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Two patients with pyogenic liver abscesses and pylephlebitis, one proven by autopsy and the other diagnosed clinically, are presented. One patient recovered after a total dose of 9,830,000 units of penicillin, of which 7,000,000 units were given by continuous intravenous drip at the rate of 1,000,000 units per day. If surgical intervention is not feasible, the use of penicillin in this, or even larger doses, is suggested as a possible life saving measure.

Seventy four patients of pyogenic liver abscess prospectively evaluated by clinical, haematological, microbiological and sonographic methods. The main objective of this study was to find out correlation between intake of indigenous alcohol and to identify class population affected. Most of the affected patients of pyogenic liver abscess are lower and middle class male and who are farmer with mean age 37±11.7 years. Our study reveals '59 (80%) cases consume that alcohol, among them 56 (95%) patients took locally prepared alcohol (TARI). Organism recovered from pyogenic liver abscess vary considerably. Escherichia coli has been the organism most commonly isolated in our study. 57 cases were treated with ciprofloxacin and sonographic guided needle aspiration. Ciprofloxacin still remains as the drug of choice for this disease and recovery was excellent. So the study reveals that indigenous alcohol is associated with the development of pyogenic liver abscess. doi: 10.3329/taj.v18i1.3299 TAJ 2005; 18(1): 21-24

Summary 1.A most unusual case of a liver abscess caused by a Salmonella is reported, apparently due to infection of a traumatic hematoma. 2.A review and description of pyogenic liver abscesses is presented, with notes on etiology, clinical picture and prognosis and treatment, emphasizing the clinical differences between the single and the multiple type of pyogenic abscesses of the liver.

1. 1. Pyogenic liver abscess occurs rarely in the aged and is characterized by a high mortality. 2. 2. The pathogenesis of pyogenic liver abscess in individuals of advanced years is similar to that of hepatic infection in younger groups of patients. In the aged, however, the diagnosis is frequently rendered more difficult by the fact that these older patients react minimally to the disease process. In individuals past the fifth decade, the onset of the infection may be insidious, and the classical signs and symptoms of pyogenic liver abscess may be diminished or absent. 3. 3. In the aged, the indications for operative treatment of pyogenic liver abscess are the same as in younger individuals, and age alone must not be considered the determining factor when the advisability of operation is in question. The type of drainage operation performed, whether transperitoneal, transpleural, or extraserous, is determined by the situation of the lesion, as in younger patients. The peculiar susceptibility of older individuals to surgical shock, because of the likelihood of concomitant degenerative changes of a cardiorenal or nervous nature, should be kept in mind, however. Success in the handling of pyogenic liver abscess in the aged will only be attained by early diagnosis and careful preoperative and postoperative treatment. In these cases, a surgical technic of utmost gentleness should be employed, and all operative procedures should be carried out in the shortest period of time practicable. 4. 4. Two cases of pyogenic liver abscess in individuals of the seventh decade of life are presented. In one case a fatal infection was associated with a calcified echinococcic cyst of the dome of the liver. In the other, recovery followed abdominal drainage of an abscess caused by the rupture of an infected gallbladder into the liver parenchyma.

The study was conducted to assess the clinico-pathological profile of 50 liver abscess cases. This study showed that liver abscess is more common in male than in female. In present study Amoebic Liver Abscess (ALA) is much more common than Pyogenic Liver Abscess (PLA) and almost all the cases belonged to low or medium socio-economic class from rural areas. This may be due to poor living conditions, over crowding and unhygienic practices which leads to fecal contamination of food and drinks which help in transmission of amoeba. Liver abscess has correlation with consumption of indigenous alcohol. Ultrasonogram is an easy, widely available non-invasive and dependable investigation to diagnose liver abscess. In the absence of sophisticated investigations (e.g. Serum antibody against amoeba) at hand, only aspiration and study of pus is a good guide to confirm and to differentiate ALA from PLA. Complications like recurrence, pleuro-peritoneal involvement or rupture of the abscess are not common. doi: 10.3329/taj.v21i1.3218 TAJ 2008; 21(1): 44-49

1. 1. An analysis is presented of 830 cases of pyogenic hepatic abscess collected from the world literature and a presentation of 47 additional cases is made. 2. 2. During the ten-year period, 1928–1937 inclusive, there were 186 cases of abscess of the liver admitted to Charity Hospital and Touro Infirmary in New Orleans. Of this number, 139 (74.7 per cent) were amebic abscesses and 47 (25.2 per cent) were pyogenic. During this same period there were 540,776 total admissions to the Charity Hospital, among which there were 160 (0.029 per cent) abscesses of the liver, and 1,152 patients diagnosed as having liver disease, of which 10.2 per cent were amebic abscesses and 3.6 per cent were pyogenic abscesses. The sex incidence of pyogenic hepatic abscess reveals a preponderance of occurrence in the male, 67.4 per cent in the collected series and 70.2 per cent in the authors'. This is probably explained by the fact that the etiologic agents occur more frequently in the male. The greatest age incidence is from the third to the fifth decades. There is no significant racial predisposition. 3. 3. Pyogenic liver abscess is primarily a complication of an intra-abdominal suppurative process with the antecedent lesions in the portal area. Of these lesions, suppurative appendicitis is the most frequent. Appendicitis was the etiologic agent in 34.2 per cent of the collected cases and 10.6 per cent of the authors' cases. This discrepancy is due to the fact that the majority of reports in the literature represented primarily the author's interest in pylephlebitis and liver abscess as complications of appendicitis. Pyogenic liver abscess can be caused also by direct extension from contiguous suppurative processes, trauma, and by transportation of microorganisms through the hepatic artery from distant foci. There is a relatively large group (59.5 per cent) of the authors' series termed “cryptogenic,” idiopathic, or primary pyogenic hepatic abscess in which the antecedent lesion could not be determined. 4. 4. The most frequently found organisms in pyogenic hepatic abscess are B. coli, streptococci, and staphylococci. 5. 5. Pyogenic hepatic abscess may be multiple or single, and usually involves the right lobe. The abscesses were single in 28.8 per cent, multiple in 71.1 per cent, and involved the right lobe alone in 41.8 per cent of the collected cases. In the authors' forty-seven cases these incidences were 54.5 per cent, 45.4 per cent, and 68.1 per cent, respectively. 6. 6. The principal symptoms and signs of pyogenic hepatic abscess are fever, pain and tenderness over the hepatic area, liver enlargement, chills, and jaundice. Characteristically, there is a leucocytosis with a proportionate increase in polymorphonuclear leucocytes. The characteristic roentgenologic changes are elevation and immobility of the diaphragm, usually the right. The diagnosis was positive in 82.1 per cent of 28 cases in the authors' series in which roentgenologic studies were made. 7. 7. The prognosis in pyogenic hepatic abscess depends upon: (1) the multiplicity of the lesions; (2) the presence or absence of complications; and (3) the type of drainage instituted. Whereas of the twenty-four cases in the authors' series with single abscess of the liver nine (37.5 per cent) died, of the twenty cases with multiple abscesses, nineteen (95 per cent) died. The mortality rate was 90.9 per cent in those cases with complications and 36 per cent in the cases without complications. The total mortality rate was 79.6 per cent in the collected cases and 72.3 per cent in the authors' series. Whereas in those cases not operated upon the mortality rate was 100 per cent in both series, in the cases in which operation was performed the mortality was 50.9 per cent in the collected series and 64.8 per cent in the authors' series. 8. 8. The complications of pyogenic hepatic abscess are usually the result of rupture or direct extension into one of the adjacent viscera. 9. 9. The treatment of pyogenic hepatic abscess may be divided into: (1) prophylactic and (2) surgical. Prophylaxis is particularly applicable to multiple hepatic abscesses which are preceded by appendicitis and pylephlebitis, because once the development has proceeded to the stage of multiple abscess formation, surgical therapy offers only the slightest hope. The treatment of solitary pyogenic hepatic abscess consists of incision and drainage. 10. 10. The employment of that type of drainage which completely avoids the slightest possibility of contamination of the peritoneal or pleural cavity is of paramount importance. The results obtained in the authors' series of cases clearly demonstrate this fact. Of the twenty-two cases in which the transperitoneal approach was employed for the institution of drainage, there were sixteen deaths (72.7 per cent). The transpleural method of drainage was used in nine cases with six deaths (66.6 per cent). In contrast to these high mortality rates is the 33.3 per cent mortality obtained in six cases in which the extraserous approach was used.

Summary Two cases of pyogenic abscess formation in the right lobe of the liver secondary to sigmoid diverticulitis are presented and discussed. The rarity of such a combination is pointed out.

Sixty-one cases of pyogenic liver abscess seen at the UCLA Hospital and the Wadsworth Veterans Administration Hospital are reviewed. Hepatic abscess should be suspected in those patients with continued sepsis who, in addition, have an increase in size and tenderness of the liver. Since the introduction of antibiotic therapy, as well as of newer diagnostic technics, there has been an increased awareness of this clinical situation. Recently there have also been changes in the etiologic, bacteriologic, and operative approach to this lesion. Previously, liver abscess has been due primarily to portal infection from intraperitoneal disease. In this series 60 per cent of the cases were due to either intraperitoneal disease or generalized septicemia. Biliary obstructive disease in older patients has also begun to increase. The predominant organisms cultured were streptococcus and staphylococcus. Gram-negative organisms, which previously accounted for the majority of abscesses, were found in only twelve cases. In the past, drainage through an “extraperitoneal” approach has been emphasized. With vigorous antibiotic therapy, however, the transabdominal approach may be employed with minimal danger. Solitary pyogenic abscess is best treated by open surgical drainage as soon as it is diagnosed. When there are multiple small abscesses in the liver, effective surgical drainage seldom can be accomplished and one must depend upon intensive chemotherapy, which at times can provide an effective recovery. An understanding of these concepts will allow early and more vigorous therapy to be instituted.

1. 1. A case of multiple pyogenic liver abscess with complicating sudden rupture into the pericardial sac is presented. 2. 2. The source of the liver abscess was not found at necropsy. 3. 3. Penicillin, 19,050,000 units, plus supportive therapy over an eight-week period, held the infection in abeyance but did not overcome it. The responsible organism was penicillin sensitive as judged by the clinical response. 4. 4. Typical electrocardiographic changes of acute pericarditis were demonstrated in the limb leads, with minimal findings in the chest leads (CF series).

Four cases of pyogenic liver abscess were diagnosed and localized by angiography and liver scan.Closed drainage by percutaneous aspiration under fluoroscopic guidance was employed for treatment in 2 cases.The use of closed aspiration along with appropriate antibiotics can decrease morbidity and mortality as well as adequately manage the patient with pyogenic liver abscess.

Pyogenic liver abscess with gas visible on roentgen examination is usually rapidly progressive and often difficult to diagnose. The presence of gas within the abscess allows the radiologist to offer a definitive diagnosis. The organism in the 3 cases presented in this article was one of the klebsiellas. Differential diagnosis includes subphrenic abscess, emphysematous cholecystitis, right renal or perinephric abscess, hepatic flexure interposed between the diaphragm and liver, and partial abdominal heterotaxia.

Excerpt Thirty-three amebic and 33 pyogenic liver abscesses have been seen at 3 Little Rock hospitals since 1940. This paper compared the clinical findings in these two diseases from the standpoint...

LIVER abscess, despite refinement in diagnostic and therapeutic aids, remains a serious illness with a high morbidity and mortality. Due to the pitfalls in differentiating amebic from pyogenic abscess and the marked difference in the mortality, we have reviewed the cases of liver abscess at Parkland Memorial Hospital since 1943 in an effort to establish clinical and laboratory features which might be used to differentiate the two. At the same time, a reasonable approach to therapy of hepatic abscesses might be established. Methods Cases were obtained by review of the infectious disease service and record room files and autopsy protocols at Parkland Memorial Hospital from 1943 to 1966. Only patients with macroscopic abscesses were selected for this review. Based on the following features, the cases were divided into amebic and pyogenic groups. Patients were classified as having amebic abscesses if they manifested one of the following: (1) demonstration of amebae

The role of anaerobic bacteria in the etiology of pyogenic liver abscess has not been fully recognized. In 11 years we have encountered 25 cases of anaerobic liver abscess, which represent...