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Pyogenic liver abscesses in adults: A 3-year study

Background: Pyogenic liver abscess (PLA), a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades. This study was undertaken to evaluate PLA in relation to age, sex, anatomical relation, etiological factors, and response to various lines of management. Materials and Methods: A prospective study was conducted during the period from September 2010 to September 2013. Amebic and hydatid liver abscesses were excluded. We recorded and analyzed the clinical presentations, diagnostic modalities, and treatment programs of PLAs. Results: A total of 423 patients were studied. The average age of patients was 42 years, ranged from 20 to 80 years. Of a total 423 patients, 386 patients (91.2%) were males and 37 (8.8%) were females. The most common symptom was fever associated with chills. The most common sign was hepatomegaly and tenderness in right hypochondrium 209 (49.4%). Alcoholism was identified as a major risk factor in 309 (73%) patients. Diabetes was present in 86 (20.3%), tuberculosis in 34 (8%), and HIV infection in 10 (2.3%) patients. Abdominal ultrasonography had a sensitivity of 97% in diagnosing liver abscess. There was a single abscess in 326 (77%) patients, the right lobe being involved in 282 (66.6%) patients. Multiple abscesses were found in 97 (22.9%). Most patients were managed conservatively with antibiotics and percutaneous drainage. 46 patients (10.8%) had ruptured liver abscesses and required peritoneal lavage at laparotomy. Death occurred in seven (2%) patients. Conclusion: Pyogenic liver abscess is a potentially fatal disease if untreated. Early diagnosis remains the cornerstone of management. Majority can be managed conservatively with antibiotics and percutaneous drainage.