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Fusobacterium necrophorum, a Gram-negative anaerobe, is the primary etiologic agent of liver abscesses of beef cattle. The bacterium, a member of the microbial community of the rumen, travels to the liver via portal circulation to cause abscesses. The severity of liver abscesses vary from mild with one or two small abscesses to severe with medium to large multiple abscesses. Leukotoxin, a secreted protein, is the critical virulence factor involved in the infection. Our objective was to compare leukotoxin production between strains of F. necrophorum isolated from mild and severe liver abscesses collected from slaughtered cattle. The quantification of leukotoxin was based on assays to measure cytotoxicity and protein antigen concentration. One-hundred strains, 50 from mild and 50 from severe abscesses, were utilized in the study. Cell-free supernatants were prepared from cultures grown in anaerobic broth at 9 and 24 h incubations. The leukotoxic activity was quantified by measuring cytotoxicity based on the release of lactic dehydrogenase from bovine lymphocyte cells, BL3, treated with the culture supernatant. Leukotoxin protein concentration was quantified by a sandwich ELISA assay with a leukotoxin-specific monoclonal antibody as the capture antibody. The leukotoxin activity and concentration were highly variable among the strains within each severity of liver abscesses. Although the leukotoxic activity was unaffected by incubation time, leukotoxin protein concentration was consistently higher at 24 h compared to 9 h incubation. Strains from severe liver abscesses had significantly higher leukotoxic activity and higher protein concentration compared to strains from mild liver abscesses (P < 0.0001) at both 9 and 24 h culture supernatants. Across all strains, the correlation coefficients between leukotoxic activity and leukotoxin concentration at 9 and 24 h were 0.14 (P = 0.17) and 0.47 (P < 0.0001), respectively. In conclusion, strains isolated from severe liver abscesses had significantly higher leukotoxic activities and leukotoxin protein concentrations compared to strains isolated from mild liver abscesses., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Extramedullary haematopoiesis (EMH) is defined as haematopoiesis occurring in organs outside the bone marrow. The liver is one of the rare sites of EMH, and to the best of our knowledge, a few cases of adult EMH of the liver have been reported in the last 20 years. Here, we reported the case of a 68-year-old man with a known history of myelofibrosis presented with vague abdominal pain. An abdominal CT scan showed a hypoattenuating periportal mass encasing the portal vein. The final diagnosis of EMH was made through the histopathological examination. This is a rare presentation of EMH, which may be easily mistaken for other pathologies such as metastases. Familiarity with this type of presentation aids in correctly diagnosing it in an appropriate clinical setting., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings., Sources of Data: We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'., Areas of Agreement: Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics., Areas of Controversy: In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings., Growing Points: As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced., Areas Timely for Developing Research: The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective To enhance theoretical support of pyogenic liver abscess (PLA) treatment by comparing characteristics of patients with either PLA with an identified infectious origin (non-cryptogenic) or PLA with no obvious underlying cause (cryptogenic). Methods This retrospective study included all first episodes of PLA in adults admitted to a tertiary hospital between 2009 and 2016. Relevant clinical data were collected for patients with cryptogenic or non-cryptogenic PLA and compared across a number of characteristics. Results In all, 178 patients were included: 111 cases (62.4%) of cryptogenic PLA, and 67 cases (37.6%) of non-cryptogenic PLA. Diabetes mellitus was significantly more prevalent in patients with cryptogenic PLA than those with non-cryptogenic PLA. The proportion of multidrug resistance/poly-microbial infection was significantly lower and Klebsiella pneumoniae infection was significantly higher in the cryptogenic versus non-cryptogenic PLA group. Metastatic infection occurred in four patients with cryptogenic PLA only, and all had diabetes and K. pneumoniae infection. Multivariate logistic regression analysis revealed that male sex, diabetes and K. pneumoniae were independent predictors for cryptogenic PLA. Conclusions Cryptogenic and non-cryptogenic PLA have distinctly different characteristics, suggesting a potential need for different treatment approaches.

Background: Salmonella enterica serovar Enteritidis is among the most reported serotypes of Salmonella species worldwide, but is rarely reported as the causative agent of a liver abscess., Case Report: We present a patient with an abdominal blunt trauma. An initial abdominal computed tomography scan revealed a rupture of the right kidney and of the liver. Two days later, his physical state deteriorated and a new computed tomography scan was obtained. An extremely large 8-centimetre liver abscess was verified. Due to the unsatisfying response to antibiotic therapy and percutaneous drainage, we operated on the patient. An appendectomy, cholecystectomy and bisegmental liver resection were performed. An intraoperative swab from the abscess was positive for Salmonella enterica serovar Enteritidis. The patient was given intravenous ciprofloxacine. The post-operative course was complicated by a Coagulase-negative Staphylococcus infection of the wound, which improved with antibiotic therapy., Conclusion: Blunt abdominal trauma may initiate an unpredictable course of the disease in chronic Salmonella carriers.

To investigate the incidence and outcome of major complication following conventional transarterial embolization/chemoembolization (TAE/TACE) therapy for hepatocellular carcinoma (HCC).From May 2010 to May 2016, all patients with major complication following conventional TAE/TACE for HCC were included. Major complication was defined as admission to a hospital for therapy, an unplanned increase in the level of care, prolonged hospitalization, permanent adverse sequelae, or death after conventional TAE/TACE therapy by Society of Interventional Radiology.During the study period, a total of 2863 TAE/TACE procedures were performed among 1120 patients, and a total of 24 patients (21 male and 3 female) developed major complication with the incidence of 2.1% (24/1120) per patient and 0.84% (24/2863) per TAE/TACE procedure. The major complications were liver rupture (n = 6), liver abscess (n = 5), femoral artery pseudoaneurysm (n = 3), cholecystitis (n = 2), biloma (n = 2), pulmonary embolism (n = 2), and 1 each of the following: cerebral lipiodol embolism, tumor lysis syndrome, partial intestinal obstruction, gallbladder perforation. The mean interval from last TAE/TACE procedure to the diagnosis of major complication was 11.1 ± 7.7 days. The treatments of the complications were conservative treatment (n = 12), conservative treatment plus percutaneous drainage (n = 3), ultrasound-guided thrombin injection (n = 3), conservative treatment plus TAE (n = 2), and conservative treatment plus surgery (n = 2). Of the 24 patients, 20 patients were recovered, and remaining 4 patients were died of major complications; therefore, the mortality rate of major complication was 16.7% (4/24).Major complication following conventional TAE/TACE therapy is uncommon; the outcomes are benign of most major complications, but some are mortality., Competing Interests: The authors have no conflicts of interest to disclose.

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

Introduction: Gastrointestinal stromal tumors are the most common mesenchymal neoplasms of the gastrointestinal tract. These tumors represent more than 80% of all mesenchymal tumors found in the gastrointestinal tract, though they account for only approximately 3% of all gastrointestinal malignancies. Literature offers case reports, which describe symptomatic gastrointestinal stromal tumors and they generally represent patients with larger tumors., Case Report: We present the case of a small gastrointestinal stromal tumor in a 40-year-old man, with associated giant liver hemangioma and fever, and with history of abdominal discomfort and fever. Clinical examination revealed hepatosplenomegaly, palpable mass in the right lower abdomen, and signs of neurofibromatosis type 1 (Morbus von Recklinghausen). Computed tomography revealed a giant tumor in the right lobe of the liver. Magnetic resonance showed abscess in the hemangioma of the liver. An intestinal tumor was incidentally found and excised during surgical laparotomy. An intestinal gastrointestinal stromal tumor was revealed by histopathology and confirmed by immunohistochemistry. Although a multidisciplinary team proposed surgical removal of the liver tumor mass, the surgeons decided to follow up the patient because of a high risk of new intervention., Conclusion: According to the available data, this is a very rare case of small intestinal gastrointestinal stromal tumor, with symptoms of fever and giant abscess in the liver hemangioma.

The results of treatment of 55 patients, in whom hepatic resection was performed in 2004-2011 yrs, were analyzed. In 30 patients (main group) various kinds of hepatic resection was done for chronic abscess of the organ; in 25 (control group)--hepatic resection was conducted for hepatic tumors. In both groups o patients a comparative estimation of hepatic functional state after the organ resection was conducted in accordance to albumin level in the blood serum, the coagulogram indices, integral ration of transferases activity and a bilirubin content. There was proved, that a hepatic functional state disorders after its partial resection in patients, suffering chronic hepatic abscess, are similar to those in tumoral hepatic affection.

Background and Objectives: Liver abscess (LA) is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom (UK)., Design and Setting: Retrospective review of LA patients from three tertiary care centers (2 from Saudi Arabia and 1 from the UK) over a period of 10 years, from 1995 to 2005., Patients and Methods: Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome., Results: A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean (SD) age was 45.2 (20.3) years for those from Saudi Arabia and 55.4 (18.8) years for those from the UK (P=.022). The majority of the patients were males (70% from Saudi Arabia and 80% from the UK). Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 (80%) patients. Organisms were isolated in 43 (52%) cases and the majority of these were coliforms (58%). Amebic liver abscesses occurred in 19 (23%) patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 (80%) patients with aspiration and/or antibiotics, and 9 (10.8%) patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome (P=.008, .029 and .001, respectively)., Conclusions: Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas.

Capsular serotypes K1 and K2, the rmpA gene (a regulator of the mucoid phenotype) and aerobactin from Klebsiella pneumoniae have been identified as the major virulence factors for pyogenic liver abscesses with high morbidity, mortality and severe complications. The pathological mechanisms remain unclear. In this study, we compared liver immune responses and pathological changes in response to different serotypes of K. pneumoniae infections. A mouse model was used to investigate cytokine and chemokine production, histopathology findings, phagocytic uptake and mortality induced by serotypes K1 (magA(+), rmpA(+), aerobactin(+)), K2 (magA(-), rmpA(+), aerobactin(+)), K62 (magA(-), rmpA(-), aerobactin(-)) and an acapsulated isogenic K1 mutant (ΔK1, magA(+), rmpA(+), aerobactin(+)). K. pneumoniae serotypes K1 and K2 showed lower 50% lethal dose values and more phagocytic resistance to neutrophils than K62 and the ΔK1 mutant. In sequential liver samples, viable bacteria counts increased 3 h to 3 days after low-dose inoculation (<10(1) colony-forming unit (cfu)) with K1 and K2, while K62 and ΔK1 cleared rapidly and became undetectable even with high-dose inoculation (∼2.9 × 10(5) cfu). Time-dependent increases in cytokines and chemokines, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-10, keratinocyte-derived chemokines and macrophage inflammatory protein-2, were observed in the serum and liver tissue of K1- and K2-infected mice, and severe disease progression manifesting as microabscesses was also identified. K62 and ΔK1 inoculation did not result in similar immune responses and histological changes. These findings illustrate the critical role of phagocytic resistance against innate immunological defense mechanisms as well as its contribution to the development of liver abscesses.

Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations', including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained and complications and mortality discussed.

Purpose: This study was conducted to evaluate the effectiveness of sonography, especially color Doppler sonography, in the differential diagnosis of cystic hepatic lesions., Methods: Ninety-two pathologically or clinically proven hepatic cystic lesions (20 cystic malignancies, 24 abscesses, and 48 simple cysts) were evaluated with gray-scale and color Doppler sonography. The sonographic features were analyzed retrospectively. The percentage, sensitivity, specificity, and positive and negative predictive values of the sonographic features of each disease category were calculated., Results: On gray-scale sonography, the simple cysts were easily distinguished from cystic malignancies and abscesses. While no significant differences were found between hepatic cystic malignancies and hepatic abscesses with respect to the number, shape, margin status, and presence of thick wall of the lesion, the presence of septation and mural nodules was significantly higher in the cystic malignancies than in abscesses. The sensitivity and specificity of color Doppler sonography in differentiating cystic malignancies from abscesses and simple cysts were 85% and 96%, respectively., Conclusions: Color Doppler sonography provides information about blood flow that supplements that gained on gray-scale sonography, and the presence of color signals in the solid portion of the cystic lesions carries a high diagnostic value in differentiating hepatic cystic malignancies from abscesses and simple cysts.

The objective of this paper is to describe the clinical and diagnostic characteristics of patients with pyogenic hepatic abscesses evaluated in the emergency room, and to know whether it is feasible to make an early diagnosis based on any of these characteristics. The setting was an urban, tertiary-care teaching hospital. This was a retrospective study of 63 adult patients admitted to our institution because of pyogenic liver abscesses from January 1991 to December 1998.

We described the clinical and bacteriological features of 12 cases of liver abscess caused by Streptococcus milleri group (SMG) during a 6-year period from 1993 to 1998. The gender was 11 males and 1 female with their ages ranging from 39 to 76 years old (mean: 53.4). The common symptoms were fever (100%), abdominal pain (67%), and appetite loss (58%). Nine cases had underlying diseases such as carcinomas and diabetes mellitus. Predominant causes of the liver abscess were cryptogenic (42%) and biliary tract disease (33%). Three patients died of an exacerbation of the carcinoma. Eight cases (67%) was single infection of SMG and no mixed infection with anaerobes. No strains isolated in this series showed resistance against penicillin G and ampicillin. SMG was highly isolated from the blood culture in eight of the 11 cases (73%). Liver abscess should be taken into consideration as one of the causes of SMG septicemia.

A 78-year-old retired pig farmer developed brucellosis and died of liver failure >20 years after her last exposure to infected livestock. This is an exceptionally long incubation period for this infection, which usually presents within weeks of exposure.

The prevalence, symptomatology, and outcome of Ascaris-induced liver abscess was studied prospectively in Kashmir, India, which is an endemic area of ascariasis, from December 1987 to December 1997. Of 510 patients with liver abscess admitted during this period, 74 had biliary ascariasis as the cause (14.51%). Of these 74 patients, 11 had intact ascaridae (live or dead) within the abscess. Six patients had a single abscess, and five had multiple abscesses. Seven patients had associated worms in the bile ducts. Ultrasonography was the main diagnostic procedure used. Ten patients were diagnosed based on clinical and ultrasound findings, and one was diagnosed during laparotomy. Most of the patients were young (age range 3-40 years) with a mean age of 17.20 years. Seven were females, and four were males. Ten patients underwent surgery; nine recovered completely, and one died postoperatively due to septicemia. Another patient died as well: a young child who presented late, was in refractory septic shock following suppurative cholangitis and liver abscess, and could not be taken for surgery. The mortality thus was 9.9%. Liver abscess following invasion of intrahepatic biliary radicles by ascaridae through the ampulla is an unusual complication of an otherwise common disease in Kashmir Valley, affecting children and young adults. The outcome depends on early diagnosis and surgical drainage of the abscess with extraction of worms from the ducts.

Historical, physical examination, clinicopathologic, radiographic and ultrasonographic findings of 13 dogs with hepatic abscesses were reviewed. Liver abscessation was characterized by number, size, shape, echogenicity and location. Solitary lesions greater than 3 cm were more common than multiple ones. The abscesses were mainly poorly echogenic lesions, often with central cavitation. The shape of the lesion ranged from round to oval or irregular. Enhancement artifact, abdominal effusion, regional lymphadenopathy and hyperechoic perihepatic fat, were identified in several dogs. Ultrasound-guided aspiration was performed in 10 of 13 dogs, and confirmed abscessation with cytologic and microbiologic evaluation. Ultrasound-guided percutaneous drainage of abscesses was performed as an adjunct to medical management in four dogs.

Color Doppler sonography was used to investigate the changes in intrahepatic portal hemodynamics in early stage hepatic abscesses (21 lesions). At time of patients' admission, 10 lesions measuring over 6 cm showed reverse flow from at least one of their corresponding segmental portal branches, but 11 lesions measuring 6 cm or less did not show this phenomenon. All portal branches with reverse flow eventually returned to a normal direction of flow after successful medication. In conclusion, a large early stage hepatic abscess may show temporary reverse portal flow on color imaging. Thus, a differential diagnosis of hepatic tumors with reverse portal flow should include early stage hepatic abscesses.

Suppurative disease of the liver and/or spleen is a rare and serious complication of human brucellosis. In the English-language literature, only nine cases have been reported, all involving adults with chronic infection. We report the case of a young child in whom abscesses of the liver and spleen developed during acute brucellosis. Brucella melitensis was cultured from an aspirate of the liver and from the bone marrow. After percutaneous drainage of the liver abscess, the patient responded to a 56-day course of antimicrobial therapy. To our knowledge, this is the first reported case of hepatosplenic abscess due to a Brucella species in a child.

Objectives: To determine typical clinical signs and clinicopathologic findings in dogs with hepatic abscesses, to assess outcome of treatment, and to evaluate the role that abdominal ultrasonography has in the diagnosis of hepatic abscesses in dogs and in monitoring response to treatment., Design: Retrospective case series., Animals: 14 dogs with hepatic abscesses., Results: Anorexia and lethargy were the most common historical complaints, followed by vomiting and diarrhea. Physical abnormalities included fever, dehydration, signs of abdominal pain, hepatomegaly, and mucosal bleeding. Hematologic abnormalities included leukocytosis with neutrophilia, mild to moderate thrombocytopenia, and mild anemia. Serum biochemical abnormalities included high alkaline phosphatase and alanine aminotransferase activities and high bilirubin concentration; hypoalbuminemia and prolonged coagulation values were also reported. Abdominal radiography revealed hepatomegaly, poor abdominal detail, a hepatic mass, or splenomegaly in 9 dogs. Thoracic radiography revealed alveolar consolidation or mixed bronchial/interstitial pulmonary patterns in 6 dogs. Hypoechoic, heteroechoic, or hyperechoic masses were identified in all dogs in which ultrasonography was performed. Escherichia coli, Clostridium sp, Klebsiella pneumoniae, Enterococcus sp, Staphylococcus epidermidis, and S intermedius were the most common bacteria isolated from hepatic abscesses. Concurrent infections were identified in the biliary tract, spleen, blood, endocardium, lung, prostate gland, peritoneum, lymph nodes, salivary gland, or brain of several dogs. Seven dogs died or were euthanatized before definitive treatment could be initiated. One dog was successfully treated with antibiotics and was alive 12 months after medical treatment. Six dogs were treated surgically (ie, full or partial liver lobectomy, drainage, abdominal lavage) and medically (ie, antibiotic administration). Five of these dogs survived and were alive 12 months after surgery. Ultrasonography was used to monitor response to treatment in several dogs., Clinical Implications: Hepatic abscesses are rare in dogs, but the clinical signs and clinicopathologic findings are similar to other inflammatory hepatic disease. Ultrasonography revealed abnormalities in all animals in which imaging studies were performed, and was successfully used to monitor response to treatment in several dogs. Medical and surgical treatments were used successfully to treat hepatic abscesses in dogs.

Clostridium septicum bacteremia is frequently associated with hematologic and colonic malignancies and neutropenia. It frequently produces 'metastatic' gangrene with excessive mortality. Standard therapy usually includes surgical debridement and antibiotics. We present a patient with metastatic breast cancer treated with high-dose chemotherapy and bone marrow transplantation. She was treated successfully with antibiotics alone despite developing Cl. septicum bacteremia and gas in hepatic metastases. The pathophysiology of this infection is reviewed.

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.

A case of multiple injury is reported in a young 35-year-old man affecting three different areas of the body which showed a septic-type development. Complete recovery was largely determined by the accuracy of the preoperative diagnosis and the correct maintenance of hemodynamic parameters.

Continuous normothermic interruption of hepatic blood flow for 20 minutes or longer was applied in 37 non-cirrhotic patients, including 7 having emergency operation and 30 elective operation. Hepatic blood inflow was interrupted for 40 to 47 minutes in 4 patients, 30 to 39 minutes in 7, 25 to 29 minutes in 14, and 20 to 24 minutes in 12. Postoperatively, 1 patient died of recurrent hemobilia, which was not related to intraoperative vascular interruption. Two patients had mild jaundice for 1 week after right trilobectomy, while the remaining 34 patients recovered uneventfully with no clinical hepatic insufficiency. This method is considered simple, safe, and acceptable for hepatic resection in non-cirrhotic patients.

A retrospective review of 29 consecutive patients with pyogenic hepatic abscesses was undertaken to ascertain the efficacy of various treatments. Percutaneous routes were used 25 times (aspiration alone in 16 and with concomitant drainage in nine), as a primary step 22 times and for recurrent abscesses, three times. An operation was required in nine patients; initially in five and after percutaneous treatment in four. Antibiotics alone were used twice. There were seven deaths, two after antibiotics alone and five after initial percutaneous aspirations. There were six recurrent abscesses, all but one after percutaneous aspiration. Our results suggest that antibiotics alone and percutaneous aspiration alone are inadequate in the treatment of pyogenic hepatic abscesses; percutaneous management is valid provided concomitant drainage is used, and that once the abscess has been successfully handled percutaneously, surgical treatment is a safe alternative as a first step, for abscesses recurring after percutaneous management, or for removal of the primary cause of the disease.

This paper deals with two patients with typhoid fever in whom hepatic manifestations were the dominant and presenting features of the illness. The ability of typhoid hepatitis to simulate other common infectious diseases in this region is highlighted. It is recommended that typhoid hepatitis should be included in the differential diagnosis of patients presenting with fever and jaundice particularly in the tropics.

Most recent reviews of pyogenic hepatic abscess emphasize percutaneous versus open surgical management and devote little time to studying the etiology or the clinical condition of the patient. In this study a detailed review was performed with a computerized analysis of multiple clinical parameters in 73 patients treated for pyogenic hepatic abscess during a 17-year period. The mean age of the patients was 55 years and 38 of them (52%) were male. The mortality rate was comparable for solitary (17%) and multiple (23%) abscesses. The likelihood of death was higher with antibiotic treatment alone (45%) or percutaneous treatment (25%) than with surgical treatment (9.5%). The primary determinant of outcome, however, was the underlying disease, i.e., malignancy or an immunocompromised patient, rather than solitary versus multiple abscesses. In addition the incidence of hepatic abscess seen at this center has doubled from the first half to the second half of the review, reflecting a population of more severely ill patients. It is apparent that in current clinical practice several methods of management are effective, and the choice of therapy should be determined by individualized selection. The principle of timely diagnosis and prompt institution of treatment appropriate to the specific patient remains the standard of care in this potentially grave disease.

A patient with multiple, pyogenic hepatic abscesses is described, and the pathophysiology, etiologies, clinical and laboratory manifestations, and management of the disease are reviewed. A 55-year-old man with a history of ethanol abuse and pancreatitis developed fever, chills, general malaise, and right upper quadrant abdominal pain two weeks before hospitalization. Baseline laboratory and hematology results included serum albumin concentration, 3.2 g/dL; serum alkaline phosphatase concentration, 239 mIU/mL; total serum bilirubin concentration, 1.3 mg/dL; white blood cell count, 18,400/cu mm; red blood cell count, 4.7 million/cu mm; hemoglobin, 12.5 g/dL; and hematocrit, 38.8%. Abdominal ultrasound showed echo-free cavities throughout the hepatic parenchyma; abdominal computed-tomography (CT) scan showed hepatomegaly and multiple radiolucent spaces. CT-guided needle aspiration of a hepatic mass yielded purulent material that grew Fusobacterium necrophorum under anaerobic conditions. On day 7, the patient was started on i.v. ampicillin sodium-sulbactam sodium. A CT scan two weeks later showed a reduction in the number and sizes of abscesses. The patient continued i.v. therapy for one month, then was discharged on a regimen of p.o. amoxicillin trihydrate-clavulanate potassium. Hepatic abscesses are either amebic or pyogenic; the latter usually has a higher mortality. The etiologies of pyogenic hepatic abscesses include ascending cholangitis, portal vein bacteremia, systemic bacteremia, extension from a contiguous focus of infection, and trauma. Diagnosis is difficult and relies highly on clinical suspicion. Clinical symptoms include hepatomegaly, fever, chills, and malaise. Abnormal laboratory values include leukocytosis, anemia, and hypoalbuminemia. The abscesses are frequently polymicrobial; Escherichia coli is the most commonly isolated species. CT is the best radiological technique for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The medical records of 222 patients with liver abscess at Siriraj Hospital from 1978 to 1985 were analysed. Amoebic abscess was three times more prevalent than pyogenic abscess. In both groups middle aged males were affected more often than others. The main clinical manifestations were fever, right upper quadrant pain and hepatomegaly. History of colitis in the past, marked leukocytosis, elevation of alkaline phosphatase and a single abscess confined to the right lobe were suggestive of amoebic liver abscess. The presence of concurrent abdominal infection, marked anemia and jaundice were associated with pyogenic abscess. Patients with pyogenic abscess developed complications more often and the case fatality rate was greater than patients with amoebic abscess. Most of the patients were successfully treated with a combination of antimicrobials and drainage.

Twelve patients with hepatic abscesses were diagnosed by ultrasound. The ultrasonic features were nonspecific, varying from totally anechoic to echogenic lesions. All the abscesses showed acoustic enhancement. Five of the patients were treated successfully with percutaneous catheter drainage.

A liver abscess resulted in vagal indigestion in 8 dairy cattle. There was cessation of transport of digesta through the omasum. Clinical signs were of variable duration and included abdominal distention and bradycardia. Medical therapy had not been effective. Left paralumbar fossa celiotomy and rumenotomy permitted detection of the liver abscess. A second surgery from a ventral approach allowed drainage of the abscess by insertion of a catheter through the abdominal wall.

Thirty-five patients with various focal intrahepatic lesions were evaluated with multiple radionuclides. Comparison of the blood pool scans with angiography and histology demonstrated an excellent correlation of these studies. Diagnostic accuracy was improved by separating the blood and pool scans into 3 categories. Each category suggested, at most, one further study to provide specific diagnostic information. Thus, by utilizing 3 radiopharmaceuticals, one can be more specific in preoperative diagnoses.

The Authors report three unpublished cases of tumoral abscess of the liver in infants and children. Two different situations are considered:--clinical findings, laboratory tests and intraoperative examination can be more in favor of a tumor at times. Means of avoiding needless excisions are outlined.--two uncommon types of abscess are considered. One type has an areolar structure whereas the other is in fact inflammatory tumoral fibrosis. This abscess is a true tumor and must be treated accordingly. Pathological studies, etiology, bacteriology and clinical aspects of such abscess of the liver are reviewed.

The presenting features of seven elderly patients with pyogenic liver abscess were reviewed retrospectively. Symptoms of malaise, anorexia and abdominal pain referrable to intra-abdominal pathology were present in only 43% cases and physical examination was frequently unhelpful. Leucocytosis, hyperbilirubinaemia and raised alkaline phosphatase were of diagnostic value in the majority of patients. Chest and urinary tract infections were frequent predisposing conditions. Antibiotic therapy for four weeks is adequate in elderly patients if combined with drainage procedures.