean follow-up of 13 months, all surviving patients had resolution of the abscess shown by either CT (11 patients) or clinical examination (22 patients). We conclude that effective drainage, whether it be surgical or percutaneous, and appropriate antibiotic coverage are the mainstays of therapy for hepatic abscesses.